Question

You are at times the only one working at the reception desk as an administration clerk at a large hospital working in the emergency department. The waiting room is full of sick and injured people and there is a two hour wait. When patients arrive they are assessed by the triage nurse into critical and non-critical care. On Thursday the 5th of February at 10:00am, Mark arrived at the emergency waiting room. Mark is a 30yr old man who is an outpatient. Mark appears to look malnourished, and has scars on his wrists. You also notice that he has wounds on the inside of his right elbow. He presented to the Triage window, and a preliminary assessment was undertaken. He appeared confused, disorientated, agitated and easily irritated. He was observed to be mumbling incoherently to individuals not present and to himself at times. When asked by the Triage Nurse, who he was talking to, Mark became irritable and yelled out loudly, “No-one! What a stupid question to ask!” Mark was then directed to take a seat and was observed to be highly restless and unsettled; wandering around the emergency room waiting area, & becoming increasingly intrusive in the care of fellow patients. He was informed by the nursing staff on several occasions to settle down and that he would be attended by the treating team as soon as they became available. Mark has been waiting for approximately an hour when he approaches the desk for the second time. He demands to be seen immediately with his flushed faced and dilated pupils. Again the nurse tried to explain Mark that there are still several patients to be seen before him, whereupon he becomes agitated and hostile. He starts swearing, shouting and shaking his fists at you, saying “I am sick and must be seen, by the doctor now.” He threatens that he may do ‘something terrible to himself’ if he isn’t seen soon by the treating doctor. As he leans across the desk, you smell the alcohol on his breath and you notice his eyes are quite bloodshot. Mark is then removed from the waiting room, and put in an emergency bed to be seen by the doctor.

1. Reading the given scenario, identify and list atleast 5 different behaviours of concern.

2. Briefly explain the signs indicating the behaviours of concern.

3.List the effective communication strategies you would use to achieve the desired outcomes in responding to behaviours of concern.

4.. Briefly explain the strategies that you would implement to deal with the identified behaviours of concern?

5.. List the important legal and ethical consideration relevant to recognising and responding to behaviours of concern.

6.. Whom should you report this incident?

7. Who needs to be consulted to seek advice and assistance from legitimate sources as and when appropriate?

Answer 1

3.

0 Reading the given Lunario, 5 different behaviours of Sconcem are - A i Confused desoriented & w Irritated I hostile id) membling incoherently to individuals not . present sto nemacy cs saw) Shouting & shaking his fiets.. CaṁScanner ..

Any situation or feeling can act as a trigger for challenging behaviour. This is frequently unpredictable. However the approach made towards the person is very important.

• Pause – stand back, take a moment before approaching and assess the situation.
• Speak slowly and clearly in a calm voice.
• Explain your care actions.
• Try not to rush the person, act calmly.
• Show respect and treat people with dignity at all times.
• Minimise boredom, social isolation and irritating factors in the environment such as noise, uncomfortable clothing.
• Enhance comfort, exercise, participation in activities, decision making and dignity.

Communication is the key

Avoid harsh aggressive or abrupt statements. Don’t say things such as “You must….”, “Don’t…..”, “Stop…….”. Use alternatives and “I’ language like “I would like you to…” It would help me if……”, “ I feel scared when…….”.

When challenging behaviour happens

• Back off where possible.
• Keep calm.
• Call for help.
• Leave the person to calm down, if possible.
• Remove others from the environment, if possible.
• Be aware of body language and tone of voice used to the person

4.

Challenging behaviour is any behaviour that causes significant distress or danger to the person of concern or others. It can include an outburst of aggression, or resistant type behaviour by clients.

Challenging behaviours are difficult for everyone involved. Whilst managing these behaviours may be part of the job, it is not acceptable for workers to be hurt.

Report early signs of challenging behaviours. Talk about your concerns with your supervisor or at team meetings. Early reporting enables management to take action.

Early Intervention support Services
Where to get help
There are many reasons why a child with a disability may act in a challenging and difficult way..It is often the means of communicating a need and they may require support to learn other ways to express the need.

There is an association between lack of communication skills and behaviours of concerns.

It is important to determine the function of your persons behaviour (or the reason why it occurs) to make sure you get help from the appropriate therapist or therapists. For example, if the underlying cause of the behaviour is a breakdown in communication, then a speech pathologist might be needed.

Positive Behaviour Support
Positive Behaviour Support (PBS) is an evidence-based intervention approach whose primary goal is to increase the quality of life of the individual exhibiting behaviours of concern by reducing both the behaviours of concern and the use of restrictive interventions, which restrict the rights or freedom of movement of a person with a disability. Restrictive interventions can include including chemical restraint, mechanical restraint and seclusion. For example, restrictive clothing that is used to prevent the person from smearing faeces.

These goals are accomplished by changing the environment to support appropriate behaviours and supporting the person to gain new skills and coping strategies

The Positive Behaviour Support practice model is applicable to all children and adults with behaviours of concern, regardless of their cognitive functioning or disability and must be used by behaviour support providers funded by the Department of Health and Human Services.

6.On duty physician

27. The aigus indicating the behaviours of concern i) Lear on the wrist & wound on the inside of his right elbow - This could suggest that Mr. Mark hora experienced an accideul and needs, imme- deate first aid ii) confersed, disoriented & agitated - This indicar tes that the Mr. Mark could have had an accident that had either affected the spinal.cood or the brain which had cut down is reduced the orygen supply which needs emergeney management to prevent complications or ii) Mumbling incoherently to individuals not present- & to himself at fissies - This suggests that the Mr. Mark could be driegs addicted of for which or pejcheatic patient forblich he an could be callienating V) Irritable of yelled out low. This is a hostile, behaviour which should be stopped to prevent any haron. fo. health care feaon or other patients present over there : - flushed face & delated peepil - Also suggest enjury to spinal cord or brain or drug addiction. it ) Smell of alcohol- of all the signs are due to severe alcoholism then emergeney treat- ment is needed otherwise the Mr. Mark could die of heppothermia... PAS Scanned with ad CarScanner

5.In emergency department triage, medical care might lead to adverse consequences like delay in providing care, compromise in privacy and confidentiality, poor physician-patient communication, failing to provide the necessary care altogether, or even having to decide whose life to save when not everyone can be saved. These consequences challenge the ethical quality of emergency care

[27/09, 9:35 PM] Niharika: There are six ethical principles that arise frequently for the nurse
[27/09, 9:36 PM] Niharika: . Respect for persons (autonomy and self-determination)
2. Beneficence (doing good)
3. Nonmaleficence (avoiding harm)
4. Justice (fairness, equitability, truthfulness)
5. Veracity (telling the truth)
6. Fidelity (remaining faithful to one’s commitment)

These principles serve as a guide to the nurse in making ethical decisions.
The legal implications of nursing practice are tied to licensure, state and federal laws, scope of practice and a public expectation that nurses practice at a high professional standard
The basis for litigation can relate to negligence, failing to exercise the level of care that a reasonable, prudent nurse would under similar circumstances; malpractice; and professional negligence, which means an act of neglect committed in the nurse’s professional .

Conclusion-
Regardless of the method, the nurse has a legal and ethical obligation to respond to the request for care. In general, the nurse should see the patient to evaluate health needs and determine the level of care required