ASSAULTIVE BEHAVIOR MANAGEMENT
Scenario One-A
You’re present on the locked adult behavioral unit as a 74 year old male, named John Rowe, admitted for an onset of dementia and to regulate his meds, is in the process of acting out by throwing some chairs against the day room wall. John’s family, including his son and daughter-in-law is also present, along with several staff members, having responded to the commotion of the chairs being thrown at the wall. The nurse in charge informs you that John was supposed to be discharged this afternoon after the doctor had written the order earlier in the day, per the family’s request, but upon arriving, the family now wants to leave John in the hospital 7 more days, stating that they feel he needs more medications to help his behavior at home, as John lives with the family and has been exhibiting delusional and forgetful behavior lately. John’s family also have told the doctor that they would like John to stay another week because they would like to go on their vacation this week and since they care for him full time, this would be the only chance they will get this year to vacation, so they want John to stay another week and have told him that he will be staying now after getting his hopes up the day before.
John has no history of violence prior to this admission and has been fixating on going home, but now that he has found out that he is not going home, he has suddenly become aggressive and unpredictable. After throwing the chairs against the wall, John yells loudly and threateningly at his family, telling them that they can’t keep him there and that he is going to his room to get his bags he’d already packed the day before in anticipation of his discharge. The family is fairly unemotional during the outburst, appearing only to be annoyed and embarrassed over the spectacle. The nurse in charge is trying unsuccessfully to reach John’s doctor and is clearly annoyed over the family’s decision to want John to stay. As John emerges from his room, clearly angry and agitated, the family tries reason with him, but only gets more aggression their way as he yells, waving his suitcase at them before walking toward the door. John begins pounding his fist and kicking the door, screaming and demanding that he be allowed to leave. Staff members and the family attempt to guide him away from the door, but John only yells louder and pushes past them all. He begins pacing around the room, yelling more and starts waving his suitcase around to keep everyone away.
1) What intervention would you recommend?
