Agressive Behavior Flashcards
What are the 4 components of crisis development?
Anxiety level
Defensive level
Acting Out person
Tension reduction
What are the 5 Phases of the Aggression Cycle?
Phase I: Triggering Phase Phase II: Escalation Phase Phase III: Crisis Phase Phase IV: Recovery Phase Phase V: Post-crisis Depression Phase
Pacing, decreased concentration, muttering, and wringing the hands are examples of what component of Crisis development?
Anxiety level
When a patient is testing your limits and “pushing your buttons”, this is an example of what component of the crisis development?
Defensive Level
When a patient acting out shifts from the verbal range to the physical range.
The Acting Out Person
True or False
When a patient is acting out staff need to physically restraint them to deescalate the situation.
False
Physical restraint of a patient is to be used as a LAST RESORT, when at other intervention methods have failed.
What crisis development component is characterized by the patient experiencing a total expenditure of energy and tension?
Tension Reduction
Explain what happens in each of the 5 phases of the aggression cycle.
Phase I: Triggering Phase: the stress event occurs
Phase II: Escalation Phase: indicators are present for the potential loss of control
Phase II: Crisis Phase: period of emotional and physical crisis
Phase IV: Recovery Phase: typically referred to as the cooling down period
Phase V: Post Crisis Depression Phase: Period of experiencing feeling associated with the cycle.
When does intervention normally occur (in what phase)?
Phase III: Crisis Phase
What phase included accusations, lower voice and change in focus of conversation?
Phase IV: Recovery Phase
True or False
The impact of aggression need to focus on the one or 2 patients that are distressed.
False
The focus needs to be on the whole milieu, including the staff, not just the one or two patients that are distressed.
Describe a staff person’s therapeutic response to escalating patients or situations.
Recognize the person’s feelings
Does not evade the issue
Give the patient an opportunity to talk
Accept their feelings
Define integrated experience.
Integrated Experience: the concept that behaviors and attitudes of staff impact on behaviors and attitudes of patients and visa versa
What does the Law of Least Restrictive Means entail?
Right to treatment in the least restrictive setting
Treatment plans are changed based on a patient’s current condition
There must be adequate rationale for the use of these practices
What are the 2 aspects of restriction?
- The nature of the choices being restricted from a patient
2. The method by which choices are restricted from a patient
What are reframing techniques?
A technique used to expand limited or constricted perceptions
What are grounding techniques?
Helping the patient focus on an object within the current environment
What are guided options?
Provide 2 choices/options that will help to de-escalate the patient.
True or False
Limit setting can be punitive, non-manipulative act in which the patient is told what behavior is acceptable.
False
Limit setting is a non-punitive, non-manipulative act in which the patient is told what behavior is acceptable.
What is the difference between information seeking and challenging?
Information- seeking: a rational question seeking a rational response
Challenging: questioning authority or being evasive; attempting to draw staff into a power struggle
It is still possible to calm down a patient at the anxiety level when the staff member does what?
When the staff member demonstrates care and concern for the patient, and patient is allowed to vent for a period of time, he or she may be able to find control
When a patient is at the defensive level staff’s statements need to be_____?
Keep statements direct and simple, don’t give patient a lot of options to choose from, it only adds confusion
What is the overall goal when a patient is at the acting out stage?
Goal here is to quickly restrain patient, to prevent them from hurting themselves or others, and to allow them to gain control over themselves.
What does the staff need to do when a patient is in the Tension Reduction Stage?
Staff needs to reassure the patient they are ok, that no one will seek revenge for the patient’s behavior, and that while their behavior was dangerous and unacceptable, the person is still accepted and cared about.
What are boundary violations?
Departures from traditional roles, locales, and arrangements in therapy. Boundary violations are so commonly associated with misconduct that their occurrence may be taken as presumptive evidence that misconduct occurred.
What is counter transference?
The analyst’s unconscious emotional needs, wishes, or conflicts that are evoked by the patient, brought into the analytic situation, and influence (usually negative) the analyst’s objective judgment and reason
What are 3 components of hostility?
Cognitive
Affective
Behavioral
What is an indirect challenge?
Indirectly challenge or deprecating the interview or the interviewer (e.g. answering in a way that suggests that the question was pointless)
What is seduction?
An attempt made by a patient to manipulate or relate to a staff member in a non-therapeutic way. It is usually nonsexual.
What are some methods of managing patient hostile behavior?
Give undivided attention to the hostile patient.
Indicate respect for the patient’s feelings
Listen without defensiveness or argument
What is the definition of seclusion?
The involuntary confining of a person alone in a room for which the person is physically prevented from leaving.
What is the most restrictive intervention?
Seclusion is one of the most restrictive interventions used in psychiatric facilities and is viewed as a negative experience by most patients.
The rationale for the use of seclusion is based on what 3 therapeutic principle?
Containment
Isolation
Decrease in sensory output
What is the difference between seclusion with a locked door and seclusion with an unlocked door?
a locked door has a mattress but no linens
True or False
Only a doctor can order the use of restraints.
True
A doctor’s order must be obtained (according to institutional policy) to use physical restraint as a patient intervention
How long after the initiation of restraints must a physician evaluate the patient?
A physician, licensed independent practitioner, registered nurse, or physicians assistant must evaluate the patient’s need for restraint within 1 hour after the initiation of the intervention.
What is the maximum amount of time a patient should be in restraints?
Restraints can be ordered for a max of 4 hours for adults, 2 hours for adolescent’s age 9-17, and 1 hour for children under 9 years.
True or False
Patient who are restrained and secluded need to be monitored face to face
True
Patients who are both restrained and secluded must be constantly monitored face to face or by audio and video equipment
What do you secure the restraints to?
Ensure restraints are secured to bed frame (not side rails of bed)
What equipment is needed to do mechanical restraint?
2 wrist cuffs
2 leg cuffs
2 restraint straps
restraint key
True or False
Patient consent is not needed for chemical restraint if they are out of control.
False
The patient needs to know what the medication is for and agree to take it. Patients should be given the option of an oral medication whenever possible
If a patient refuses chemical intervention what do you do?
If a patient refuses, stop and inform the nurse. The patient has the right to refuse meds.
What is the difference between strike and grab?
Strike: a weapon coming in contact with a target
Grab: the control or destruction of a part of one’s anatomy
What are the different types of child abuse?
physical
sexual
emotional
neglect
What are the different types of spousal abuse?
physical
sexual assault/rape
emotional abuse
What is the cycle of violence related to spouse abuse?
Tension-building
Acute battering stage
Honeymoon stage
At what age are children most likely to get abused?
Under 3 years old
Who is most likely to abuse a child?
Parents brought up with harsh corporal punishment
Mothers age 26
Males 30
True or False
An abused child will protect their parents.
True
Because of the fear of abandonment or reprisal.
What are the factors of an abusive male?
Age 29-33
uneducated
unemployed
white
What are the factors of an abusive female?
reverse sexism
inheritance of violence
lack of social skills
exposure to stressors
What are the 4 levels of child abuse?
Level 1 - No additional services
Level 2 - Enrollment in DVAW
Level 3 - Enrollment in one or more services (therapy)
Level 4 - Long term treatment of sexual abuse offenders
What is the definition of rape?
Rape is an act of sexual intercourse that is forced upon a person and/or the unlawful compelling of a person through physical force or duress to have sex
True or False
Sex is a dominate issue
False
Sex is rarely the dominant issue
Most males who commit rape are what age?
ages 25 - 44
51% white
34% is with alcohol
Most females raped are how old?
16-24
True or False
Most rapes occur in the victims neighborhood.
True
How many stages of violence are there?
Child Abuse
Spousal Abuse
Elder Abuse
What are the signs and symptoms of shaken baby syndrome?
retinal hemorrhages from shaking
subdural hematomas
cerebral edema
True or False
Physical restraint a therapeutic tool?
True
What is included in a family assessment for child abuse?
parent function
child’s function
the quality of interaction among family members
True or False
Drugs and Alcohol are a military family stressor.
False
The time frame fro a level 4 child abuse is how long?
longer than 24 weeks
Who must continually asses the patient while they are in restraints?
nursing staff
What is the best way to manage an aggressive patient?
Hostile withhold/evade
Indirect challenge
Direct challenge
Irritation
