Managing Anger & Aggression: Exam 2

Question 1

Although we would like to assure ourselves that psychiatric patients do not pose safety risks, the truth is that physical violence does occur in psychiatric units. Iozzino et al. (2015) looked at a pool of data that included nearly 24,000 psychiatric inpatients. They found that ____% of these clients committed an act of violence. This lesson will discuss ways to recognize and mitigate these risks.

Answer 1

17%

Question 2

Anger results when we sense a loss of control or attack on our personhood. Anger is healthy when handled appropriately and expressed assertively. Anger is unhealthy when it turns into ____________________ (i.e., behaviors meant to threaten or injure another person). (Ex: impatient, being treated less than others)

Answer 2

Aggression

Question 3

Easier to prevent the problem vs. being the problem. Recognize the aggression before it occurs to prevent a bad outcome.

Answer 3

Predisposing Factors

Question 4

What makes some clients more prone to aggressive behaviors?

Answer 4

Biological/neurological factors
Social/cultural factors
Psychological factors Environmental factors

Question 5

Anti-social personality disorder has a strong _____ basis. What factor does this fall under?

Answer 5

Genetic
Biological/neurological factor

Question 6

Types of social/cultural factors:

Answer 6

Role models
Positive rewards
Culture

Question 7

Seeing aggression modeled in the home (e.g., having an abusive parent), community, or popular media (movies and video games) can teach children to act aggressively. (ex: childhood seeing an aggressive parent, might become the same as the parent… a kid doing something that they know would make the parent angry.)

Answer 7

Role models

Question 8

Sometimes aggressive behaviors are reinforced by others. This can occur, for example, when parents yield to their children’s demands when they throw temper tantrums.

Answer 8

Positive rewards

Question 9

In many cultures, the expectation is that men can express __________, but other more vulnerable emotions should not be expressed (e.g., sadness, depression, fear, loneliness). Common in society, may cause anger. What social/cultural factor does this fall under?

Answer 9

Anger
Culture

Question 10

Maladaptive patterns of thinking can produce aggressive behaviors. Cognitive-behaviorists teach aggressive clients to restructure their thinking. What factor does this fall under?

Answer 10

Psychological factor

Question 11

Problems in the ____________ (e.g., overcrowding, staff inexperience, controlling staff, poor limit setting) can increase aggression. Non-structural environment that can lead to aggression. Problems in the ____________ (e.g., overcrowding, staff inexperience, controlling staff, poor limit setting) can increase aggression. What factor does this fall under?

Answer 11

Milieu
Environmental factor

Question 12

____________________ is the best intervention for managing aggression. We want to identify clients who are likely to become aggressive and intervene before the problem occurs. Warning signs: facial expressions, posture, breathing, closed fist, pacing, etc.

Answer 12

Prevention

Question 13

Assessing Risk for Violence:

Answer 13

History
Diagnosis
Red flags

Question 14

What is your client’s history? Have they committed acts of violence in the past? Increased aggression. What risk factor for violence is this?

Answer 14

History

Question 15

What psychiatric illnesses does your client have? Certain psychiatric illnesses increase a client’s risk of committing an act of violence (e.g., schizophrenia, major depression, bipolar disorder, substance use disorder, antisocial personality disorder, borderline personality disorder, and dementia). Increased aggression. What risk factor for violence is this?

Answer 15

Diagnosis

Question 16

Does your client have any prodromal behaviors (e.g., defiant affect, rigid posture, clenched fists and jaw, agitation, pacing, slamming or pounding, talking loudly and rapidly, using profanity, making threats)? These behaviors may indicate that a violent outburst is imminent. What risk factor for violence is this?

Answer 16

Red Flags

Question 17

A simple, helpful tool for assessing a client’s likelihood of acting violently. A score of two or more indicates a high likelihood of aggression within the next 24 hours (63% accuracy). Daily behavioral/mindset scoring sheet, aggression determination.

Answer 17

The Brøset Violence Checklist

Question 18

Actions that proceed aggression.

Answer 18

Prodromal

Question 19

De-Escalation techniques:

Answer 19

1. Use a __calm__, caring voice
2. Set __limits__ and identify consequences. (ex. not appropriate language being used by the patient.)
3. Tell the client you are concerned and would like to _understand_____ (e.g., “You seem
   upset, can you tell me what’s going on?”). Communicate with the patient about seeing anger and aggression ( aggression = loss of control and person-hood attacked)
4. Seek to ___understand _______ what is behind the anger/aggression. Empathize with patient and understand why they are mad.
5. Reduce ___stimulation _________ and loud noise. (quite place)
6. Respect the client’s personal ___space_______. (“Anger = Distance x 2”)
7. Give the client ___options______ (e.g., time out, PRN medication, walk outdoors).
8. Attempt to redirect attention to a ____positive ____________ activity (e.g., eating a snack, soft
   music, sports/leisure activity).

Question 20

Nursing Intervention for anger/aggression:

Answer 20

● Remember, early detection/prevention is the best intervention.
● Prodromal behaviors are an emergent problem (i.e., they must not be ignored). Socially accepted can’t look away as a nurse, must respond! Ask what the problem is and respond to those behaviors (ex: suicidal patient)
● Set clear __limits__________, describe consequences, and always follow through.
● Avoid ____touching____________ clients that are angry or anxious.
● Keep a safe distance. (“Anger = Distance x 2”) Don’t want to be too far away because it will result in yelling and not consist of a regular conversation. Double space is someone is angry.
● Ensure no one is blocking the _exit/door_____________. You don’t want the patient and/or yourself blocking the door!
● Help the client find alternative ways of releasing tension (e.g., exercise, punching
bag) and expressing anger (e.g., notifying the staff of a concern).
● Ensure sufficient staff is present; call for help if necessary.
● Use the ___least_______ restrictive means possible. Offer the client a PRN medication, time
out, open seclusion, etc.
● Debrief after the incident (with staff and the client). Talk to the patient also about the incident to determine how they will handle it better in the future!