Week 7 Anger, Aggression, Violence Flashcards
Define anger.
An emotional response to frustration of desires, a threat to one’s needs
Define aggression.
Action or behavior that results in a verbal or physical attack
Define seclusion.
the involuntary confinement of a patient alone in a room, or area from which the patient is physically prevented from leaving
Anger is a __ human emotion
normal
How can experiencing anger help a person?
When expressed assertively and handled appropriately, can provide an individual with a positive force to solve problems and make decisions concerning life.
Anger does not need to be a __ __
negative expression
An emotional response to frustration of desires, a threat to one’s needs, or a challenge
Anger
When does anger become a problem?
When it is not expressed and when it is expressed aggressively
How can anger be channeled into health productive persuits?
Exercise, art, meditation, etc
Anger is an emotional state that varies from…
mild irritation to intense fury and rage
Anger is capable of being under __ __
personal control
An action or behavior that results in a verbal of physical attack
Aggression
__ tends to be used synonymously with violence
Aggression
What is the intent of aggression?
To threaten or injure the victim’s security or self-esteem
Aggression is not always __
inappropriate
When is aggression necessary?
Sometimes for self-protection
Aggression is an __. Anger is an __.
action; emotion
An objectionable act that involves intentional use of force that results in or has the potential to result in injury to another person
Violence
Violence is __ an objectionable act
ALWAYS
Define violence.
An objectionable act that involves intentional use of force that results in or has the potential to result in injury to another person
Crisis = __ + __
danger + opportunity
Crisis moments can be both…
dangerous and frightening
How can a crisis become an opportunity?
Can cause you and person in crisis to grow and strengthen you relationship with one another
In the hospital setting, where is violence most frequently seen?
Psychiatric units, emergency departments, geriatric units
What are 3 biological factors that contribute to the etiology of violence/anger/aggression?
Specific area of the brain
Neurotransmitters
Predisposition
What are 4 psychological factors that contribute to the etiology of anger/aggression?
Behavior theory
Learned response
Social learning theory
Imitate others
What are 4 brain conditions associated with anger/violence?
Brain tumors
Alzheimer’s disease
Temporal lobe epilepsy
TBI
What is behavioral theory?
Emotions including anger are learned responses to the environment
What is social learning theory?
Believes that anger, aggression, and violence are behaviors that are imitated from others
There is always a __ behind anger
Feelings
__-__ is one of the strongest forms of learning
Role-modeling
What are neurophysiological disorders?
Several disorders of, or conditions within, the brain that have been implicated in episodic aggression and violent behavior
What are 6 types of neurophysiological disorders that can lead to aggression?
Temporal or frontal lobe epilepsy
Brain tumors
Brain trauma
TBI
Encephalitis
Psychosis
A specific behavior is positively or negatively reinforced
Operant conditioning
Define operant conditioning.
A specific behavior is positively or negatively reinforced
What type of behavior change occurs with operant conditioning?
Voluntary behavior change
Define positive reinforcement.
A response to the specific behavior that is pleasurable or produces the desired results
A response to the specific behavior that is pleasurable or produces the desired results
Positive reinforcement
Define negative reinforcement.
A response to the specific behavior that prevents an undesirable result from occurring
A response to the specific behavior that prevents an undesirable result from occurring
Negative reinforcement
Appropriate or aggressive expressions of anger can be learned through __ __
operant conditioning
What are biochemical factors that predispose someone to anger and aggression?
Hormonal dysfunction
Low serotonin
Thiamine and niacin in ETOH abuse
What are serotonin receptors called?
5HT receptors
How do low serotonin levels cause predisposition to anger and aggression?
May increase pain sensitivity, impulsiveness, and aggression
What type of hormonal dysfunction is associated with a predisposition to anger/aggression?
Hyperthyroidism
What two vitamin deficiencies are associated with a predisposition to anger and aggression?
Thiamine and niacin
How do thiamine and niacin predispose someone to anger and aggression?
May cause irritability and disorientation
What medical factors are associated with a predisposition to anger and aggression?
UTIs
Infections
Dehydration
Electrolyte imbalances
Blood sugar imbalances
Sensory changes
When someone is expressing anger and aggression, you should always look for…
a potential medical etiology
What socioeconomic factors are associated with a predisposition to anger and aggression?
Poverty
Perceived or actual injustice, unfairness, inequality
How does poverty put someone at risk for anger and aggression?
Associated deprivation
Disruption of families
Unemployment
What environmental factors have been associated with an increase in aggressive behavior?
Physical crowding of people
Availability of firearms
Discomfort associate with moderate increase in environmental temperature
Use of alcohol and drugs
What drugs are associated with an increase in aggressive behavior?
Cocaine
Amphetamines
Hallucinogens
Minor tranquilizers/sedatives
What are common comobidities with anger/aggression/violence?
PTSD
Substance use d/o
Psychiatric d/o
CVD
Strokes
What type of psychiatric disorders does anger/aggression/violence coexist with?
Depression
Anxiety
Psychosis
Personality disorders
What does anger look like?
Increased demands
Irritability
frowning
Redness in face
Pacing
Twisting of hands
Clenching and unclenching of fists
Speech increased rate and volume may be slowed
What is the single best predictor of future violence?
History of violence
Who is at higher risk for violence?
Delusional
Hyperactive
Impulsive
Non-adherent to medications
What questions would you ask a patient to assess major factors associated with violence?
- Does the individual have a wish or intent to cause harm?
- Does the individual have a plan?
- Does the individual have the means available to carry out the plan?
- Does the individual have demographic risk factors?
What are demographic risk factors associated with violence?
Male
Age 14-24
Low socioeconomic status
Inadequate support system
Prison time
When does aggression most often occur when interacting with a nurse?
Limit setting by the nurse
What psychological factors indicates a higher risk for violence?
History of limited coping skills
Lack of assertiveness
Use of intimidation
What assessment findings would indicate risk for aggression?
Agitation
Restlessness
Escalating anxiety
Resistance to suggested treatment
What cognitive changes put a patient at risk for aggression?
Anything that may cause the person to misinterpret things…
Confusion
Disorientation
Delirium
Psychosis
Hallucinations
Delusions
What assessment findings in the patient’s history would indicate risk for aggression?
Aggression management required at time of transfer
History of assault or threatening behavior
Known history of drug or alcohol abuse
History of assault or threatening behavior is a high indication for aggression especially if…
It occurred within the last 12 months or hours
What are signs/symptoms that usually precede violence?
Hyperactivity
Increased anxiety/tension
Verbal abuse
Loud or very soft voice
Stone silence
Intense eye contact
Avoiding eye contact
Recent acts of violence
Possession of a weapon
Isolation that is uncharacteristic
The nurse’s ability to intervene during an act of aggression depends on…
Self-awareness of strengths, needs, concerns, and vulnerability
Without self-awareness, nursing interventions can end up being…
Impulsive or emotion based
What must the nurse consider when intervening during an act of aggression?
Choice of words
Tone of voice
Non-verbal communication
Body posture
Facial expressions
What must you keep in mind when a patient is expressing verbal abuse towards the nurse?
It is not personal, it is nothing against you
What can aid in developing a therapeutic relationship to prevent acts of aggression?
Having numerous, brief, nonthreatening, nondirective interactions
What can aid in developing a therapeutic relationship to prevent acts of aggression?
Having numerous, brief, nonthreatening, nondirective interactions
How should the nurse approach a potentially violent patient?
In a controlled, nonthreatening, caring manner
What can the nurse do to be perceived as less of a threat when approaching a patient?
Allow the patient enough space
How much space should the nurse give the patient?
Always stay approximately 1 foot farther than the patient can reach with arms or legs
What else should the nurse be aware of when approaching a potentially violent patient?
Make sure you have an escape route
What should the nurse do when a patient invaders her space or is verbally abusive?
Do not take it personally or respond in kind
Ideally, interventions should begin…
Prior to any signs of escalation
When a nurse starts her shift, she should do an assessment so she can…
Get a baseline for what their behavior is
How should the nurse speak to a patient who is potentially aggressive?
Slowly and in short sentences using a calm voice
What type of conversation should the nurse use to speak to a patient who is potentially aggressive?
Use open ended questions rather than challenging statements
What should the nurse do when a patient expresses angry feelings or behaviors?
Find out what is behind these emotions. Ask “tell me what you are feeling.”
When a patient is expressing aggressive behaviors, what should the nurse do about the environment?
Choose a quiet place to talk to the patient and make sure other staff members are aware of the situation and are available to assist if needed
The nurse should not ever __ patients
Challenge
What intervention can the nurse use to give the patient control?
Identify patient’s options and encourage the individual to assume responsibility for choices made. “Do you want to go to your room or to the quiet room?”
When the nurse is using deescalating techniques, she must never…
Take chances. Always maintain personal safety
If the nurse sees a patient escalating, she should…
Intervene immediately, not later
When is it appropriate to use a PRN medication for aggression?
To alleviate symptoms and in conjunction with psychosocial interventions
How is long-term aggression treated?
The focus is based on treating the underlying psychiatric disorder
Don’t stand in front of…
the patient or in front of the doorway
Why should the nurse not block the doorway?
Patient may view this as confrontational
If a patient’s behavior starts to escalate, what should the nurse do?
Provide feedback, possibly allowing the patient to explore feelings and hopefully deescalate
When should the nurse use verbal confrontation?
Should be discussed when the patient is calm
The presence of security may…
escalate the patient
What is considered a supportive stance?
Posture must be confident but not confrontational
Stand at an angle, not toe to toe
Hands visible
Always stay about 1 foot further than the patient can reach
What non-verbal and verbal cues should the nurse display during an escalation in behavior?
Maintain appropriate eye contact
Keep facial expression even, caring, confident, engaged
Try to get patient to talk to you
