Week 3: Violent and aggressive behaviour Flashcards
What is the instinctive theory?
being attacked and naturally your instinct is to fight to save oneself (1920s Freud)
Bobo Doll Experiment
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What is the frustration/aggression theory?
Frustration/Aggression Theory- prevented from achieving a goal, frustration may turn to aggression (football fans when team start to lose) (Barker et al 1941)
What physiological factors can cause aggressive behaviour?
Physiological Factors- brain tumours, hormonal imbalance, altered brain chemistry organic brain injury
Study show frontal lobe damage persons are more likely to engage in impulsive acts of aggression
What are the two types of aggression?
Benign Aggression reactive response to protect ourselves from danger
Malignant Aggression results from a desire to be destructive in order to express an unhappiness (a failure to fulfill needs)
What is a Co-creationist perspective?
“violence is the product interactions between two agencies” (Patterson and Miller 2004).
Violence by service users requires staff participation if only by default
The interactions between the physical and social environments on service users can result in violence
E.g. You are delivering bad news to someone who is upset and they are pressing you for an answer. You decide to tell them in the middle of a busy ward. The situation escalates and staff come to help you but this appears to make the situation worse.
Focus on the Ws
Who- are you the best person, is there a relative you could talk to first to support, do you need a colleague
Where- low stimulus, quiet area, free from potential weapons
When- choose the time best for all (do not rush or feel you have to talk right here right now)
Why- have the reasoning and concise relevant information (choose how much information you need to give pre- conversation if possible)
What is de-escalation?
A range of strategic interpersonal interventions that can be used therapeutically in order to reduce heightened states of emotional and physiological arousal (Mott & Walton 2005)
Each situation should be regarded as being totally unique and there will be a complex interchange of verbal and non verbal dynamics that shape the outcome of the incident
Affective Model:
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The Process
“The process of de-escalation is about establishing rapport to gain the patient’s trust, minimizing restriction to protect their self esteem, appearing externally calm and self-aware in the face of aggressive behaviour, and intuitively identifying creative and flexible interventions that will reduce the need for aggression”.
Antecedent, recognition and developing skills
Staff and patient interactions continues to be identified as a frequent antecedent to assaults in psychiatric wards (Duxbury & Whittington 2005)
Developing de-escalation skills therefore critical to reducing violence
What characteristics do staff need to be able to effectively de-escalate?
Self aware, honest, open, non-judgmental, supportive, coherent and confident
Express genuine concern in a non-threatening and non-authoritarian manner
Ability to empathize to help patient feel understood, validating their experience to gain trust and reduce the need for aggressive behaviour
Manage you- Physical barriers- survival instincts
De-escalation techniques are inherently abnormal. They go against our natural ‘fight or flight’ reflexes
Fight- confront the threat and deal with it
Flight- get as far away from the threat as quickly as possible.
Flock- group mentality and finding kindred spirits
Freeze- state of inertia –shutting down
How must staff maintain self-control in order to effectively de-escalate?
Staff calmness will help the patient manage feelings of anger by communicating they are trusted not to be violent (Duperouzel 2008)
Remaining calm aids staff to make the most therapeutic decision
Effective de-escalators can appear calm even when anxious by focusing on assessment and acknowledging their own fear
Suppress personal feelings of offence or anger- perceiving the patient behavior is out of their control is a useful tip
Behaviour/person split. Draw a distinction between patients’ behaviour, which might be seen as bad, and the patients themselves, who are not (Safewards)
What verbal and non-verbal skills do staff need?
Calm, gentle and soft tone of voice- asking the patient what may be helpful, exploring what lead up to the incident can help resolve, negotiate
Tactful language, and, with care, sensitive humour
Active listening- evidence to patient they are being understood and listened to
Body language should express concern- posture, proximity, eye contact and facial cues
Touch boundaries can be calming for some however threatening for others
