Concept Analysis

Concept Analysis

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Concept Analysis

Agitated patients have difficulty expressing their needs and can become verbally and physically hostile towards emergency department (ED) staff. Concerns emerge that substance abuse and mental illness patients now contribute to one in eight ED cases (Tucker et al., 2020). A major concern, however, is that health workers are not confident handling tense patients, and who show signs of relentlessness, lack of cooperation, and display other forms of agitation (Tucker et al., 2020). The fear causes patients to be sedated inappropriately, which can prolong recovery, lengthen the period of admission, and extend an already prolonged ED stay (Tucker et al., 2020). The phenomenon of interest for this analysis is that effectively applying verbal de-escalation may improve relationship with patients in inpatient settings. Health workers have deployed various intervention approaches but research indicate that some of the traditional approaches may not be as effective as verbal de-escalation. The analysis reminds health workers dealing with agitated patients to follow certain objectives that would lead them towards the targeted goals. The objective of this paper is to serve as a way to better know the concept of verbal de-escalation and how the process can help to relate with agitated patients receiving care in inpatient settings.

Concept Analysis Description

Richmond et al. (2012) provide much information that helps to understand how verbal de-escalation works in relation to handling agitated patients. Richmond et al. (2012) describe what agitated patient means and how verbal de-escalation works. According to Richmond et al. (2012), caregivers increasingly handle agitated patients and recommend various techniques for relating with such people. Other than alcohol and substance abuse, which is among the leading causes for agitation, general medical conditions and a new environments are some of the factors that could lead to agitation. An agitated patient feels uneasy, has little patience, display nervousness, and may show stubborn behavior. Richmond et al. (2012) further assert that agitation is a serious behavioral emergency that requires immediate intervention. The researchers further assert that traditional forms of handling agitated patients such as involuntary medication and routine restraints have been exchanged with much stress on a non-coercive techniques. Specialists have discovered that if care to agitated patients is issued with sincere dedication, prosperous results can emerge far much faster and better than could be imagined before development of new approaches. Richmond et al.’s (2012) purpose for conducting the concept analysis is to show how verbal de-escalation provides a better chance to engage agitated patients. Richmond et al. (2012) inform that interveners should deploy a 3-phase approach to achieve impressive results. The first step is to engage the patient verbally through which the intervener builds a collaborative relationship. Finally, the intervener verbally de-escalates the patient out of the agitated situation. Richmond et al. (2012) contend that verbal de-escalation is often a fundamental aspect in engaging agitated patients and assisting them become an active participant in the evaluation and treatment process.

The concept analysis is relevant to the POI because it provides much information about how verbal de-escalation helps to assist agitated patients. The information shows that whereas sometimes alternative interventions such as environment planning and voluntary medication are helpful in helping and engaging agitated patients, verbal de-escalation proves to be the most effective. Besides, the concept analysis provides tips that may help health workers when working with agitated patients. The first goal when working with an agitated patient according to the analysis by Richmond et al. (2012) is to make sure every participant is safe from potential threats. The intervener should ensure the staff, patient, and others participating directly or indirectly are safe. The concept analysis relates to the POI because it helps to understand that achieving targeted results when working with agitated patients require interveners to help the client manage their distress and emotions and uphold or achieve control over their behavior. The analysis also shows the importance of avoiding any use of restraints at all costs and to avoid as much as possible any forms of coercive interventions that could possibly enhance agitation. Thus, the analysis serves as a key guide on how to use verbal de-escalation to engage and treat agitated patients.

The concept analysis can be widely applied to other phenomena of interest, which implies that it has higher transferability. It is possible to relate the information by Richmond et al. (2012) to what Iroku-Malize and Grisson (2018) say in their study that uses a systematic literature review approach to gather data. Iroku-Malize and Grisson (2018) inform that effective handing of agitated patients require interveners to follow a five-step approach. According to Iroku-Malize and Grisson (2018) the initial phase is to categorize the agitation as being severe, moderate, or mild because categorization helps to know the kind of sedation required to suppress agitation. The second phase that Iroku-Malize and Grisson (2018) proposes is to verbally de-escalate using suitable techniques. Wilson et al. (2015) give examples of verbal de-escalation techniques such as changing tone or adjusting eye contact. Wilson et al. (2015) also recommend approaches such as change in body language and avoiding overreaction as some of the effective verbal de-escalation techniques that may help to contain agitated approaches. The analysis shows that information from the concept analysis may help to interveners in clinical settings to interact and help patients who display agitation. Information from the concept analysis is also applicable in other contexts, including in home care settings. Health workers dealing with agitated patients in home settings should consider similar factors to when assisting inpatients. Based on the guidelines from the concept analysis health workers assisting agitated patients in home settings should ensure everyone is safe, assist the patient control their emotions, avoiding restraints, and avoiding coercions that could provoke agitation. Addressing similar concepts by other scholars and being able to apply concepts from the concept analysis to help agitated patients in home settings affirm that the transferability of the concept analysis to other phenomena of interest is high.

Another phenomena of interest where the concept analysis fits appropriately is in the handling of agitated people who are not sick. The directives are effective and may not only be applicable in the clinical setting or in helping agitated patients receiving homecare. People may become agitated due to different reasons such as lack of sleep, lack of job, and conflicts that may not lead to sickness (Goodman et al., 2020). Such people also require effective intervention to ease their problem and associated tensions and discomfort. Thus, applying verbal de-escalation as proposed in the concept analysis may help to ease agitation.

Critical Appraisal of Concept Analysis

Concept

The concept in Richmond et al. (2012) is that it is possible to effectively engage agitated patients by applying verbal de-escalation. The concept is that in addition to restraining from practices that could provoke agitation, which is often through verbal blunders it is essential to consider other fundamental factors. Richmond et al. (2012) in the concept analysis urges health workers to shift their method of assisting agitated patients such as involuntary medication and routine restraints that have served for many years before it became apparent that noncoercive approaches are more effective when handling such patients. Richmond et al. (2012) advocate for noncoercive techniques arguing that when the intervention is applied with genuine dedication, prosperous results can emerge far much better than previously perceived.

Antecedents

Various antecedents could lead an intervener to consider verbal de-escalation as a suitable alternative to helping agitated patients. Period of engagement with substance and alcohol abuse is a critical antecedent because this may determine level of agitation in a patient. Another antecedent that could determine the outcome of using verbal de-escalation to help agitated patients is the patient’s ability to regulate their emotions. People usually differ in the way they control emotions. It is easier to work with or engage those who can easily regulate their emotions compared to those who can hardly regulate their temper. More fundamentally, it is would be difficult to use verbal de-escalation if the patient suffers from mental illness because this may make it difficult for them to read and interpret certain signals associated with verbal de-escalation.

Attributes

The concept analysis presents various attributes that help to understand who requires verbal de-escalation and when it works best. According to Richmond et al. (2012) those who require verbal de-escalation are those who display evident forms of agitation. Verbal de-escalation works best with agitated patients because such people become aggravated when they feel the intervener is offensive or does not care about their agitated state. Such attributes relate to the POI because it is not necessary to use verbal de-escalation in contexts where the patient does not display signs of agitation. Furthermore, the attributes relate to the POI because they reiterate the importance of verbal de-escalation in improving relationship with agitated patients.

Consequences

Effective application of verbal de-escalation makes it possible to achieve impressive outcomes. Applying verbal de-escalation while adhering to all guidelines makes it possible to eradicate the uneasy feelings and impatience associated with agitation (Ropolo et al., 2020). Besides, being able to use verbal de-escalation appropriately makes it possible to regulate the nervousness, stubborn behaviors, or violence that are likely to emerge when dealing with an agitated patient (Ropolo et al., 2020). The consequences relate to PIO as they verify that appropriate application of verbal de-escalation while adhering to all provisions present a better chance to contain agitations that could disrupt the intervention process. Besides, it is easier to achieve the goals and objectives of handling an agitated patient by effectively deploying verbal de-escalation. For instance, using the approach guarantees the safety of others, helps the affected person to manage his emotions, presents a chance to avoid restraints that could worsen the situation, and allows interveners to avoid coercive approaches that could worsen agitation.

Concept Map

Using a concept map give a graphical presentation of the connection between using verbal de-escalation to engage and treat agitated patients. A concept map also known as conceptual diagram is a presentation that shows suggested interconnections between different concepts. The concept map that appears in the appendix section provides much information about the connection between the phenomenon of interest, the concept, the antecedents, attributes, and consequences. One benefit of presenting the ideas using a concept map is that it provides the opportunity to know the connection between various factors without having to read the entire report to get an idea of what the report addresses. Furthermore, the concept map helps to save time, which is always of essence.

Outcome Conclusion

The paper is a review of a concept analysis by Richmond et al. (2012) about the possible impact of verbal de-escalation in helping agitated patients. It identifies agitation as a serious behavioral emergency deeding immediate attention but shows the need to embrace better and more effective intervention techniques as opposed to traditional techniques such as involuntary medication and routine restraints. The analysis confirms that being careful when applying verbal de-escalation helps to manage the uneasy feelings, impatience, nervousness, violence, and stubborn behavior associated with agitation. However, the paper through the concept analysis reveals that dealing with agitated patients require interveners to follow certain objectives. Such health workers should protect the safety of all stakeholders, strive to help the patient manage their emotions, avoiding restraints, and avoiding coercive practices that could worsen the situation. Otherwise, failing to adhere to recommended guidelines could derail the attempts to relate and possibly treat agitated patients, especially those displaying intense forms of agitation. The paper also describes a concept amp that helps to understand the interconnection between verbal de-escalation and patient agitation and the possible consequences of effective application of the intervention approach. Overall, health workers should be conversant with the concept of verbal de-escalation to handle agitated patients more effectively.

Appendix A – Concept Map

References

Goodman, H., Brooks, C., Price, O., & Barley, E. (2020). Barriers and facilitators to the effective de-escalation of conflict behaviours in forensic high-secure settings: A qualitative study. International Journal of Mental Health Systems, 14(59), https://ijmhs.biomedcentral.com/articles/10.1186/s13033-020-00392-5

Iroku-Malize, T., & Grisson, M. (2018). The agitated patient: Steps to take, how to stay safe. The Journal of Family Practice, 67(3), 136-147. https://cdn.mdedge.com/files/s3fs-public/Document/February-2018/JFP06703136.PDF

Richmond, J., et al. (2012). Verbal de-escalation of the agitated patient: Consensus statement of the American association for emergency psychiatry project BETA de-escalation workgroup. Western Journal of Emergency Medicine, 13(1), 17-25. doi: 10.5811/westjem.2011.9.6864

Ropolo, L., Morris, D., Khan, F., & Downs, R. (2020). Improving the management of acutely agitated patients in the emergency department through implementation of project BETA (best practices in the evaluation and treatment of agitation). Journal of the American College of Emergency Physicians Open, 1(5), 1-10. doi:10.1002/emp2.12138

Tucker, J., Whitehead, L., Palamara, P., Rosman, J., & Seaman, K. (2020). Recognition and management of agitation in acute mental health services: A qualitative evaluation of staff perceptions. BMC Nursing, 19(106), https://bmcnurs.biomedcentral.com/articles/10.1186/s12912-020-00495-x

Wilson, M., Nordstrom, K., & Vike, G. (2015). The agitated patient in the emergency department. Current Emergency and Hospital Medicine Reports, 3(4), doi:10.1007/s40138-015-0087-5