1 Client Challenges Yenilyn Brito Chamberlain School of Nursing NR 509 Advanced Physical Assessment Dr. Kathy Butler September 7th, 2022 2 Client Challenges Scenario of a Violent Client A 22-year-old male client was brought to the clinic held by his father and his uncle. The client walks in with much resistance as if he does not want to be forced to walk. He also appears agitated and trembling with anger while talking inaudibly. One of the statements captured while he talks alone is, 'One day I will kill her.' The client's father and uncle force him to sit on a chair as he resists, shouts, and kicks the furniture. After the nurse practitioner realized the patient's violent behavior, he tried to calm him down and gave him Midazolam medication before starting the assessment. Midazolam is a fast-acting benzodiazepine medication commonly used for the management of anger and agitation among psychiatric patients. After some minutes, the patient calms down, and the assessment begins. Potential Client Behaviors Consistent with Violence According to the scenario presented, there are several behaviors that show that the client is violent. One of them is how the client was held. The client was held by two people in a manner that he could not exceed them with energy and harm them. The second behavior is resistance to walking willingly. Though the client was held by two people, he appeared almost to exceed them with energy regardless of his young age. The third behavior is that the patient appeared agitated, talking inaudibly. While talking, the client could be heard saying that he will eventually kill the person one day, which implies that he is much violent. Moreover, the client was shouting at the family members for bringing him to the counselling clinic and kicking the furniture. Kicking furniture is among the behaviors that indicate that a client is violent (Trifu et al., 2020). Professional Approach to Address the Behavior There are several professional ways of addressing violent behavior among clients and communicating with them appropriately. These ways can be grouped into two categories, 3 including pharmacological and non-pharmacological approaches. Pharmacological approaches involve the use of appropriate medications to calm down the client. One of the medications involves Midazolam. Midazolam has been one of the medications that have been proven to act very first on violent psychiatric clients (Trifu et al., 2020). The medication is commonly used among clients who display violent behavior to the extent that it is challenging to handle them. The medication is used to come down the patient to enable the healthcare professional to undertake various assessment practices. The medication is also recommended for short-term use to avoid its high risk for increased side effects. Some side effects of using this medication for a prolonged period include respiratory depression and oversedation (Ulrich et al., 2018). On the other hand, one of the non-pharmacological approaches to address violent behavior involves remaining calm and listening to the client (Bickley et al., 2021). When dealing with violent clients, healthcare providers should keep on asking open-ended questions and stay calm to listen to the responses from the client. Failure to remain silent may provoke the client further, making him or her more violent. The more the client talks while being listened to, the more the violent behavior disappears, making him or her calm. The second professional nonpharmacological approach recommended when dealing with violent clients is to give them sufficient time to explain why they are angered (Ulrich et al., 2018). When using this strategy, the healthcare provider should acknowledge the client’s grievances and ask him or her the aspects that have triggered the anger. The other approach involves maintaining eye contact, though not for a prolonged period. This makes the client understand that the healthcare professional is attentively listening to his or her grievances, thus becoming more open in giving more information regarding the underlying issues. 4 Example of How to Document the Encounter When dealing with clients, it is necessary to document various aspects to be used as a reference in the future (Bickley et al., 2021). Documenting the client's conditions enhances good record keeping facilitating easy treatment and management of patients. There are different ways in which the client's encounter can be documented appropriately. The first aspect that should be documented is the client identification information such as name, age, race, and gender (Pardede & Laia, 2020). The client’s identification information would make it easy for another healthcare provider to identify him if he visits the facility in the future. The second aspect involves recording how the client was brought into the facility. Indicating details about how the patient was brought into the facility assists in understanding the client’s behavior and how to handle him. The other aspect to document involves the possible behaviors that the client displayed, which illustrates his violent behavior (Pardede & Laia, 2020). Some examples of such behavior include being agitated, trembling with anger, being resistant to walk willingly, uttering threatening words, and kicking the furniture. These behaviors can also assist in predicting the possible mental condition that the client is likely to be experiencing. 5 References Bickley, L. S., Szilagyi, P. G., Hoffman, R. M., & Soriano, R. P. (2021). Interviewing, communication, and interpersonal skills. In L. S. Bickley, P. G. Szilagyi, R. M. Hoffman, & R. P. Soriano (Eds.)., Bates' Guide To Physical Examination and History Taking (13th ed, pp. 60-68). Wolters Kluwer. Pardede, J. A., & Laia, B. (2020). Decreasing Symptoms of Risk of Violent Behavior in Schizophrenia Patients through Group Activity Therapy. Jurnal Ilmu Keperawatan Jiwa, 3(3), 291-300. https://doi.org/10.32584/jikj.v3i3.621 Trifu, S. C., Tudor, A., & Radulescu, I. (2020). Aggressive behavior in psychiatric patients in relation to hormonal imbalance. Experimental and Therapeutic Medicine, 20(4), 34833487. https://doi.org/10.3892/etm.2020.8974 Ulrich, R. S., Bogren, L., Gardiner, S. K., & Lundin, S. (2018). Psychiatric ward design can reduce aggressive behavior. Journal of Environmental Psychology, 57, 53-66. https://doi.org/10.3892/etm.2020.8974
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