AGGRESSION IN PSYCHIATRIC SURGICAL PATIENTS

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

. . .
s. In their study of the effects of pain assessment and assessment of alcohol withdrawal within a medical-surgical setting, it was found that multidisciplinary assessment and withdrawal protocol produced higher quality care, fewer " against medical advice" discharges, fewer negative interactions between patients and staff, and also decreased the length of stay in the hospital. Spies and Rommelspacher (1999) have also addressed the need for withdrawal-related assessment in alcoholic surgical patients, combined with quick treatment for withdrawal. If assessment shows a strong substance abuse problem, the authors feel that the ideal treatment is to prevent alcohol withdrawal prior to surgery by adequate prophylaxis. If alcohol withdrawal symptoms develop after surgery or trauma, immediate therapy is required then. The authors go on to note that withdrawal symptoms can be controlled using the combination of a benzodiazepine (in Europe, also chlormethiazole) with haloperidol or clonidine. However, they report that for best results, the drug regimens must be individualized and symptom-oriented, using doses that are generally larger that those that are used in detoxification units. Sohr (1996) provides a complex list of various
. . .

Some common words found in the essay are:
Implications Summary, Ramsey Snyder, Contract Assessment, Moran Maston, Spies Rommelspacher, According Morrison, Hospital Sohr, Schaffer Campbell, Sanchez-Gallegos Viens, Phelps Cowan, substance abuse, surgical patients, psychiatric diagnosis, patients substance abuse, et al, morrison et, aggressive behavior, difficult patients, psychiatric surgical, patients substance, morrison et al, surgical patients psychiatric, quality care, psychiatric diagnosis substance, diagnosis substance abuse,
Approximate Word count = 3777
Approximate Pages = 15 (250 words per page)

More Essays on AGGRESSION IN PSYCHIATRIC SURGICAL PATIENTS