Anger, aggression, and violence Flashcards
anger
emotional response to frustration of desires, threat to needs, varies in intensity
- normal emo response
- can be under personal control
What precipitates anger?
Anxiety, embarrassment, fear, w/d, sub abuse, sleep deprivation, attn-seeking, pain, stress, past trauma, loss of personal power, diff in goals and knowledge
Aggression
action or behavior that results in verbal or physical attack
- threaten or injure victim’s security and self-esteem
- can cause damage with words, physical
- not always appropriate, need for self-protection
What is aggression designed to do?
Punish
Violence
Intentional force and potential for injury
Warning signs of violence
Hyperactivity, inc anx, chx in speech, verbal abuse, recent violence, eye contact, have weapon, unusual loud or soft voice
Enviro factors for violence
hot, cold enviro, crowded, inexperienced staff, controlling staff, prior limits set, privilege revoked
Biggest predictor of violent bx
HX VIOLENCE
and also hyperactivity?
Other predictors of violence
hyperactive, impulsive, delusional, non-adherent, setting limits by nurse, poor coping lack assertion, use intimidation
Risk assessment
anx, restless, history assault, hx drugs/alc misuse, cog chx that may cause misinterpreted enviro, resistant to enviro, aggression management needed during transfer
General implementations for violence
Have good interactions, approach in controlled manner, stay 1 ft further than pt can reach, give escape route, don’t respond, speak low, short sentences, open ended Qs, ID source of bx, detail to enviro, give pt options, good eye contact, confident expression, encourage pt to sit and talk
Best time to intervene during violence
Before escalation
Nurse’s role with de-escalation
- de-escalate
- non-verbal cues
- acknowledge feelings
- encourage talking
Pt defensive rxn
challenges, glare, refuse, release
What is pt release?
Pound fists, throw things but mean no harm
Pt intimidation/acting out bx
begin with swearing, sexist comments, terroristic, intimidating
What to do when pt intimidating/acting out
call for help, remove weapons, be aware of non-verbal bx, limit actions/words that direct the pt and avoid agreeing just to agree, be firm, isolate interventions; if they listen, can say “agg will not achieve goal”
tension reduction
rationality recurrs; reachable and teachable
- make coping strategies, re-est rapport, revise POC to include these agg bx
Seclusion
invol confinement of pt alone
- physically can’t leave
When is seclusion used
For safety with violence and self-destructive bx
Restraint
Any manual method, phys or mech device, material, equip that immobilizes
- potential for injury
NC for s&r
- last resort
- need orders w/i 1h by face to face dr who assesses
- notify pt/advocate, ongoing assessment, doc bx
- open door with sitter outside/inside and safety, toilet, comfort, nutrition/hydration, cap refill
- wedge pillow under head to help breath
Is all 4 rails up a restraint?
Yes unless you have seizures
For whom are restraints an additional hazard?
Kids bc underdev
