S21 · Likely to harm others
Risk Safety and protection
Definition
Anger, confusion, or illness may lead to violence toward other people.- Anger
- psychosis
- intoxication
- confusion
- past violence
- Threats
- clenched fists
- pacing
- shouting
- damaging objects
📋 Scenario
A patient with a history of violence is becoming restless and irritable on the ward after an argument with a visitor.
Subjective (S): "Leave me alone."
Objective (O): Pacing; raised voice; clenched jaw; past aggression when intoxicated; no threats or physical acts so far.
Assessment tools for this scenario: CP-SAFE Safety & Falls Score
Validated scales to consider: Morse Fall Scale
**CarePath diagnosis:** Likely to harm others related to anger and past violence (risk factors); no signs of the problem are present yet.
**Interventions and rationale**
| Intervention | Rationale |
|---|---|
| Stay calm. | A calm nurse sets the tone and lowers the patient's arousal, whereas an anxious or sharp manner can make anger worse. |
| Keep a safe distance. | A safe distance gives the nurse room to move away and reduces the chance of being hit. |
| Give space. | Space lets an angry person feel less cornered, which often reduces the urge to lash out. |
| Use de-escalation. | Calm talk, listening and a low voice can settle anger without force and keep everyone safer. |
| Call for help. | Extra staff add safety and presence, and calling early is better than waiting until violence has started. |
| Follow policy. | Policy guides safe, lawful responses and protects the patient, staff and others on the ward. |
| Treat the cause. | Pain, intoxication, fear or illness can drive aggression, so treating the cause lowers the chance of it returning. |
**Expected outcomes**
- No harm to staff or other patients.
- Patient calms within 30-60 minutes.
- Cause assessed and treated.
**Linking the data to the diagnosis**
A patient with a history of violence is becoming restless after an argument with a visitor. He says, "Leave me alone," and is pacing, with a raised voice and clenched jaw. He has been aggressive in the past when intoxicated. No threats or physical acts have occurred, so this is a risk diagnosis based on anger and past violence, not actual harm. The plan aims to prevent harm to staff and other patients by staying calm, giving space and calling for help, so he settles within 30 to 60 minutes and the cause is found and treated.
CarePath diagnosis
Likely to harm others related to anger and past violence (risk factors); no signs of the problem are present yet.
Interventions and rationale
Listed in priority order.
| Intervention | Rationale |
|---|---|
| 1. Stay calm. | A calm nurse sets the tone and lowers the patient's arousal, whereas an anxious or sharp manner can make anger worse. |
| 2. Keep a safe distance. | A safe distance gives the nurse room to move away and reduces the chance of being hit. |
| 3. Give space. | Space lets an angry person feel less cornered, which often reduces the urge to lash out. |
| 4. Use de-escalation. | Calm talk, listening and a low voice can settle anger without force and keep everyone safer. |
| 5. Call for help. | Extra staff add safety and presence, and calling early is better than waiting until violence has started. |
| 6. Follow policy. | Policy guides safe, lawful responses and protects the patient, staff and others on the ward. |
| 7. Treat the cause. | Pain, intoxication, fear or illness can drive aggression, so treating the cause lowers the chance of it returning. |
Expected outcomes
- No harm to staff or other patients.
- Patient calms within 30-60 minutes.
- Cause assessed and treated.
Linking the data to the diagnosis
A patient with a history of violence is becoming restless after an argument with a visitor. He says, "Leave me alone," and is pacing, with a raised voice and clenched jaw. He has been aggressive in the past when intoxicated. No threats or physical acts have occurred, so this is a risk diagnosis based on anger and past violence, not actual harm. The plan aims to prevent harm to staff and other patients by staying calm, giving space and calling for help, so he settles within 30 to 60 minutes and the cause is found and treated.