Chapter 21 Anger and Aggression Anger and aggression

Chapter 21 Anger and Aggression

Anger and aggression n Anger ¨ Primal, not always logical-human emotion ¨ Varies in intensity from mild irritation to rage and fury Aggression ¨ Hostile reaction that occurs when control over anger is lost ¨ Used in attempt to regain control over stressor or flee situation ¨ Violence: refers to physical aggression Patients communicate increase anxiety before it escalates to anger, aggression, or violence: Remember-LISTEN TO THE PTS

Prevalence and community n n Anger and violence common aspects of social interaction Of the 1. 6 million violent deaths in US, ½ were suicides and 1/3 were homicides and 1/5 were casualties of war Persons with psych disorder 5 x more violent Medical & neurological causes of organic brain syndrome can result in agitated, aggressive or violent behavior

Theory n n n Anger stimulates hypothalamus causing body to react to anticipation of harm Heredity is a factor (males with XYY chromosome more prone) Selyes General Adaptation Syndrome ¨ Fight or Flight Freud’s Ego Defense Mechanisms ¨ Suggest mind can channel anger into socially acceptable ways Lewis ¨ Most important contributor is early & ongoing physical, sexual or emotional abuse

Theory n Neurobiological factors ¨ Brain structure: Limbic system-mediates primitive emotion & behaviors necessary for survival ¨ Neurotransmitters: cholinergic & catecholaminergic mechanisms involved in predatory aggression. Serotonergic and GABA modulate aggression ¨ Genetic Factors: twin studies proved genetic component to violence in addition to childhood violence

Cultural considerations n n n Violence is complex issue Socioeconomic, medical and psychiatric issues are contributing factors Substantial correlations between environment and aggression (poverty, unemployment, poor) Males are more violent than females Subculture supports intimidation & aggression as means of problem solving and achieving social status reinforces the use of violence (gangs)

Application of nursing process n Assessment ¨ Accurate, early can identify pt anxiety before it escalates to anger and aggression ¨ Leads directly to appropriate nursing diagnosis and intervention ¨ Expressions of anxiety and anger are similar (increased demands, pacing, irritability, frowning, red face, clenching of fists) ¨ On admission, obtain comprehensive history of pt gathered from variety of sources if possible ¨ Remember: patient history is a good predictor of risk for violence ¨ Assessment guidelines review

Application of nursing process n n n Diagnosis ¨ Patient safety is 1 st priority ¨ Risk for self directed violence and risk for other directed violence are primary nursing diagnosis ¨ If pt is escalating and not amenable to early nursing interventions or deescalating techniques then medication and/or restraints may be necessary Outcome Identification ¨ Inclusion of short, intermediate and long term goals Planning ¨ Necessitate sound assessment, including history (previous acts of violence, comorbid, disorders, present coping skills, alternative and nonviolent ways to handle anger (de-escalation techniques)

Application of nursing process n Implementation ¨ Ensure safety ¨ Stages of Violence Cycle n n n Pre-assaultive phase: de-escalation techniques Assaultive phase: Medication, Seclusions (involuntary confinement of pt alone in room), Restraint (refers to any manual method or mechanical device, material, or equipment attached or adjacent to patients body, restricts movement Post-assaultive phase: post seclusion/restraints staff should review the incident with pt and others

Application of nursing process n Implementation ¨ Critical Incident Debriefing; staff analysis of violent episode ¨ Documentation of violent episode ¨ Anticipated increased anxiety and anger in hospital settings ¨ Anxiety reduction techniques ¨ Interventions for patient with cognitive deficits n Catastrophic reaction; severe agitation and aggression including scream, cry or strike out due to fear ¨ Psychotherapy n Manage chronic aggression n Behavioral interventions n Cognitive behavioral approaches

Application of nursing process n Implementation ¨ Pharmacological, Biological & Integrative Therapies n Medications for acute aggression ¨ ¨ n Medications for chronic aggression ¨ ¨ ¨ n Atypical antipsychotics/ Typical antipsychotics Benzodiazepines Carbamazepine (Tegretol) Beta-blockers Buspar Lithium Anticonvulsants (Lamictal) Evaluation Care plan with specific outcome criteria and review essential ¨ Provides info about the extent to which interventions have achieved the outcomes ¨