Suicide, Agression, Anger Flashcards
An emotional state ranging in intensity from mild irrigation to intense fury and rage
The act of initiating hostilities, that arouses attack, and/or the disposition to use verbal to physical destructiveness addressed towards another
Anger
Agression
Workplace violence is most commonly found where?
ED’s, mental health units, waiting rooms, geriatric units
The event that happens just prior to the change in behavior. May be real or perceived.
Trigger
Aggression occurs most often in the context of limit seeing by the nurse. Remember tone and personal space.
Behavior change, when we first notice something is wrong.
Escalation
May include verbal acting out: raising voice, angrier tone, verbal threats, rude comments, etc
Patient loses impulse control
Physical acting out
Discharge of overpowering emotions that have built up
Discharge
What are some motor signals of escalation?
Pacing in an agitated way, continual movement, forceful movement. Advancing toward/retreating from staff in a deliberate manner. Clenching and releasing of fists.
What some speech signals of escalation?
Angry, loud, forceful speech. Inappropriate intensity or affect. Extremely quiet but pushed speech (speaking through teeth). Pressured speech (rapid, urgent).
Affect signals of escalation?
Nervous/upset appearance, with a change in pallor (reddened, dramatically pale face), clenched teeth, grimace, rapid or heavy breathing.
Paranoid stare: peculiar, unblinking look, raised upper and/or lower eyelids
What are milieu characteristics that are conducive to violence?
Loud, overcrowding, staff inexperience, authoritarian staff, poor limit setting, staff inconsistency.
Explain the assault cycle?
Trigger, anxiety behavior change, escalating phase, acting out verbally, physical acting out, tension reduction
What’s involved in verbal de-escalation?
Rule of 5’s (no more than five words, one syllable each), do not touch, give choices, clear limits, stand in non-confrontive way, body language (no finger-pointing, avoid steady eye contact)
The intentional act of killing oneself. Explain further?
Suicide. Ambivalence is usually present. Intervention makes the difference. Individual believes it will end the problem.
Having thoughts about committing suicide.
Ideation. Varies in intensity, refer to the C-SSRS.
Is there a plan? Do they intend to act on the ideation? What was their intent? Behavior, is there a past history of attempts?
What’s involved in a suicide assessment? C-SSRS
Columbia-Suicicde Severity Rating Scale
Risk, ideation, behavior, plan and lethality of plan, verbal clues, behavioral clues
What determines the lethality of a suicide plan?
Method, access, specificity, protective factors
What are some examples of myths about suicide?
People who talk about it don’t commit it, they only want attention. They only want to hurt themselves and not others. There is no way to help someone who really wants to kill themselves. Ironing verbal threats or challenging the person to carry out their plans will reduce the behavior.
What are some protective factors when it comes to suicide?
Social supports, active religion/faith, presence of dependent young children, ongoing supportive relationship with caregiver, absence of a mental disorder or substance abuse, living close to medical and mental resources, problem-solving and coping skills, restricted access to highly lethal methods
What may happen once the decision to kill themselves has been made?
Conflict and anxiety may cease and the person can appear calm and untroubled. Ambivalence is key. When the patient’s mood improves, they may still feel hopeless/helpless about their situation.
What is the priority nursing diagnosis for suicide?
Risk for suicide or potential for injury.
Others include ineffective coping, hopelessness, social isolation, spiritual distress, chronic low self-esteem, post-trauma syndrome, ineffective family coping
What are some examples of outcomes/goals when it comes to suicide?
Not harm self this shift. Verbalize suicidal ideation and discuss these with nursing staff. Verbalize a desire to livened 3 reasons for living. Identify 3 supporting persons outside the hospital whom they will call before acting on SI.
Interventions for suicide?
Communication, be aware of the times when the patient is at increased risk, ensure pt swallows all medications, no suicide contract, safety plan, encourage alternatives/coping skills, build self-esteem, follow-up psychotherapeutic interventions
What might survivors of suicide feel?
Massive guilt, disturbed self concept, impotent rage with guilt and blaming, search for meaning, denial. What if questions, have the need to go over and over the event, look for answers.
Superficial to moderate self harm?
Severe self harm?
Cutting, burning, scratching
Castration, amputation
