Anger, Hostility, and Aggression Flashcards
Anger
- a feeling that everyone experiences
- important to recognize anger, express, and manage angry feelings in a positive manner
- assertive communication
- practice your “I” statements
anger that is expressed inappropriately or suppressed can lead to hostility or aggression
Hostility
emotion expressed through:
- verbal abuse
- lack of cooperation
- violation of rules or norms
- threatening behavior
behavior intending to intimidate or cause emotional harm
Physical Aggression
-behavior that is meant to harm, punish, or force into compliance another person
person attacks or injures another person or destroys property
Catharsis
means for release of anger
ex) hitting a punching bag, screaming into pillow
Anger/Hostility and Medical Complications
associated with CAD and HTN
Defense w/ Anger/Aggression
- acting out: behavioral expression of emotions
- person deals w/ emotional conflicts through actions rather than reflection or feelings
common in children and adolescence
Aggression: Etiology
Neurobiologic theories:
- low serotonin
- increased dopamine and norepinephrine
- damage to limbic system
Psychosocial theories:
- toddlers = tantrums (expected development)
- growth and develop impulse control
- dysfunctional parenting and inconsistent response to behaviors = may result in more impulsivity, decreased frustration tolerance
Stages of Aggression
triggering phase escalation phase crisis phase recovery phase postcrisis phase
Triggering Phase
incident that initiates the aggressive response
assessment:
- subtle change in behavior
- increased irritability
- pacing/restlessness
Escalation Phase
escalating behavior that is moving toward loss of control
intervention: show of force (staff will control the situation if the client cannot)
assessment:
- flushed face
- punching fists
- loss of ability to solve the problem clearly
Intervention during first two phases:
prevent the behavior from becoming aggressive (intervene early)
Crisis Phase
client becomes physically aggressive
loss of ability to:
- perceive events accurately
- express feelings appropriately
- solve problems
- control behavior
intervention: safety! security, seclusion, restraints (think least restrictive intervention first, and here we need safety)
assessment:
- breaking things
- fighting/punching
- yelling/screaming
Recovery Phase
the client regains physical and emotional control
assessment:
- lowering voice
- deceased muscle tension
- can communicate better
intervention:
-help client relax/get some sleep
Postcrisis Phase
client attempts reconciliation w/ others and returns to previous level of functioning
assessment:
- show of remorse
- crying
- becoming upset upon reflection of the incident
intervention:
- remove from seclusion/restraints
- give feedback on behavior
- give education on how to handle situation better (expression of emotions)
Debriefing
occurs especially after crisis phase occurs
documentation of incident, nursing interventions implemented
discuss event w/ coworkers and evaluate effectiveness of nursing interventions and what could have been done differently
Prevention
removing anything from you that could be used as a weapon or to hurt you
check chart and assess for hx of violence
most important factor in assessing a pt’s risk for violence is a hx of violence
General Assessment Findings of Anger/Aggression
- pacing/restlessness
- intense eye contact or no eye contact
- facial expression of frowning or grimacing
- clenched fists
- rapid breating
- appearing tense
- loud rapid speech
Management of the Environment
- management of milieu
- frequent rounding
- identifying early warning signs
- group activities, card games and other informal activities help engage the client
- notify supervisors of concerns and report incidences immediately
Nursing Awareness
- be alert to changes in the milieu
- note exits and important phone numbers
- dress w/ safety in mind
- confusion, loud noise, and crowding may increase stress levels
- meal times, shift changes can also be higher risk times because it’s usually more chaotic times on unit and there also may be decreased presence of staff on unit during those times
Nursing Care
- provide safe environment
- follow policy
- assess for triggers
- use least restrictive intervention first
Nursing Approach
- calm, non-threatening eye contact, smile
- listen
- respect personal space
- avoid laughing inappropriately
- hands visible and relaxed
- don’t approach alone
General Interventions
- exercise (walking)
- mindfulness
- assertive communication
- CBT
Meds
- haloperidol + lorazepam
- olanzapine
- mood stabilizers (valproic acid) - depending on underlying or comorbid mental health disorder
- benzodiazepines
Special Considerations
be mindful of language barriers and utilize interpreter services to decrease misunderstandings
-not being able to understand or communicate can increase stress and risk
