Anger, Aggression, and Violence Flashcards
What is aggression?
An emotion that results in a verbal or physical attack. Aggression is not always inappropriate
What is bullying?
A repetitive behaviour that sustains an imbalance of power.
What are de-escalation techniques?
Methods and tools, including advanced communication skills, used to defuse any incident of acting out, anger, aggression, or violence.
What is rage?
An uncontrollable, violent state of anger that prevents a person from thinking clearly or logically, impeding psychosocial or cognitive-behavioural interventions.
What is trauma-informed care?
Care focused on patients’ past experiences of violence or trauma and the role it currently plays in their lives
What is violence?
Any action that has the intent to harm. It can be directed at self, others, or objects.
Are people with mental illness more likely to be violent?
- In Canada 3% to 5% of interpersonal violence (physical force or power toward an individual or group causing injury, death, psychological harm) is attributed to mental illness (Leyton, 2018)
- In Canada psychiatric illness/symptoms such as paranoia, depression, grandiose personality accounts for less then 1% of violence (Leyton, 2018).
Who are more likely to be victims of violence, people with mental illness or the general public?
In Canada persons with a mental illness are 2.5 – 4 times more likely to be victims of violence than the rest of the population (Dragicevic, 2018)
The Mentally ill in Canada are 10-20 times more likely to die by suicide than commit homicide
What are feelings which might precipitate anger?
Discounted, ignored or rejected Unheard
Embarrassed or humiliated Insecure
Frightened Overwhelmed (no control)
Guilty Tired
Hurt Inadequate
Threatened Vulnerable
**In general bio / psycho / sociological factors **
How might you assess for potential anger, aggression or violence tendencies?
History (if present usually documented on chart, flagged)
* Male * Young (14-24, remember testosterone levels in men/pubescent are positively associated with violence)
* Substance abuse
* History of incarceration
* Low socioeconomic status/inadequate supports
* Poor coping skills**
What milieu chaacteristics may be conducive to violence in the hospital or institution setting?
- Overcrowding
- Staff inexperience
- Provocative or controlling staff
- Poor limit setting
- Arbitrary revocation of privileges
- Language or other communication barriers
- Cultural barriers
What is the most important predictor of imminent violence?
Hyperactivity (pacing, restlessness)
What symptoms of psychosis might precipitate aggression?
-hallucinations
- command hallucinations
- paranoia
- jumbled thoughts
What can nurses do to decrease violence?
- Pay attention to the environment or the milieu ALL THE TIME
- Be aware of what might cause violence
- Watch for early warning signs – anticipate and assess for any changes in behaviour
- Know common prevention measures – be aware of your own body language
- Know de-escalation techniques
- Know your unit policy/procedures
- Most importantly – know your patient – **develop trusting relationships **
How do nurses contribute to aggression & anger?
- by not knowing their patients
- not recognizing early warning signs and getting ahead of escalating behaviour.
- Staff who want to control, who enforce rules just because they can
- Staff who don’t respect the integrity of patients
- Communication issues
- Cultural barriers
- Unmet needs
What are signs that lead to the following nursing diagnoses: Ineffective coping, stress overload, risk for other directed violence?
- Exhibiting feelings of frustration, fear , anxiety, irritability
- Saying they are angry, defiant, say they have no control
- Behaviour: hyperactivity, pacing, withdrawing, ruminating, sullen.
What nursing interventions are appropriate for pre-aggression signs?
- Give information/give space
- Inform colleagues of your plan to intervene
- Offer one to one, listen, acknowledge, validate and act if you can.
- Help them identify what is triggering them and what thoughts are fueling it (do some CBT)
- Be calm, Be relaxed, be Honest
- Offer choices: away from others, medication.
When a situation has escalated to acting out, what is the desired outcome?
Safety
What are signs leading to the diagnosis of risk for other directed violence?
*Exhibiting loss of control over self: intent to harm, may acquire a weapon
*Saying abusive words, hostile, loud volume
*Behaviour: Hyperactivity, pacing, stomping, clenching, sweating, eye contact change, assaultive
What are appropriate nursing interventions for the nursing diagnosis risk for other directed violence?
- Communicate clear, be concise.
- Convey kindness, confidence, calmness.
- No more choices: offer one thing, ie medication.
- If violence imminent Code White: know the plan: restraint, seclusion, medication. (doctor orders)
What is an internal locus of control?
Internal LOC: clients believe their actions are biggest factor in outcomes. For example the client with a spine injury seeks to know what their options are and what they can do.
What is an external locus of control?
Clients see outcomes external to them. Tendency to blame
others for their difficulties. The same client with a spine injury may be angry and abusive to the nurse as finds it difficult to cope.
What interventions may be appropriate for the older adult population related to angry or aggressive behaviour?
- Patience and Kindness is the best intervention.
- Reality Orientation for some.
- Validation Therapy for others
- Caution with medication, restraint and seclusion.
- Specialized care
What is the current healthcare policy regarding the use of restraints?
Restraint as a last resort
What are the different kinds of restraints?
1) Chemical
2) Mechanical
3) Seclusion
What is involved in motivational interviewing?
- Goal is empowerment – Empowerment – the psychological sense of personal control, involvement, influence, & awareness of options in one’s life
- Aimed at behaviour change
- Patient centered/ Patient directed
- Uses the change continuum, and attempts to establish concrete steps to increase readiness for change
- Ambivalence & resistance are expected
What are some techniques for motivational interviewing?
- Reflective Listening: assess for Conviction and Confidence
- Eliciting motivational statements
- Examining ambivalence
- Conviction: importance, consider risks & benefits, explore concerns about behaviour, hypothetical look over the fence, explore next possible steps.
- Confidence: brainstorm for successful past efforts, affirming & summarizing statement, builds motivation
