They Dare to Resist Care
They Dare to Resist Care
This very interesting, adequately powered study offers insights for virtually all nurses. Although reliability and validity of the survey tool are not provided, the results should sound both valid and reliable to most nurses. The variance in patient diagnoses and the nursing activities associated with RTC is not surprising and reflects, to some extent, the different clinical settings. To a lesser extent, the physical and nonphysical behaviors demonstrated by resistant patients also reflect the clinical setting, although some behaviors were apparent in all settings. Nurses working with the elderly in long-term care facilities and those in EDs were somewhat more at risk for physical contact in an RTC event.
The researchers emphasized that the behaviors associated with RTC -- both physical and nonphysical -- are very similar to those seen with patient-initiated violence, making distinguishing between these 2 processes (which are the result of different patient motivations and require different management strategies) very difficult. However, the ability of nurses to recognize the patient defensiveness that underlies RTC can set the stage for an appropriate response that can de-escalate the situation and ultimately facilitate better patient care. Patients who demonstrate RTC need understanding, reassurance, and a flexible approach to management rather than restraint, seclusion, and application of security measures. Potential strategies to avoid triggering resistance include reducing noise, respecting personal space, and allowing patients more control over routine care. More nursing education in the areas of assessment and management is needed, particularly in how to differentiate between aggression and RTC. Such patients may require alternative approaches to care and much more flexibility on the part of nurses caring for them, but the end result is likely to be a much more cooperative patient, which can only make life easier for the nurse.
Abstract
Viewpoint
This very interesting, adequately powered study offers insights for virtually all nurses. Although reliability and validity of the survey tool are not provided, the results should sound both valid and reliable to most nurses. The variance in patient diagnoses and the nursing activities associated with RTC is not surprising and reflects, to some extent, the different clinical settings. To a lesser extent, the physical and nonphysical behaviors demonstrated by resistant patients also reflect the clinical setting, although some behaviors were apparent in all settings. Nurses working with the elderly in long-term care facilities and those in EDs were somewhat more at risk for physical contact in an RTC event.
The researchers emphasized that the behaviors associated with RTC -- both physical and nonphysical -- are very similar to those seen with patient-initiated violence, making distinguishing between these 2 processes (which are the result of different patient motivations and require different management strategies) very difficult. However, the ability of nurses to recognize the patient defensiveness that underlies RTC can set the stage for an appropriate response that can de-escalate the situation and ultimately facilitate better patient care. Patients who demonstrate RTC need understanding, reassurance, and a flexible approach to management rather than restraint, seclusion, and application of security measures. Potential strategies to avoid triggering resistance include reducing noise, respecting personal space, and allowing patients more control over routine care. More nursing education in the areas of assessment and management is needed, particularly in how to differentiate between aggression and RTC. Such patients may require alternative approaches to care and much more flexibility on the part of nurses caring for them, but the end result is likely to be a much more cooperative patient, which can only make life easier for the nurse.
Abstract
