Anger and Aggression Management PDF

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Summary

Complete chart on anger and aggression based on lecture notes...

Description

Anger and Aggression Management Definition

Assessment

Anger an EMOTIONAL state that varies in intensity from mild irritation to intense fury and rage

Aggression Goal directed with an intent of harming someone/thing - ACTION

- Need not be a negative expression: can have positive or negative functions Positive: unfair situation that needs to be right Negative: denied, expressed inappropriately and leads to aggression - Normal human emotion that, when handled appropriately and expressed assertively, can provide an individual with a positive force to solve problems and make decisions concerning life situations. - Becomes a problem when it is not expressed, and when it is expressed aggressively. - Causes physiological changes (e.g., increased heart rate, blood pressure, and levels of biogenic amines). - Norepinephrine and epinephrine are common with anger à fight or flight! Anger is: – Not a primary emotion; learned – Typically experienced as an automatic inner response to hurt, frustration, or fear – A physiological arousal, instilling feelings of power and generating preparedness – Significantly different from aggression – Capable of being under personal control • Frowning • Clenched fists • Low-pitched words forced through clenched teeth • Yelling and shouting • Intense or no eye contact • Easily offended • Defensive • Passive-aggressive • Emotional overcontrol and flushed face • Intense discomfort • Tension

- Physical or verbal response that can indicate rage and harm - Is one way that individuals express anger - Is a behavior that is intended to threaten or injure the victim’s security or self-esteem - Can cause damage with words, fists, or weapons, but it is virtually always designed to punish

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Predisposing Factors

Pacing Restlessness Tense face and body Verbal or physical threats Threats of homicide or suicide Loud voice, shouting, use of obscenities Argumentative Increased agitation Overreaction to environmental stimuli Panic anxiety leading to misinterpretation of the environment Disturbed thought processes Suspiciousness Disproportionate anger

Modeling • Role modeling is one of the strongest forms of learning. • Role models can be positive or negative. • Earliest role models are the primary caregivers. • As the child matures, role models can be celebrities or any other influential individual in the child’s life. Operant Conditioning • Operant conditioning occurs when a specific behavior is positively or negatively reinforced. – A positive reinforcement is a response to the specific behavior that is pleasurable or produces the desired results. – A negative reinforcement is a response to the specific behavior that prevents an undesirable result from occurring. • Ex. “I have no intention of unpacking and staying on this unit.” To avoid a confrontation, the nurse unpacks the client’s belongings. • Anger and aggression can be learned through operant conditioning. Neurophysiological Disorders • Several disorders of, or conditions within, the brain have been implicated in episodic aggression and violent behavior. They include: – Temporal or frontal lobe epilepsy – Brain tumors – Brain trauma – Encephalitis Biochemical Factors • Aggressive behavior may have some correlation to alterations in brain chemicals. These include: – Hormonal dysfunction associated with hyperthyroidism – Alterations in the neurotransmitters epinephrine, norepinephrine, dopamine, acetylcholine, and serotonin; these chemicals may play a role in facilitation or inhibition of aggression

Predisposing Factors (cont.)

Assessing Risk Factors

Nursing Diagnoses

Planning/ Implementation

Socioeconomic Factors • High rates of violence exist within the subculture of poverty in the United States. • Poverty is thought to encourage aggression because of the associated deprivation, disruption of families, and unemployment. Environmental Factors • Several environmental factors have been associated with an increase in aggressive behavior. They include: – Physical crowding of people – Discomfort associated with a moderate increase in environmental temperature – Use of alcohol and some other drugs, particularly cocaine, amphetamines, hallucinogens, and anabolic steroids – Availability of firearms Prevention is the key issue in the management of aggressive or violent behavior. Three factors are important considerations in identifying extent of risks: • Past history of violence • Client diagnosis: anxiety, SUBSTANCE ABUSE IS THE BIGGEST ONE • Current behavior • SET LIMITS • IF GIVING CHOICES: NEVER GIVE MORE THAN 2 OPTIONS — Past history of violence — Considered the most widely recognized risk factor for violence in a treatment setting. — Client diagnosis • The most common client diagnoses associated with violence include: — Substance use disorders — Schizophrenia — Major depression — Bipolar disorder — Neurocognitive disorders — Antisocial, borderline, and intermittent explosive personality disorders — Current behavior • Certain behaviors are predictive of impending violence and have been termed the “prodromal syndrome.” –IMPENDING VIOLENCE • They include: — Rigid posture — Clenched fists and jaws — Grim, defiant affect — Talking in a rapid, raised voice — Arguing and demanding — Using profanity and threatening verbalizations — Agitation and pacing — Pounding and slamming – Complicated grieving (if anger is related to a loss) – Ineffective coping – Risk for self-directed or other-directed violence – Outcome behaviors are identified as criteria for evaluation. – Remain calm. – Set verbal limits on behavior. – Keep a diary of anger. – Avoid touching the client. – Help determine source of anger. – Ignore derogatory remarks. – Help find alternative ways of releasing tension. – Role model. – Observe for escalation of anger. – When behaviors are observed, first ensure that sufficient staff is available. Techniques for dealing with aggression include: – Talking down – Physical outlets – Medications – Call for assistance – Restraints – Observation and documentation – Ongoing assessment – Staff debriefing

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