Caring for Pts with Anger and Aggression

Question 1

types of trauma

Answer 1

1. single incident trauma
2. complex or repetitive trauma
3. developmental trauma (Toxic stress)
4. intergenerational trauma
5. historical trauma

Question 2

single incident trauma

Answer 2

r/t an unexpected and overwhelming event such as an accident, natural disaster, a single episode of abuse or assault, sudden loss, or witnessing violence

Question 3

complex or repetitive trauma

Answer 3

r/t ongoing abuse, domestic violence, war, ongoing betrayal, often involving being trapped emotionally and/or physically

Question 4

developmental trauma

Answer 4

• results from exposure to early ongoing or repetitive trauma
• often occurs within the child’s care giving system and interferes with healthy attachment and development

Question 5

intergenerational trauma

Answer 5

• psychological or emotional effects that can be experienced by people who live with trauma survivors
• Coping and adaptation patterns developed in response to trauma can be passed from one generation to the next

Question 6

historical trauma

Answer 6

• cumulative emotional and psychological wounding over the lifespan and across generations emanating from massive group trauma.
• These collective traumas are inflicted by a subjugating, dominant population
• Intergenerational trauma is an aspect of historical trauma

Question 7

examples of historical trauma

Answer 7

genocide, colonialism (for example, Indian hospitals and residential schools), slavery and war

Question 8

toxic stress

Answer 8

• is severe and prolonged inthe absence of the buffering protection of supportive relationships
• Sources caninclude things like physical or emotional abuse, chronic neglect, severematernal depression, parental addiction, or family violence
• disrupts brain architecture and leads to lifelong problems in learning,behaviour, and both physical and mental health

Question 9

allostatic load

Answer 9

• when stress hormones remain elevated overlong periods of time, they produce “wear and tear” on the brain and certain biological systems
• isassociated with vulnerability to health problems later in life

Question 10

how can we reduce exposure of toxic stress at children?

Answer 10

development of supportive environments

Question 11

how can safety and trustworthiness be established among clients?

Answer 11

welcoming intake procedures; adapting the physical space to be less threatening; providing clear information about the programming; ensuring informed consent; creating crisis plans; demonstrating predictable expectations; and scheduling appointments consistently

Question 12

what are key aspects of implementation of a trauma-informed approach?

Answer 12

safety measures and changes in treatment culture

Question 13

what are key elements of trauma-informed services?

Answer 13

staff education, clinical supervision, and policies and activities that support staff self-care

Question 14

anger

Answer 14

• affective state experienced as the motivation to act in ways to warn, intimidate or attack those who are perceived as challenging or threatening
• part of the f/f response to help resolve a situation

Question 15

what is the difference between anger and aggression?

Answer 15

anger = feeling 
aggression = behaviour

Question 16

similarity between anger and aggression?

Answer 16

both often arise from the person’s belief that their view of a situation is the only correct one

Question 17

when does anger occur?

Answer 17

when there is a threat, delay, thwarting of a goal or conflict between goals

Question 18

behavioural expressions of anger

Answer 18

• suspicious behaviour
• verbal hostility
• physical violence

Question 19

suspicious behaviour

Answer 19

hypervigilance to external cues; attends more to cures that fit with current thinking patterns

Question 20

verbal hostility

Answer 20

verbal comments that are sarcastic or blaming and often expressed with the intent to hurt others; may be used as a means of getting attention or inviting others to take action

Question 21

physical violence

Answer 21

Act of striking out, throwing an object, pushing etc. that appears to be intended to cause harm to a person or object

Question 22

violence

Answer 22

physical assault, verbal assault, threats, sexual assault, brandishing a weapon, destroying property, etc

Question 23

types of violence

Answer 23

physical violence 
verbal violence (can have subcategories ie. sexual violence can be verbal or physical)

Question 24

etiology of violence (underlying stressors/factors)

Answer 24

Perceived disrespect
The three D’s dementia, delirium, depression
Confusion or misinterpretation of stimuli
Pain
Incontinence
Constipation
Dyspnea
Substance withdrawal

Question 25

cognitive neuroassociation model

Answer 25

brain associates the current experience of physiologic sensations with memories, ideas and previously experienced reactions (response may be intensified or suppressed)

Question 26

physiologic signs for potential violence

Answer 26

• flushing
• pallor (freeze response)
• sweating
• gooseflesh
• hardened muscle tone
• hyperventilation
• tachycardia, HTN (difficult to assess for)

Question 27

what do you want to know when someone is exhibiting precursors to violence?

Answer 27

is the person in an emotional crisis or behaviour emergency?

Question 28

emotional crisis

Answer 28

- coping skills are challenged 
Staring - prolonged or avoids eye contact
Tone of voice - rude, sarcastic, upset
Anxiety - jittery, crying, flushed face
Mumbling - muttering, slurred speech
Pace - inc activity

Question 29

behavioural emergency

Answer 29

• imminent danger
  Personal space invaded
  Activity level increases and intensifies
  Verbal violence and threats

Question 30

limit setting

Answer 30

• acknowledges a person’s concerns and provides a structure that helps them to contain their behaviour
• uses validation to reduce emotional intensity so that an escalating person is able to follow a simple request
• provides an individual with options which allows for face-saving choices

Question 31

steps for limit setting

Answer 31

1. Validate their feelings
2. Identify the problematic behaviour
3. Explain why it is problematic. Be specific and focus on the behaviour, not the person.
4. Give choices and consequences – give the person choices and outline the consequence of each choice.
5. Give the person a time frame and follow through on the consequences. Avoid power struggles. You can’t force or order someone to do something. You can only tell them what YOU can and will do.

• Explain why behaviour is problematic/unsafe; use clear short sentences to explain actions; offer full attention and allow pt to express concerns

Question 32

environmental limit setting and PRNs

Answer 32

includes limiting visitors; reduce stimulation; room search; removing dangerous items
PRNs include nicotine replacement; CIWA

Question 33

verbal de-escalation

Answer 33

• Communicate respectfully and clearly
• Use a trauma-informed approach
• Focus on the person and find out what the need. Nod and make eye contact
• Avoid taking things personally, blame, and power struggles
• Avoid “YOU” statements, and “calm down,” “relax,” “I understand”
• Use PVPC Verbal de-escalation strategies

Question 34

compliance check

Answer 34

If you suspect the patient is escalating to a behavioral emergency, you do a compliance checks to assess, such as “can you have a seat while I…?” If they do not cooperate they are likely in or headed toward a behavioral emergency

Question 35

VIHA restraint policy

Answer 35

• Assess and address causes of unsafe behaviour
• Care planning
• Seek consent
• Only VIHA-approved physical restraints to be used
• Monitoring and reassessment
• Documentation and communication