HANDLING AGGRESSION IN PSYCHIATRIC SURGICAL PATIENTS WHO ALSO
What actions can be taken by the advanced registered nurse practitioner to reduce aggressive behavior in surgical patients with both a psychiatric diagnosis and a substance abuse problem? According to Morrison, Ramsey and Snyder (2000a), determining an answer to this question is important for several reasons. First, most staff nurses are woefully unprepared for handling the complexity of issues attending to this patient type which means that many of patients' needs go unmet.
Second, Morrison et. al (2000a) report that an unfortunate reality is that the health care system is seeing an increase in these and similar patient types. Indeed, it is noted that up to 40 percent of all hospital admissions in the United States, are for patients who have some form of substance abuse problem either alone or in addition to the reason for admission.
Third, the increase in these patient numbers coupled with inadequate nurse training is producing sustained stress on nursing staff. Not only is the experience of stress a painful consequence for nurses, it is also costly for hospitals which can lead to increased absences from work, turnover, and burnout (Morrison et al, 2000a).
Thus, providing nurses with a general care framework for dealing with the hostility and aggressiveness that is often associated with surgical patients with both a psychiatric diagnosis and a substance abuse problem (see: Melia, Moran & Maston, 1999) is an important need for nurses. The purpose of this paper is to first briefly present and discuss an interactive conceptual model of factors giving rise to the aggressive behavior and second, to delineate and discuss the steps advanced practice nurses can take to address the problem.
What gives rise to aggressive behavior in psychiatric surgical patients with a substance abuse problem? According to Morrison et. al (2000a), this occurs as the result of b...