Anger, Aggression, and violence Flashcards
what is anger
emotional response to frustration, a threat to ones needs, or a challenge
when handled appropriately can provide individual with positive force to solve problems and make decisions
varies in emotional state from mild irritation to intense fury and rage
capable of being under personal control
can be channeled into something positvie
aggression
an action or behavior that results in a verbal or physical attack
used synonymously with violence
intended to threaten or injure the victims security or self esteem
can cause damage with words, fists, or weapons, always designed to punish
no always inappropriate and is sometimes necessary for self-protection
violence
always an objectionable act that involves intentional use of force that results in or has potential to result in injury to another individual
crisis= Danger + opportunity
crisis can be dangerous but can be used for both you and individual in crisis to grow and to strengthen your relationship with one another
etiology of anger
biological factors - areas of the brain, neurotransmitters, predisposition
psychological factors, behavioral therapy, learned response, social learning theory, imitate others
predisposing factors to anger and aggression
modeling
neurophysiological disorders
operant conditioning
biochemical factors
medical factors
*always look for potential medical causes
socioeconomic factors
environmental factors
modeling
role-modeling is the strongest form of learning
can be positive or negative
significant others or celebrities
neurophysiological disorders
several disorders or conditions within the brain implicated in episodic aggression and violent behavior
temporal or frontal lobe epilepsy, brain tumors, brain trauma, encephalitis, TBI, psychosis
operant conditioning
specific behavior positively or negatively reinforced
Pavlov’s dog
biochemical factors affecting aggression
hormone dysfunction: Hyperthyroidism
low serotonin
thiamine and niacin
medical factors: UTI, electrolyte dysfunction
comorbidities of agression/anger
PTSD
SUD
coexist with depression, anxiety, psychosis, personality disorders
cardiovascular disease
strokes
what does anger look like?
increased demands
irritability
frowning
redness in face
pacing
twisting hands
clenching and unclenching of fists
speech increased in rate and volume or may be slowed
assessment of anger and aggression
a history of violence is the single best indicator of future violence
individuals are delusional, hyperactive, impulsive, predisposed to irritability, non-adherent to meds are at higher risk of violence
aggression by individuals occurs most often in the context of limit setting by nurse
hx of limited coping skills, including lack of assertiveness or use of intimidation, indicates higher risk of violence
questions to assess major factors associated with violence
does individual wish or intend to harm
do they have a plan
does the individual have the mean available to carry out plan
does the individual have demographic risk factors (male, 14-24, low socioeconomic status, inadequate support system, prison time)
risk assessment identifies for aggression
agitation, restlessness, escalating anxiety
resistance to suggested treatment
history of assaultive or threatening behavior esp. last 12m/12h
known history of drug or alcohol misuse
cognitive changes causing misinterpretation of environments and staff care activities (delirium, delusions, psychosis, hallucinations)
predictors of violence
hyperactivity (pacing, restless)
increasing anxiety, tension (clenched jaw or fists, rigid posture, fixes or tensed facial expression, mumbling to self)
verbal abuse (profanities, argumentativeness)
loud voice, change of pitch, very soft voice
intense eye contact or avoidance of eye contact
recent acts of violence
possession of a weapon or object that can be used as one
isolation that is uncharacteristic
psychosocial interventions
interventions begin prior to any signs of escalation
approach patient in a controlled, nonthreatening and caring manner
allow pt enough space to be perceived as less of a threat ( stand 1 foot farther than arm length from pt)
make sure you have escape route
do not take anything personal, respond in kind manner.
deescalating techniques
maintain patients self-esteem and dignity
calmness
assess the patient and situation
identify stressors and stress indicators
respond early
use calm tone of voice
invest time
remain honest
avoid invading personal space in times of high anxiety, personal space increases
avoid arguing
give several clear options
use genuineness and empathy
be assertive not aggressive
maintain personal safety at all times
considerations for staff safety
avoid wearing dangling earrings, scarves
ensure enough back up staff
always know layout of area and where exits are
do not stand in front of patient or block exits
if behavior escalates provide feedback allowing for patient to explore feelings and hopefully deescalate
maintain appropriate eye contact
keep facial expression even, caring, confident, engaged
try to get pt to talk to you
supportive stance
confident posture not confrontational
stand at an angle not toe to toe
hands visible
always stay about 1 foot further than arm/leg length away
youth violence risk factors
environmental- peer influence and gang related behavior
biological- impulse control or self-regulation problems
family- attachment problems, family stress, autocratic parenting, disengaged parenting, lack of supervision
level 1 anger/aggression/violence
the patient is asking simple, normal questions
expressions of anxiety, frustration, impatience, irritability
raised voice, highly animated, reddened face, clenched fist, restlessness, repetitive movements
change in behavior- calm to loud; loud to calm
level 1 staff intervention/responses
answer the question
avoid institutional/systems language/jargon
avoid coming off as cold and uncaring
come across as a real human being
avoid talking about how you feel about it/the situation
do: stay calm and in control, try to understand concern, listen for truth, reflect their emotion appear as personable as possible, comfort measures
dont: take the bait
get defensive
counterattack
be easily offended
level 2
defensiveness
beginning loss of rationality
pt asks challenging questions
person is standing in your personal space; staring; glaring
refusing; refusing your requests; loudly and adamantly refusing to go along with treatment, becoming very angry and defensive
releasing- table pounding, loud sighing, throwing things, but not at you, not meant to cause harm
