Anger & Agression Flashcards
Primary accelerator of aggression
anger
verbalizes anger
swearing; verbal abuse
screaming, yelling
defiance, temper tantrum
sources of anger/aggression
Sarcasm, impatience, pouting, sulking
passive aggression
Verbal Aggression or Abuse
- repetitive pattern
- warning sign of assault and battery
- social norms influence degree of verbal abuse that is tolerated
Passive Aggressive
- express anger indirectly and undermine others
- deny anger and its source even when confronted
- frustrate others around them
Passivity
- turn anger inward
- might be unaware of underlying anger
- unable to say “no”
- believe others take advantage of them
Assertiveness
- positive way of expressing feelings
- respect rights of others and self
- use energy constructively
Common problems r/t aggression
- traumatic head injury
- damage to limbic, amygdala, or hippocampus
- Alzheimer’s
- alcohol and substance abuse/withdrawal
- nutritional deficiencies (thiamine and niacin)
- medication non-adherence
Model that looks at how person interacts with their environment
Social-psychological anger aggression model
Model that looks more at society (poverty, gangs, drugs)
Sociocultural anger aggression model
Triggering Phase of Assault Cycle
- stress producing event occurs initiating the stress response
- nonviolent anger
- present no danger to others
Escalation Phase of Assault Cycle
- responses represent escalating behaviors that indicate a movement towards the loss of control
- irrational; threatening anger
- loss of control impending
Crisis Phase of Assault Cycle
- period of emotion and physical crisis; loss of control occurs
- loss of control
- pt approaching an attack on the environment, self, other patients, staff
Recovery Phase of Assault Cycle
-period of cooling down; person slows down and returns to normal responses
Post-crisis Depression Phase of Assault Cycle
person attempts reconciliation with others; debriefing needs to occur with the pt
Primary symptom of this disorder is aggression
Intermittent Explosive Disorder
DSM-IV criteria for Intermittent Explosive Disorder
- several episodes of failure to resist aggressive impulse (leads to assaultive acts)
- degree of aggression expressed is grossly out of proportion to precipitating stressor
- aggressive episodes aren’t better accounted for by another disorder or effects of substance or medical condition
Prodromal sensations of Intermittent Explosive Disorders
- head pressure
- chest tightness
- echo sounds
Onset of Intermittent Explosive Disorder
childhood
How does nurse assess variables of aggression
- self assessment is critical
- consider angry behaviors as sign of communication (possible loss of control)
- nurses are ineffective if they withdrawal from hostile or demanding pt
What are some milieu elements that contribute to escalation of aggression
- excessive stimuli/noise with low ratio of nurses
- overcrowding/lack of sufficient space
- lack of resources for energy expenditure
- perceived lack of control/freedom
- lack of structured and unstructured diversional activities (exercise, movies, games, crafts)
- lack of quiet rooms and space
Likely times a patient will exhibit aggression
- change of shift
- mealtimes
- visiting hours, off unit, during change
- invasive procedures
- hospital admission (TDO)
Predisposing conditions to aggression
- severe pain
- confusion, malnutrition, infection
- med toxicity, liver/kidney insufficiency
- brain dysfunction, psychosis
- antisocial PD, borderline PD
Nursing Intervention of Triggering Phase
- calm, clear, simple communication
- walk toward pt while talking while lowering voice
- encourage ventilation of feelings, problem solving
- avoid challenging pt
- remind pt to stay in control (make good decisions)
- suggest time out in room
- PO anti-anxiety or anti-psychotic meds can be given
Nursing Intervention for Escalation Phase
- take charge
- maintain safe distance (not within swinging)
- state observation that pt is losing control
- administer prn med (IM if necessary)
- offer time out or voluntary seclusion
- staff on standby (show of support: more staff)
Nursing Intervention for Crisis Phase
- external control essential
- seclusion or restraint (follow protocols)
- state IM medication
Time Out
- decrease stimuli
- RBHC: cannot last longer than 30 min
- able to come and go as please
Seclusion
- CONTAINMENT in seclusion room (locked door)
- goals: prevent pt harming self or others, decrease stimuli, and increase intensive nursing care
- degrees vary and dependent on pt current status
- adults up to 4 hours and children up to 1 hour
Restraint
- order required
- 6-8 staff needed to safely control pt
- impose physical control, restraint
- pt placed in prone position with wrist and ankle restraints applied and secured to frame of bed
- administer IM med
Physician must evaluate pt within _______ for care and documentation
one hour
What do you assess on pt in restraint and how often
- q10min
- hydration
- elimination
- circulation (place one finger under restraint)
- passive ROM every 1-2 hours
Nursing Intervention for Recovery and Depression Phase
- provide support/reassurance that pt is not being punished while in seclusion
- allowed back in milieu ASAP
- document incident
- staff debriefing
Pt ready to be released from restraints when:
- show signs of self control
- up to 20min of calm behavior in adults and 5 min in children
- decreased anxiety and agitation
- stabilized mood
Trauma-Informed Care
- requires staff to ask ALL pt about any past traumatic events to determine how they may be affected if need to use behavioral interventions
- ask pt what helps calm them down
Staff Assault Victims
- debriefing and recovery may be complicated
- similar to being victim of crime
- loss of trust, sense of control, self-esteem
- PTSD may result
- supportive interventions needed
- nurse can press charges
