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ABSN > anger, aggression & violence (329 E1) > Flashcards

anger, aggression & violence (329 E1) Flashcards

1
Q

What is anger?

A

Anger is an emotional response to frustration of desires, a threat to one’s needs, or a challenge that varies in intensity from mild irritation to intense fury and rage.

Anger is a normal human emotion that, when handled appropriately, can help solve problems.

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2
Q

When does anger become a problem?

A

Anger becomes a problem when it is not handled appropriately and when it is expressed aggressively.

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3
Q

What is aggression?

A

an action or behavior (that is intended to threaten or injure) that results in a verbal or physical attack, tends to be used synonymously with violence
not always inappropriate & is sometimes necessary for protection

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4
Q

What are the risk factors for increased angry, aggressive, or violent feelings and behaviors?

A

Risk factors include:
* History of violence (best indicator)
* Delusional or hyperactive states
* Impulsivity
* non adherence to meds
* Lack of coping skills
* Substance abuse
* Psychiatric illnesses

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5
Q

List some signs that may indicate a person is becoming angry.

A
  • Irritability
  • Frowning or grimacing
  • Redness in the face
  • Pacing
  • Clenching and unclenching of fists
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6
Q

What are some feelings that may precipitate anger?

A
  • Anxiety
  • Fear
  • Inadequacy
  • Rejection
  • Stress
  • Tired
  • Unheard
  • Out of control
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7
Q

What are some warning signs of potential violence?

A

-Hyperactivity (most important)
-Increasing anxiety and tension
-Loud voice or change of pitch
-Verbal abuse
-Possession of a weapon
-stone silence
-intense eye contact
-recent acts of violence
-has weapon
-isolation that is uncharacteristic

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8
Q

True or False: A history of violence is the single best predictor of future violence.

A

True

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9
Q

What is the role of the nurse during escalating situations?

A

The nurse should use safety techniques, maintain a non-threatening demeanor, and have an escape route.

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10
Q

Seclusion

A

the involuntary confinement of a patient alone in a room or area from which the patient is physically prevented from leaving
** may only be used for the mgt of violent or self destructive behavior**

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11
Q

What is the goal of seclusion?

A

The goal of seclusion is SAFETY for the patient and others, never punitive

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12
Q

What should interventions ideally begin prior to?

A

Interventions should ideally begin prior to any signs of escalation.

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13
Q

What are some general interventions to de-escalate a situation?

A
  • Approach the patient in a controlled manner
  • Speak slowly and calmly
  • Use open-ended questions
  • Identify underlying feelings
  • Pay close attention to the environment
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14
Q

What is the purpose of the Broset Violence Checklist (BVC)?

A

The Broset Violence Checklist is used to assess the risk of violence based on specific observable behaviors.
compares present behaviors to baseline

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15
Q

What is a major consideration for staff safety during a violent incident?

A

Always know the layout of the area, keep neutral facial expressions, do not wear dangle items and ensure enough backup staff is available.

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16
Q

What should staff do if a patient’s behavior escalates?

A

Provide feedback, allow the patient to explore feelings, side to the side of patient & doorway and ensure personal safety.

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17
Q

What is defined as restraint?

A

Restraint is any manual method, physical or mechanical device that immobilizes or reduces the ability of a patient to move freely.

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18
Q

When may seclusion or restraint be used?

A

Seclusion or restraint may only be used as a last resort when the patient poses a danger to self or others.

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19
Q

What is a key factor in assessing the risk of violence?

A

A history of violence is the single best predictor of future violence.

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20
Q

What is the role of self-assessment for nurses in managing violent situations?

A

Nurses must be self-aware of their strengths, needs, concerns, and vulnerabilities to intervene effectively.

21
Q

What are some de-escalation techniques for staff?

A
  • Respond early
  • Maintain calmness
  • Use a calm tone of voice
  • Be genuine and empathetic
  • Be assertive
  • Maintain patient’s self esteem & dignity
  • Be honest
  • Give several clear options
  • Determine pt goals & needs
22
Q

Fill in the blank: The __________ is an assessment tool that includes items such as confused, irritable, and physically threatening.

A

[Broset Violence Checklist (BVC)]

23
Q

What should be determined prior to seclusion and restraint?

A

Roles and responsibilities for the team, including who will lead, communicate with the patient, prepare the area, administer medication, provide one-on-one care, document, and lead debriefing.

These roles are critical to ensure a coordinated and safe approach during seclusion and restraint.

24
Q

What increased danger is associated with child restraint?

A

Underdeveloped trachea, intercostal muscles, and diaphragm make children more easily restricted by a restraint device.

This anatomical difference requires careful monitoring and responsiveness to respiratory distress.

25
Q

What should be done if a patient complains of difficulty breathing during restraint?

A

Always respond to the patient’s complaint.

This includes checking for intercostal muscle retractions and the use of accessory muscles.

26
Q

What could increased struggling movements from a patient indicate?

A

An attempt to increase air flow or signs of respiratory distress.

Check oxygen saturations and be alert to late signs like cyanosis around lips and mouth.

27
Q

What might decreased struggling in restraints indicate?

A

Decreased level of consciousness (LOC).

This is a critical sign that should prompt immediate assessment.

28
Q

Which medical conditions might compromise breathing in a restrained patient?

A
  • Asthma
  • Obesity
  • Chronic obstructive pulmonary disease
  • Spinal injury
  • Seizure disorders
  • Pregnancy
  • Delirium or dementia

Each of these conditions requires careful consideration when implementing seclusion and restraint.

29
Q

What is a contraindication for seclusion and restraint?

A

-Patients with extremely unstable medical and psychiatric conditions
-COPD
-spinal injury
-seizure disorder
-pregnancy
-delirium pr dementia

This includes conditions such as chronic obstructive pulmonary disease and seizure disorders.

30
Q

What is critical incident debriefing?

A

An immediate and mandatory debriefing for staff and patients involved in the seclusion and restraint episode.

This process includes evaluating actions taken and lessons learned.

31
Q

What components should be included in critical incident debriefing?

A
  • Prevention of the episode
  • Team response
  • Safety maintenance
  • Policy adherence
  • Restraining process evaluation
  • Lessons learned
  • Respect for patient dignity
  • Need for staff education

These components help improve future responses and patient care.

32
Q

What role does a nurse play in a patient’s recovery regarding anger management?

A

Role model and educator.

The nurse teaches coping skills, de-escalation techniques, and assists in identifying triggers for anger and aggression.

33
Q

Fill in the blank: The nurse teaches a variety of methods to appropriately express _______.

A

anger.

This includes educating patients on constructive ways to manage their emotions.

34
Q

What should nurses educate patients about to manage behavior?

A
  • Coping skills
  • De-escalation techniques
  • Self-soothing skills

These skills are essential for patients to manage their emotions effectively.

35
Q

violence

A

always an objectionable act that involves intentional use of force that results in or has the potential to result in injury to another individual

36
Q

in hospital settings, violence is most frequently seen in

A

1) ED
2) Psychiatric units
3) Geriatric units
4) intensive care units

37
Q

milieu characteristics conducive to violence

A

-environment (too hot/cold/loud)
-overcrowding
-staff inexperience
-controlling staff
-poor limit setting
-revocation of privileges

38
Q

when can you use meds for intervention

A

-when pt is showing signs of anxiety or agitation
-in conjunction w/ psychosocial interventions

39
Q

patient behavior: defensiveness

A

-pt asks challenging questions
-person is standing in your personal space
-pt is refusing
-pt is releasing (table pounding, lough sighing, throwing things)

40
Q

patient behavior: intimidation / acting out

A

When angry expression turns to hostility and abuse or aggression (any activity that is intended to cause or can cause physical harm).
May begin as accusations, comments about competence, irrelevant personal remarks.

41
Q

intimidation / acting out signs of danger

A

-Persistent swearing
-Sexist or racist comments
-Personal or specific threats of harm
-Intimidating comments
-Terroristic type threats
-Any physical behavior directed at a person

42
Q

indication of use of restraints

A

To protect patient & others from harm

43
Q

legal requirements for restraints

A

Multidisciplinary involvement

Appropriate healthcare provider order according to state law

Patient advocate or relative notified

Seclusion & restraint discontinued as soon as possible

44
Q

documentation of restraints

A

Behavior(s) leading to seclusion and restraint

Least restrictive measures used prior to seclusion and restraint

Interventions used and patient’s response

Plan of care for seclusion and restraint use implemented

Ongoing evaluation by the nursing staff

45
Q

how often does documentation need to occur for a non violet pt in restraints

A

-skin & circulation q1
-nourishment & toileting q2
-ROM q4

46
Q

how often does documentation need to occur for a violet pt in restraints

A

-wellbeing, mood, circulation, resp, skin q15mins
-nourishment & toileting q2
-ROM q4
-order renewal q4

47
Q

if a pt is in restraints, what might increased struggling movements indicate

A

attempt to increase airflow

48
Q

if a pt is in restraints, what might decreased struggling movements indicate

A

decreased LOC

ABSN (171 decks)

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