Anger, Hostility and Aggression (Exam 3) Flashcards
If anger is handled appropriately, what is the positive effects of it?
Handled appropriately, a positive force for resolving conflicts, solving problems, making decisions
Hostility
Verbal aggression
How is hostility expressed?
Expressed through verbal abuse, lack of cooperation, violation of rules or norms, threatening behavior
When would a person express hostility?
May be expressed when a person feels threatened or powerless
Physical aggression
attack on or injury to another person or destruction of property
What is physical aggression meant to do?
Meant to harm or punish another person or force into compliance
Where are common places of aggression?
Nursing homes- pts with dementia there
When someone is hostile and aggressive, when should you intervene?
Intervene earlier= less of a meltdown
What is a not healthy response to anger?
Not healthy to deny or try to eliminate anger
Inappropriate expression of anger can lead to:
Inappropriate expression can lead to hostility/aggression.
Phases of Hostility and Aggression
Trigger
Escalation
Crisis
Recovery
Postcrisis
When assessing patients for anger, hostility and aggression, what should you assess for in the individual client?
History of violent or aggressive behavior in the past
How client handles anger
Beliefs about anger
When assessing pts for hostility and aggression, what should you be aware of in the psychiatric environment/unit milieu?
Be aware of factors influencing aggression in psychiatric environment/unit milieu
Why should you assess a patient’s behavior?
To determine what phase they are in of the aggression cycle.
The Nursing Process: Data analysis of anger, hostility and aggression
Risk for other-directed violence
Ineffective coping
The Nursing Process: Outcome identification- Client will
Not harm self or threaten others
Refrain from intimidating/frightening behaviors
Describe feelings and concerns without aggression
Comply with treatment
The Nursing Process: Interventions - Early intervention
Most effective and least restrictive when implemented early in the aggression cycle
The Nursing Process: Interventions - Managing the environment
Planned activities
Scheduling one-to-one interactions
Offer opportunity for problem-solving or conflict resolution
Consider safety of other patients
The Nursing Process: Interventions in the triggering phase
Approach in a nonthreatening, calm manner
Convey empathy
Encourage verbal expression of angry feelings
Use clear, simple, short statements
Allow client time for self-expression
Suggest client go to a quieter area
Offer PRN medications if ordered
Suggest physical activity, such as walking
The Nursing Process: Interventions during the Escalation Phase
Take control
Provide directions in a firm, calm voice
Direct client to time-out in quiet room or area
Communicate that aggressive behavior is not acceptable
Offer medication if refused in triggering phase
Show of force
Managing Aggressive Behavior during the crisis phase
Take charge of situation for safety
Restraint
In order for restraints to be used, what must be done?
Only staff with training should participate in restraint.
Four to six trained staff members are needed.
Inform client that behavior is out of control and staff is taking measures for safety.
Management of aggressive behavior: recovery phase
Talk about situation or trigger
Help client relax or sleep
Help client explore alternatives to aggressive behavior
Assess and document any injuries
Debrief staff
Encourage other clients to talk about feelings
Management of aggressive behavior: postcrisis phase
Remove patient from restraint or seclusion as soon as criteria met
Calmly discuss behavior (no lecturing or chastising)
Give client feedback for regaining control
Reintegrate client as soon as he or she is able to participate
When is care of pt with anger, hostility and aggression most effective?
Care is most effective when anger defused in an earlier stage.
What is the goal of the nurse for angry, hostile, aggressive clients?
Goal is to teach angry, hostile, potentially aggressive clients to express feelings verbally and safely without threats or harm to others or destruction of property.
What are overt actions of workplace hostility?
Overt actions: verbal outbursts, physical threats
What are passive activities of workplace hostility?
Passive activities: refusing to perform assigned tasks, uncooperative attitude
What is workplace hostility?
Occurrence of disruptive and intimidating behaviors
includes workplace bullying
New standards of leadership for workplace hostility
Code of conduct defining acceptable and inappropriate, unacceptable behaviors
Process for managing disruptive/unacceptable behavior
Education on expected professional behavior
Zero tolerance = all are held accountable
Self-Awareness Issues
Be aware of own management of anger.
Practice and gain experience in restraint/seclusion before using.
Be calm, nonjudgmental, and nonpunitive.
Learn from watching experienced nurses to deal with hostile or aggressive clients.
