Management of Aggression and Violence Chapter 34 Anger

Management of Aggression and Violence Chapter 34

Anger • Affective state experienced as the motivation to act in ways that warn, intimidate or attack those who are perceived as challenging or threatening • Targets – Others – Impersonal objects/life situations – Oneself

Experience of Anger • Anger is a signal that something is wrong. • It is a normal human emotion. • It is inappropriate expression of anger that may be threatening to the self or others. • Difficulties expressing anger are associated with psychiatric problems. • Behavioral expressions of anger may vary.

Aggression vs. Violence • Aggression – Verbal statements that are intended to threaten – Does not occur in a vacuum – Must consider the context • Violence – A physical act of force intended to cause harm to a person or an object – Conveys a message that the perpetrator’s point of view is correct, not the victim’s

Models Biological – Cognitive neuroassociation – Neurostructural model - emotional circuit – Neurochemical model - serotonin

Models Psychological – Psychoanalytic – Behavioral theories – Drive – Social learning – Cognitive

Models Social – Western society’s values competitive, individualistic – Interactional theory - Morrison

Nursing Management Psychosocial Assessment Biologic Assessment • Exposure to toxic chemicals • Thought processing • Missed doses of medications • Perception • Intoxication and withdrawal • Sensory impairment • Characteristics • Social factors, such as home, family or community problems – History or evidence of CNS lesion or dysfunction – Sudden onset and unprovoked – Outburst less controlled – Episode with clear beginning and end – Expression of remorse after episode – Financial – Legal

Nursing Diagnosis • Risk for self-directed violence • Risk for other-directed violence

Planning Interventions • Development of a partnership between nurse and patient, who work together to find solutions to prevent the recurrence of explosive episode • Guidelines for reducing risk: • Using non-threatening body language • Respecting patient’s personal space and boundaries • Positioning for immediate access to door • Leaving door open when talking to patient • Knowing where colleagues are, let colleagues know where you are • Removing clothing or accessories that could be harmful

Biologic Interventions Administering and Monitoring Medications • Atypical antipsychotics • SSRIs • Beta-adrenergic receptor blockers • Lithium carbonate • Divalproex sodium and carbamazepine

Psychological Interventions Affective Interventions – Validating – Listening to patient’s illness experience – Exploring beliefs

Psychological Interventions Cognitive Interventions – Giving commendations – Offering information – Providing education – Contracting

Psychological Interventions Behavioral Interventions – Using bibliotherapy – Interrupting patterns – Providing choices

Social Interventions • Reducing stimulation • Anticipating needs • Interactional processes

Nurses’ Responses to Assault • Affective – Irritability – Depression – Anger – Anxiety – Apathy • Cognitive – Suppressed or intrusive thoughts of assault • Behavioral – Social withdrawal • Physiologic – Disturbed sleep – Headaches – Stomach aches – Tension