Page 6 - Guide to PICU

Dealing with the Aggressive Patient

 Medicate early and medicate often. Nurses should have a very low threshold for
behaviours that may require prns. Offer prns regularly. It is better to get some meds in your
patient early so things don’t end up in a code situation requiring chemical restraints.

 Patients who are demonstrating verbal, physical or sexual aggression should be handled
with a high degree of caution. Don’t be afraid to ask a colleague for help. Some patients

should only have two staff to care for them.

 Patients who are verbally abusive will swear at you, hurl racial or homophobic language
and often question your competence. Please don’t take it personally. Take time to get to
know them and let them get to know you so they do not see you as the enemy or a threat.

Keep your voice low and calm when speaking to them.

 There is a difference between setting limits and trying to exert power and control. Make
sure you understand the difference

 Patients who demonstrate sexually inappropriate behavior should have two-person care.
Where possible, they should be assigned to a staff that is the opposite of their sexual
preference. Ensure you are watching them at all times, particularly with other patients.

 Patients who can become physically aggressive should also be two-person care (talk to your

colleagues about when it is appropriate to have security present before going in a room).

 Meals should be served on Styrofoam trays for all patients in PICU. Drinks may need to be

poured into a cup before serving. Make sure that any cutlery given is returned and
discarded. Patients have tried to hoard their cutlery in the past.

 Make yourself really familiar with the Least Restraint policy. You have probably not needed
to know it thoroughly to work on 7M, but on PICU – the proper implementation of the

policy, the assessments you are required to do, when an order needs to be renewed and
the documentation (N:\Mental Health\CLINICAL SKILLS 2019\Documentation) surrounding
restraint all must be done according to policy.

 Knowing how to use the Pinel restraints, discontinuing the use of mechanical restraints and
the procedures for having them cleaned are essential. Take the time to go through the

restraint bag and read the documentation enclosed.
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