Scenarion response

The Five Phases of the Aggression Cycle

Most patients with mental health disorders are not aggressive. However, it is
important for nurses to be able to know the signs and symptoms associated
with the five phases of aggression, and to appropriately apply nursing
interventions to assist in treating aggressive patients. Please read the case
study below and answer the four questions related to it.

Christopher, who is 14 years of age, was recently admitted to the hospital for
schizophrenia. He has a history of aggressive behavior and states that the devil
is telling him to kill all adults because they want to hurt him. Christopher has a
history of recidivism and noncompliance with his medications. One day on the
unit, the nurse observes Christopher displaying hypervigilant behaviors, pacing
back and forth down the hallway, and speaking to himself under his breath. As
the nurse runs over to Christopher to talk, he sees that his bedroom door is
open and runs into his room and shuts the door. The nurse responds by
attempting to open the door, but Christopher keeps pulling the door shut and
tells the nurse that if the nurse comes in the room he will choke the nurse. The
nurse responds by calling other staff to assist with the situation.

1. What phase of the aggression cycle is Christopher in at the beginning of this scenario?

What phase is he in at the end the scenario? (State the evidence that supports your answers).
Christopher at the beginning of the scenario is in the Triggering Phase of aggression due to his
pacing and displaying restlessness with hypervigilant behavior (Videbeck, 2020). At the end of
the scenario he is in the Escalation Phase of aggression with his threats to harm the nurse, hostile
language, loss of control to solve the conflict and think clearly (Videbeck, 2020).

2. What interventions could have been implemented to prevent Christopher from escalating at the
beginning of the scenario?

Interventions that could have been done was to not run towards the patient but to approach the
patient in a calm, non-threatening manner. The approach the nurse took to address the patient,
who has a history of Schizophrenia and aggressive behavior was not therapeutic for the patient’s
current state of mind and situation. The patient is displaying the Triggering phase as he is pacing
and being hypervigilant (Videbeck, 2020), the nurse running towards the patient would
exacerbate this. Listening to what the patient has to say and showing empathy towards the
patient’s situation and feelings is another intervention for the nurse in this phase to help prevent
the patient from escalating, by promoting self-expression and verbal communication. And finally,
offering the patient medication ordered by the physician (Videbeck, 2020).

3. What interventions should the nurse take to deescalate the situation when Christopher is
refusing to open his door?

Communicating to the patient that aggression and violence is unacceptable, but providing the
patient with two options to choose from in this situation to provide a self of control. The first
option is to offer the patient space, in this case, he is already in his own room. This gives the
patient a place of quite away from distraction of the nurse pulling on the door. Another option is
offering the patient another staff member to talk to and communicate his concerns instead of the
current nurse that is caring for the patient, since the nurse had already called for other staff
members to help, offering this option can remove the stimulus, which is the nurse from the
situation, as a way to deescalate the patient since he was running away from that particular nurse
in the first place. When other staff step in, this is an opportunity to offer medication to this
patient, if he had refused previously (Videbeck, 2020).

4. If a restrictive intervention (restraint/seclusion) is used, what are some important steps for the
nurse to remember?

In the event that restrictive interventions were implemented to the team would have to
collaborate to maintain patient safety and facility protocols. The least restrictive and the shortest
amount of time needed for the patient to regain control and maintain safety of self and others is
best when it comes to secluding the patient and applying restraints. Physical restraints should
always be used as a last resort, after all other interventions have failed to deescalate a situation
where the patient was going to harm himself or others (Hasan and Abulattif, 2019). When
physical restraints are applied, a face to face evaluation of the patient and safety assessment
should be performed no more than one hour after applying the devices and frequent checks after
(Hasan and Abulattif, 2019). Physician’s order every four hours to maintain restraints on the

patient. The nurse would need to document the situation, how it escalated, interventions that
failed and status of the patient before and after the restraints were applied. Medication
administration, if any, and how the patient is reacting to the medication.