Business teach all members to perform a job in order

business) teach all members to perform a job in order to
run the business→ led to the supported employment model ,
which has been more effective in helping persons with SMI achieve
employment

Known predictors of violence and management strategies for potentially violent patients
Chap.27, pg 515-528
❖ Predictors of Violence
1. Signs and Symptoms that usually (not always) precede violence:
a. Hyperactivity→ most important predictor of imminent
violence (pacing, restlessness, etc)
b. Increasing anxiety and tension→ clenched jaw or fist, rigid
posture, fixed or tense facial expression, mumbling to self
(pt may have sob, sweating, & rapid pulse)
c. Verbal abuse→ profanity, and argumentativeness
d. Loud voice, change of pitch; or very soft voice causing others to
strain to hear
e. Intense eye contact or avoidance of eye contact
2. Recent acts of violence, including property violence
3. Stone silence
4. Alcohol and drug intoxication
5. Possession of weapon or object that may be used as a weapon
6. Isolation that is new
7. Milieu characteristics conducive to violence:
a. overcrowding
b. staff inexperience
c. provocative or controlling staff
d. poor limit setting
e. arbitrary revocation of privileges
❖ De-Escalation Techniques: Practice Principles
➢ Maintain pts self-esteem and dignity
➢ Maintain calmness (yourself and pt)
➢ Assess pt and situation
➢ Identify stressors and stress indicators
➢ Respond as early as possible
➢ Use calm, clear tone of voice
➢ Invest time
➢ Remain honest
➢ Establish what the pt considers to be his/her need
➢ Be goal-oriented
➢ Maintain a large personal space
➢ Avoid verbal struggles
➢ Give several options
➢ Make clear the options
➢ Utilize a nonaggressive posture
➢ Use genuineness and empathy
➢ Attempt to be confidently aware
➢ Use verbal, nonverbal, and communication skills
➢ Be assertive (not aggressive)

➢ Assess for personal safety
Know safety and legal considerations for seclusion and restraint Chap. 27
❖ Seclusion→ “the involuntary confinement of a patient alone in a room, or area
from which the patient is physically prevented from leaving.”
➢ the goal is never punitive; rather the goal is safety of the patient and
others
❖ Restraint→ “any manual method, physical or mechanical device, material, or
equipment that immobilizes or reduces the ability of the patient to move his/her
legs, arms, body, or head freely.”
❖ Prior to an episode of seclusion, a patient must be assessed for contraindications
of seclusion:
➢ pregnancy
➢ COPD
➢ head or spinal injury
➢ seizure disorder
➢ abuse
➢ hx of surgery or fracture
➢ morbid obesity
➢ sleep apnea
❖ Patient may not be held in seclusion or restraint without an order from a licensed
practitioner
❖ once in a restraint, pt must be directly observed and formally assessed at
frequent, regular intervals for level of awareness, level of activity, safety within
restraints, hydration, toileting needs, nutrition, and comfort
❖