Anger, Hostility and Aggression (Exam 3)

Question 1

If anger is handled appropriately, what is the positive effects of it?

Answer 1

Handled appropriately, a positive force for resolving conflicts, solving problems, making decisions

Question 2

Hostility

Answer 2

Verbal aggression

Question 3

How is hostility expressed?

Answer 3

Expressed through verbal abuse, lack of cooperation, violation of rules or norms, threatening behavior

Question 4

When would a person express hostility?

Answer 4

May be expressed when a person feels threatened or powerless

Question 5

Physical aggression

Answer 5

attack on or injury to another person or destruction of property

Question 6

What is physical aggression meant to do?

Answer 6

Meant to harm or punish another person or force into compliance

Question 7

Where are common places of aggression?

Answer 7

Nursing homes- pts with dementia there

Question 8

When someone is hostile and aggressive, when should you intervene?

Answer 8

Intervene earlier= less of a meltdown

Question 9

What is a not healthy response to anger?

Answer 9

Not healthy to deny or try to eliminate anger

Question 10

Inappropriate expression of anger can lead to:

Answer 10

Inappropriate expression can lead to hostility/aggression.

Question 11

Phases of Hostility and Aggression

Answer 11

Trigger
Escalation
Crisis
Recovery
Postcrisis

Question 12

When assessing patients for anger, hostility and aggression, what should you assess for in the individual client?

Answer 12

History of violent or aggressive behavior in the past

How client handles anger

Beliefs about anger

Question 13

When assessing pts for hostility and aggression, what should you be aware of in the psychiatric environment/unit milieu?

Answer 13

Be aware of factors influencing aggression in psychiatric environment/unit milieu

Question 14

Why should you assess a patient’s behavior?

Answer 14

To determine what phase they are in of the aggression cycle.

Question 15

The Nursing Process: Data analysis of anger, hostility and aggression

Answer 15

Risk for other-directed violence

Ineffective coping

Question 16

The Nursing Process: Outcome identification- Client will

Answer 16

Not harm self or threaten others

Refrain from intimidating/frightening behaviors

Describe feelings and concerns without aggression

Comply with treatment

Question 17

The Nursing Process: Interventions - Early intervention

Answer 17

Most effective and least restrictive when implemented early in the aggression cycle

Question 18

The Nursing Process: Interventions - Managing the environment

Answer 18

Planned activities

Scheduling one-to-one interactions

Offer opportunity for problem-solving or conflict resolution

Consider safety of other patients

Question 19

The Nursing Process: Interventions in the triggering phase

Answer 19

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

Question 20

The Nursing Process: Interventions during the Escalation Phase

Answer 20

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

Question 21

Managing Aggressive Behavior during the crisis phase

Answer 21

Take charge of situation for safety

Restraint

Question 22

In order for restraints to be used, what must be done?

Answer 22

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.

Question 23

Management of aggressive behavior: recovery phase

Answer 23

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

Question 24

Management of aggressive behavior: postcrisis phase

Answer 24

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

Question 25

When is care of pt with anger, hostility and aggression most effective?

Answer 25

Care is most effective when anger defused in an earlier stage.

Question 26

What is the goal of the nurse for angry, hostile, aggressive clients?

Answer 26

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.

Question 27

What are overt actions of workplace hostility?

Answer 27

Overt actions: verbal outbursts, physical threats

Question 28

What are passive activities of workplace hostility?

Answer 28

Passive activities: refusing to perform assigned tasks, uncooperative attitude

Question 29

What is workplace hostility?

Answer 29

Occurrence of disruptive and intimidating behaviors

includes workplace bullying

Question 30

New standards of leadership for workplace hostility

Answer 30

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

Question 31

Self-Awareness Issues

Answer 31

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.