Suicide, Agression, Anger

Question 1

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

Answer 1

Anger

Agression

Question 2

Workplace violence is most commonly found where?

Answer 2

ED’s, mental health units, waiting rooms, geriatric units

Question 3

The event that happens just prior to the change in behavior. May be real or perceived.

Answer 3

Trigger

Aggression occurs most often in the context of limit seeing by the nurse. Remember tone and personal space.

Question 4

Behavior change, when we first notice something is wrong.

Answer 4

Escalation

May include verbal acting out: raising voice, angrier tone, verbal threats, rude comments, etc

Question 5

Patient loses impulse control

Answer 5

Physical acting out

Question 6

Discharge of overpowering emotions that have built up

Answer 6

Discharge

Question 7

What are some motor signals of escalation?

Answer 7

Pacing in an agitated way, continual movement, forceful movement. Advancing toward/retreating from staff in a deliberate manner. Clenching and releasing of fists.

Question 8

What some speech signals of escalation?

Answer 8

Angry, loud, forceful speech. Inappropriate intensity or affect. Extremely quiet but pushed speech (speaking through teeth). Pressured speech (rapid, urgent).

Question 9

Affect signals of escalation?

Answer 9

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

Question 10

What are milieu characteristics that are conducive to violence?

Answer 10

Loud, overcrowding, staff inexperience, authoritarian staff, poor limit setting, staff inconsistency.

Question 11

Explain the assault cycle?

Answer 11

Trigger, anxiety behavior change, escalating phase, acting out verbally, physical acting out, tension reduction

Question 12

What’s involved in verbal de-escalation?

Answer 12

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)

Question 13

The intentional act of killing oneself. Explain further?

Answer 13

Suicide. Ambivalence is usually present. Intervention makes the difference. Individual believes it will end the problem.

Question 14

Having thoughts about committing suicide.

Answer 14

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?

Question 15

What’s involved in a suicide assessment? C-SSRS

Answer 15

Columbia-Suicicde Severity Rating Scale

Risk, ideation, behavior, plan and lethality of plan, verbal clues, behavioral clues

Question 16

What determines the lethality of a suicide plan?

Answer 16

Method, access, specificity, protective factors

Question 17

What are some examples of myths about suicide?

Answer 17

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.

Question 18

What are some protective factors when it comes to suicide?

Answer 18

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

Question 19

What may happen once the decision to kill themselves has been made?

Answer 19

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.

Question 20

What is the priority nursing diagnosis for suicide?

Answer 20

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

Question 21

What are some examples of outcomes/goals when it comes to suicide?

Answer 21

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.

Question 22

Interventions for suicide?

Answer 22

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

Question 23

What might survivors of suicide feel?

Answer 23

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.

Question 24

Superficial to moderate self harm?

Severe self harm?

Answer 24

Cutting, burning, scratching

Castration, amputation

Question 25

What factors are associated with self mutilation?

Answer 25

Sexual/physical abuse, BPD, Meds, psychosis. Feelings of abandonment, anger, anxiety.

Question 26

Stages of self mutilation?

Answer 26

Precipitating event, intensification of feelings, attempts to cope, action, aftermath

Question 27

What’s involved in intervention in the physical acting out phase?

Answer 27

Make the area/situation safe. Show of force. Only the leader speaks. Breathe. Seclude/restrain to maintain safety.

Question 28

What’s involved in intervention in the tension reduction phase?

Answer 28

Re-establish rapport, help pt recognize triggers and escalating emotions. Teach alternatives to assaultive behavior, assist to acknowledge consequences of actions. Debriefing

Question 29

What topics of discussion need to be included in a debriefing after an intervention?

Answer 29

Pt behavior associated with the incident. Intervention techniques used by the staff. Effect of environmental factors.