Agitation

After 2 hours in the department D is still weak but is becoming more agitated. He has not yet been examined or had a full set of observations, nor has he had any interventions.

Behaviours of distress, previously called challenging behaviour, are defined as of such an intensity, frequency or duration as to threaten the quality of life and/or the physical safety of the individual or others and is likely to lead to responses that are restrictive, aversive or result in exclusion. (RCPsych, Challenging behaviour: a unified approach, 2007). Other terms used include behaviours that challenge or behaviours of concern. There might be shouting, screaming, throwing, kicking, spitting, absconding or even hiding or withdrawing. Its important to remember that all behaviour is a form of communication. Our own behaviour is contagious, so we need to avoid appearing threatening. Minimising the number of staff involved can also be helpful, along with reducing any environmental stimulation such as noise or bright lights. Alongside de-escalation, we need to manage the causes of the distress, which is in turn causing the behaviour. You can find out more about behaviours of distress here.