Behaviours of concern in recovery
Sep 04, 2025
From Agitation to Escalation: Recognising Behaviours of Concern in the PACU
The recovery room is a dynamic environment where patients may emerge from anaesthesia with a range of physical and psychological responses. While many recover smoothly and straight forward, some exhibit behaviours of concern that can escalate into critical and dangerous situations if not promptly recognised and managed. Recovery nurses play a crucial role in identifying these behaviours early, ensuring both patient and staff safety.
🚨 Agitation or Restlessness
This may be caused by hypoxia, pain, urinary retention, emergence delirium, or inadequate reversal of anaesthetic agents. Patients may thrash, pull at lines or airway devices, or attempt to climb out of bed, posing a danger to themselves and staff. Early assessment of a potential physiological cause is vital before assuming psychological factors.
🚨 Aggression or Violence
Less common but poses significant risk. Triggers can include delirium, substance withdrawal, or severe pain. De-escalation strategies, maintaining a calm approach, and calling for assistance are essential. Physical restraint should only be used as a last resort and in line with hospital policy.
⚠️ Non-verbal Signs of Distress
Such as grimacing, moaning, or guarding, should not be overlooked. These may indicate poorly controlled pain or evolving complications such as bleeding or compartment syndrome.
⚠️ Refusal of Care or Non-Compliance
In the immediate postoperative period this can also be concerning, particularly if patients remove oxygen, monitoring, or refuse medications or nursing care. Recovery nurses must balance respecting autonomy with ensuring safety, often requiring careful communication and negotiation with the patient and the wider healthcare team.
Ultimately, behaviours of concern in recovery are often symptoms of an underlying physiological issue. Nurses must approach them with structured assessment, clear communication, and rapid escalation when required. By recognising behaviours as potential warning signs of emergencies, recovery nurses safeguard patient outcomes and contribute to a safe perioperative environment.
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References:
Australian College of PeriAnaesthesia Nurses. (2022). Standards for practice: Post anaesthesia care. ACPAN. https://www.acpan.edu.au
Radtke, F. M., Franck, M., MacGuill, M., Seeling, M., Lütz, A., Westhoff, S., & Spies, C. D. (2010). Emergence delirium after general anaesthesia in adults: Incidence, risk factors and impact on patient outcome. European Journal of Anaesthesiology, 27(9), 873–880. https://doi.org/10.1097/EJA.0b013e32833b3a1f
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