anger, aggression, violence w1 Flashcards
aggression
Anger
violence
________ - Normal emotional response to frustration of desires, a threat to someones needs, or a challenge that varies in intensity from mild irritation to intense fury/rage
________ - an action or behavior that results in a verbal or physical attack
______ - An objectionable act that involves intentional use of force that results in or has the potential to result in injury to another individual
Anger - Normal emotional response to frustration of desires, a threat to someones needs, or a challenge that varies in intensity from mild irritation to intense fury/rage
Aggression - an action or behavior that results in a verbal or physical attack
Violence - An objectionable act that involves intentional use of force that results in or has the potential to result in injury to another individual
restraint
Critical incident debriefing
seclusion
______ - Immediate and mandatory debriefing for staff and pt who took part/witnessed the seclusion/restraint episode
_______ - manual method, physical or mechanical devise, material/equipment that immobilized or reduces the ability of a patient to move body freely
______ - involuntary confinement of a patient alone in a room or area from which the patient is physically prevented from leaving
Critical incident debriefing - Immediate and mandatory debriefing for staff and pt who took part/witnessed the seclusion/restraint episode
Restraint - manual method, physical or mechanical devise, material/equipment that immobilized or reduces the ability of a patient to move body freel
Seclusion - involuntary confinement of a patient alone in a room or area from which the patient is physically prevented from leaving
_______
Normal emotional response to frustration of desires, a threat to someones needs, or a challenge that varies in intensity from mild irritation to intense fury/rage
- Normal human emotion
- when handled appropriately and expressed assertively, can provide individual with a positive force to solve problems and make decisions concerning life situations
- problem when it is not handle appropriately and it is expressed aggressively
- is capable of being under personal control
Anger
what does ______ look like:
- irritability
- frowning or grimacing
- red face
- pacing
- fidgeting or twisting of hands clenching and unclenching of fists
- speech changes - increased in rate and volume, slowed, or silence
- making increased demands
anger
feelings that may precipitate ____:
- anxiety
- discounted
- embarrassed
- frightened
- fear
- humiliated
- hurt
- ignored
- inadequate
- insecure
- unheard
- out of control of the situation
- rejected
- threatened
- tired
- vulnerable
anger
situations that may precipitate _______:
- withdrawal/substance abuse or addictions
- diagnosed by psychiatric illness
- internal stimuli – auditory hallucinations
- attention-seeking
- sleep deprivation
- pain
- stress
- past trauma
- loss of personal power
- difference in expectations or goals
- difference in knowledge
- poor communication
- inaccurate or incomplete information
- environment – too hot, too loud, etc.
anger
_________
an action or behavior that results in a verbal or physical attack
- tends to be used with violence
- behavior is intended to threaten or injure the victims security or self esteem
- can cause damage with words or strikes to body (fists, kicks, weapons) but it always is designed to punish
- not always inappropriate, sometimes necessary for self-protection
aggression
_________
An objectionable act that involves intentional use of force that results in or has the potential to result in injury to another individual
Violence
Warning signs of ________:
- hyperactivity (most important predictor) – pacing, restlessness
- increasing anxiety and tension – clenched jaw or fist, rigid posture, fixed or tensed facial expression, mumbling to self
- speech changes – rate, rhythm or volume, or silence
- verbal abuse – profanity, argumentativeness
- intense eye contact or avoidance of eye contact
- recent acts of violence
- possession of a weapon
- isolation that is uncharacteristic
violence
milieu characteristics conducive to _______:
- environment – too hot, too loud, etc.
- overcrowding
- inexperienced staff
- controlling staff
- poor limit setting
- revocation of privileges
violence
patient assessment: general risk identification includes assessing for -
- history of violence – best predictor of future violence
- pts who are delusional, hyperactive, impulsive, irritable, or non-adherence to medication - higher risk for violence
- aggression by individuals occurs most often in the context of limit setting by the nurse – asking pt to do/not do something
- history of limited coping skills, lack of assertiveness, use of intimidation – higher risk for violence
- agitation, restlessness, escalating anxiety
- resistance to suggested treatment
- didn’t come willingly
- history of drug or alcohol misuse
- cognitive changes (delirium, psychosis, hallucinations, etc.) that may cause the person to misinterpret the environment or staff care activities
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self-assessment
- nurses must be self-aware of strengths, needs, concerns, and vulnerability
- if not nursing interventions may be impulsive or emotion based
- nurse must be aware of words, tone of voice, non-verbal communication (body posture and facial expression)
staff safety
- avoid dangle items
- know layout
- stand to the side of pt and encourage pt to sit
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A.A.V. interventions
- begin interventions prior to any signs of escalation
- non-threatening, non-directive interactions will help in developing a therapeutic relationship
- approach patient in a controlled, non-threatening, caring manner
- allow space (1 foot further than the patient can reach) – perceived as less of a threat
- ensure escape route
- do not take it personally or respond in kind if pt invades space or is verbally abusive
- speak slowly, short sentences, low and calm voice
- open ended statements and questions
- identify what is behind the angry feelings and behaviors
- encourage pt to assume responsibility for choices made
- talk to the pt in a quiet and visible place
- avoid medical jargon
0
pharmacological interventions
- PRN meds
- Long term treatment of A/A/V is based on treating the underlying psychiatric disorder
0
de-escalation techniques
- early response
- assess pt and situation
- identify stressors
- identify pt needs
- stay calm
- use calm clear tone of voice
- be genuine and empathetic
- be assertive – not aggressive
- avoid arguing
- give several clear options
- invest time
- be honest
- maintain pt self-esteem and dignity
- avoid invading personal space
- maintain personal safety
0
patient defensiveness: loss of rationality
- pt asking challenging questions
- pt in your personal space
- refusing your requests
- releasing – throwing things (not at you), banging fists, sighing loudly
nurse response
- isolate the interaction – move the pt, others, allow yourself and exit
- reduce enviro stimulation
- speak clear, slow, few words
- non-verbal communication
- firm, empathy
- allow releasing as long as its not threatening
patient intimidation/acting out - when angry expressions turns to hostility and abuse or aggression (any activity that is meant to cause physical harm)
- may begin as accusations, comments about competence, and irrelevant personal remarks
danger signs:
- persistent swearing
- sexist or racist comments
- personal or specific threats of harm
- intimidating comments
- terroristic threats
- any physical behavior directed at a person
nurse response
- call for help
- protect self
- verbal intervention
o control non verbal communication
o short sentences
o don’t agree just to agree
o explain aggression will not achieve desired goal – if person is still rational
0
__________
decrease in energy, rationality returns, reachable teachable moments
staff interventions
- therapeutic rapport
- revise care plan
tension reduction
________ – involuntary confinement of a patient alone in a room or area from which the patient is physically prevented from leaving
- never punitive
- goal – safety for pt and others
- only used for the management of violent or self-destructive behavior that puts others safety at risk
_________ – manual method, physical or mechanical devise, material/equipment that immobilized or reduces the ability of a patient to move body freely
- never restrain in prone position
- increased danger in child restraint
seclusion
restraint
seclusion and restraint
- last resort
- pt is danger to self or others
- less restrictive interventions have been ineffective
- modification to care plan
- safe and appropriate techniques used
contraindications
- unstable medical and psychiatric conditions
- COPD
- Spinal injury
- Seizure
- Pregnancy
- Delirium or dementia
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