Chapter 11 Anger, Hostility, & Violence Flashcards
Discuss anger, hostility, and aggression. Describe psychiatric disorders that may be associated with an increased risk of hostility and physical aggression in clients. Describe the signs, symptoms, and behaviors associated with the five phases of aggression. Discuss appropriate nursing actions for the client during the five phases of aggression. Describe important issues for nurses to be aware of when working with angry, hostile, or aggressive clients.
Anger
A normal human emotion, is a strong, uncomfortable, emotional response to a real or perceived provocation
Results when a person is frustrated, hurt, or afraid
Can be constructive or destructive
Constructive Anger
If there is an unfair or wrong situation or self-defense
Destructive Anger
When denied, suppressed, or expressed inappropriately
Increases risk of health problems (e.g., HTN, ulcers, CAD
Effects of Anger When Handled Appropriately & Expressed Assertively
Can be a positive force that helps a person resolve conflicts, solve problems, and make decisions.
Anger energizes the body physically for self-defense when needed by activating the “fight-or-flight” response mechanisms of the SNS
Effects of Anger When Handled Inappropriately or Suppressed
Can cause physical or emotional problems or interfere w/relationships
Hostility
AKA Verbal Aggression
An emotion expressed through verbal abuse, lack of cooperation, violation of rules or norms, or threatening behavior
May express hostility when they feel threatened or powerless
What is the intention behind hostility?
Intended to intimidate or cause emotional harm to another, and it can lead to physical aggression
Physical Aggression
Behavior in which a person attacks or injures another person or destroys property
What is the intention behind physical aggression?
Both verbal and physical aggression are meant to harm or punish another person or to force someone into compliance
Some clients with psychiatric disorders display hostile or physically aggressive behavior that represents a challenge to nurses and other staff members.
(T/F) True or False: Anger is a negative feeling and should be repressed.
FALSE!!
Anger or angry feelings are not bad or wrong. It is not healthy to deny or try to eliminate ever feeling angry. It is essential for good health to recognize, express, and manage angry feelings in a positive manner.
When does anger become negative?
When the person denies it, suppresses it, or expresses it inappropriately
- A person may deny or suppress (i.e., hold in) angry feelings if they are uncomfortable expressing anger.
Possible consequences are physical problems such as:
- Migraine headaches
- Ulcers,
- CAD
Emotional problems such as depression and low self-esteem.
Assertive Communication
Uses “I” statements that express feelings and are specific to the situation
Ex) “I feel angry when you interrupt me,”
Ex) “I am angry that you changed the work schedule without talking to me.”
This allows appropriate expression of anger and can lead to productive problem-solving discussions and reduced anger
Catharsis
Activities that are supposed to provide a release for strong feelings such as anger or rage
Can increase instead of alleviate angry feelings
CONTRAINDICATION for angry patients
Activities that are non-violent tend to be more effective:
- Walking
- Drawing
- Talking w/ another person
Example of Catharsis
Hitting a punching bag or yelling
Cognitive Behavioral Techniques (CBT) to Alleviate Anger
Distraction, problem-solving, reframing one’s perspective
High hostility and anger are associated w/…
…increased risk of CAD & HTN
Hostility can lead to angry outbursts that are NOT effective for anger expression
Simply suppressing or attempting to ignore angry feelings may adversely affect control of hypertension
Controlling one’s temper or managing anger effectively should not be confused with suppressing angry feelings
Anger-related personality traits and social inhibition are associated with the presence and severity of coronary artery disease
Anger Suppression in Women
Anger suppression is more common in women than men
Women have been socialized to maintain and enhance relationships with others and to avoid the expression of the so-called negative or unfeminine emotions such as anger
Often results when:
- People deny them power or resources
- Treat them unjustly
- Behave irresponsibly toward them
School-age girls report experiences of disrespect, dismissal, and denial of the right to express anger
Offenders are usually their closest intimates
Manifestations of anger suppression through somatic complaints and psychological problems are more common among women than men
Hostile & aggressive behavior can be…
…sudden & unexpected
What are the stages of an aggressive incident?
1) Triggering Phase
2) Escalation Phase
3) Crisis Phase
4) Recovery Phase
5) Postcrisis Phase
Triggering Phase
An incident or situation that initiates an aggressive response
Signs, Symptoms, & Behaviors
- Restlessness
- Anxiety
- Irritability
- Pacing
- Muscle tension
- Rapid breathing
- Perspiration
- Loud voice
- Anger
Escalation Phase
The client’s responses represent escalating behaviors that indicate movement toward a loss of control.
Signs, Symptoms, & Behaviors
- Pale or flushed face
- Yelling, swearing
- Agitation
- Threatening, demanding
- Clenched fists, threatening gestures
- Hostility
- Loss of ability to solve the problem or think clearly
