Caring for Pts with Anger and Aggression Flashcards
types of trauma
- single incident trauma
- complex or repetitive trauma
- developmental trauma (Toxic stress)
- intergenerational trauma
- historical trauma
single incident trauma
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
complex or repetitive trauma
r/t ongoing abuse, domestic violence, war, ongoing betrayal, often involving being trapped emotionally and/or physically
developmental trauma
- 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
intergenerational trauma
- 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
historical trauma
- 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
examples of historical trauma
genocide, colonialism (for example, Indian hospitals and residential schools), slavery and war
toxic stress
- 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
allostatic load
- 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
how can we reduce exposure of toxic stress at children?
development of supportive environments
how can safety and trustworthiness be established among clients?
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
what are key aspects of implementation of a trauma-informed approach?
safety measures and changes in treatment culture
what are key elements of trauma-informed services?
staff education, clinical supervision, and policies and activities that support staff self-care
anger
- 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
what is the difference between anger and aggression?
anger = feeling aggression = behaviour
similarity between anger and aggression?
both often arise from the person’s belief that their view of a situation is the only correct one
when does anger occur?
when there is a threat, delay, thwarting of a goal or conflict between goals
behavioural expressions of anger
- suspicious behaviour
- verbal hostility
- physical violence
suspicious behaviour
hypervigilance to external cues; attends more to cures that fit with current thinking patterns
verbal hostility
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
physical violence
Act of striking out, throwing an object, pushing etc. that appears to be intended to cause harm to a person or object
violence
physical assault, verbal assault, threats, sexual assault, brandishing a weapon, destroying property, etc
types of violence
physical violence verbal violence (can have subcategories ie. sexual violence can be verbal or physical)
etiology of violence (underlying stressors/factors)
Perceived disrespect The three D’s dementia, delirium, depression Confusion or misinterpretation of stimuli Pain Incontinence Constipation Dyspnea Substance withdrawal
cognitive neuroassociation model
brain associates the current experience of physiologic sensations with memories, ideas and previously experienced reactions (response may be intensified or suppressed)
physiologic signs for potential violence
- flushing
- pallor (freeze response)
- sweating
- gooseflesh
- hardened muscle tone
- hyperventilation
- tachycardia, HTN (difficult to assess for)
what do you want to know when someone is exhibiting precursors to violence?
is the person in an emotional crisis or behaviour emergency?
emotional crisis
- 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
behavioural emergency
- imminent danger
Personal space invaded
Activity level increases and intensifies
Verbal violence and threats
limit setting
- 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
steps for limit setting
- Validate their feelings
- Identify the problematic behaviour
- Explain why it is problematic. Be specific and focus on the behaviour, not the person.
- Give choices and consequences – give the person choices and outline the consequence of each choice.
- 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
environmental limit setting and PRNs
includes limiting visitors; reduce stimulation; room search; removing dangerous items
PRNs include nicotine replacement; CIWA
verbal de-escalation
- 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
compliance check
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
VIHA restraint policy
- 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
