Unit 10 Anger Aggression and Violence Chapter 27 Flashcards
What is Anger
Anger is an emotional response to frustration of desires, a threat to one’s needs (emotional or physical), or a challenge.
What is aggression
Aggression is an action or behavior that results in a verbal or physical attack.
Aggression is an action or behavior that results in a verbal or physical attack. Aggression tends to be used synonymously with violence. However, aggression is not always inappropriate and is sometimes necessary for self-protection.
What is violence
Violence involves intentional use of force that results in or has the potential to result in injury to the other person.
Which of the following actions is a predictor of violence
A. pacing down the halls
B. talkativeness
C. avoidance of eye contact
D.isolation
A. pacing down the halls
Predictors of Violence
Hyperactivity
-physical symptoms (muscle tension, pacing, silence, jaw clenching),
-Verbally abusive,
- intense eye contact
Predictors of violence
Continual assessment – Recognize signs of increased anxiety/agitation
Signs and symptoms that usually (but not always) precede violence:
* Hyperactivity: most important predictor of imminent violence (e.g., pacing,
restlessness)
* Increasing anxiety and tension: clenched jaw or fist, rigid posture, fixed or
tense facial expression, mumbling to self (patient may have shortness of
breath, sweating, and rapid pulse)
* Verbal abuse: profanity, argumentativeness
* Loud voice, change of pitch; or very soft voice, forcing others to strain to
hear
* Stone silence
* Intense eye contact or avoidance of eye contact
* Recent acts of violence, including property violence
* Alcohol or drug intoxication
* Possession of a weapon or object that may be used as a weapon (e.g., fork,
knife, rock)
* Isolation that is uncharacteristic
* Milieu characteristics conducive to violence:
* Overcrowding
* Staff inexperience
* Provocative or controlling staff
* Poor limit setting
* Arbitrary revocation of privileges
Environment that increase risk of violence
Environment that increase risk
– Staff inexperience,
-overcrowding,
-poor limit setting
What is Trauma Informed Care
Trauma-informed care is an older concept of providing care that has recently been reintroduced. It is based on the notion that disruptive patients often have histories that include violence and victimization.
Trauma-informed care focuses on the patient’s past experiences of violence or trauma and on the role these experiences currently play in their lives.
Nursing Interventions to decrease agitated patient
Identify increased anxiety, behaviors that indicate possible violence and
intervene
Approach patient in a controlled nonthreatening and caring manner
If the situation progresses, remember each level of anxiety has a specific approach
Staff safety
Avoid wearing dangling earrings, necklaces and scarves
Enough staff?
Be familiar with the layout of the area
Do not stand directly in front of the patient of in front of the doorway
Provide feedback and avoid confrontation
What is the amount of distance you should keep away from a client at risk for violence
Allow the patient enough space so that you are perceived as less of a threat.
Always stay approximately 1 foot farther than the patient can reach with arms or legs.
Side stance
More than arms
length from patient reach
Be sure you have left yourself an escape route if necessary; that is, make sure that the patient is not between you and the door.
When speaking to an agitated client , what is the nurses first intervention
Pay close attention to the environment. Choose a quiet place to talk to the patient but one that is visible to staff. This is most beneficial in helping a patient regain control. Staff should know you are working with the patient, keep an eye on the interaction, and be prepared to intervene if the situation escalates.
De-escalation Techniques
- Maintain the patient’s self-esteem and dignity
- Maintain calmness (your own and the patient’s)
- Assess the patient and the situation
- Identify stressors and stress indicators
- Respond as early as possible
- Use a calm clear tone of voice
- Invest time
- Remain honest
- Determine what the patient considers to be needed
- Identify goals
- Avoid invading personal space; in times of high anxiety, personal space
increases - Avoid arguing
- Give several clear options
- Use genuineness and empathy
- Be assertive (not aggressive)
- Do not take chances; maintain personal safety
Should restraints be ordered PRN
A. yes
B. no
B. no
Pharmacological interventions
Antianxiety meds
Antipsychotics
6 Ways to ensure Staff safety
Avoid wearing dangling earrings, necklaces, and scarves in acute care environments. The patient may become focused
on these and grab at them, causing serious injury.
2. Ensure that there is enough staff for backup. Only one per- son should talk to the patient, but staff need to maintain an
unobtrusive presence in case the situation escalates.
3. Always know the layout of the area. Correct placement of furniture and elimination of obstacles or hazards are import- ant to prevent injury if the patient requires physical interven-
tions.
4. Do not stand directly in front of the patient or in front of the
doorway. The patient may consider this position as confrontational. It is better to stand off to the side and encourage the patient to have a seat.
5. If a patient’s behavior begins to escalate, provide feedback: “You seem to be very upset.” Such an observation allows exploration of the patient’s feelings and may lead to deescala- tion of the situation.
6. Avoid confrontation with the patient, either through verbal means or through a “show of support” with security guards. Verbal confrontation and discussion of the incident must occur when the patient is calm. A show of force by security guards may serve to escalate the patient’s behavior. Security personnel are better kept in the background until they are needed to assist.
Are seclusions and restraints used as a last resort
A. Yes
B. no
A. Yes
Seclusion and Restraint – LAST RESORT
Least restrictive - traumatic
Never for convenience of staff
Never as punishment
Observation
Documentation
