Management of Aggression and Violence

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Management of Aggression and Violence

• Chapter 34

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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

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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.

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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 perpetrators point of
  view is correct, not the victims

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Models

• Biological
• Cognitive neuroassociation
• Neurostructural model - emotional circuit
• Neurochemical model - ? serotonin

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Models

• Psychological
• Psychoanalytic
• Behavioral theories
• Drive
• Social learning
• Cognitive

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Models

• Social
• Western societys values - competitive,
  individualistic
• Interactional theory - Morrison

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Nursing Management

• Biologic Assessment
• Exposure to toxic chemicals
• Missed doses of medications
• Intoxication and withdrawal
• Characteristics
• 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

• Psychosocial Assessment
• Thought processing
• Perception
• Sensory impairment
• Social factors, such as home, family or
  community problems
• Financial
• Legal

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Nursing Diagnosis

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

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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 patients 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

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Biologic Interventions

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

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Psychological Interventions

• Affective Interventions
• Validating
• Listening to patients illness experience
• Exploring beliefs

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Psychological Interventions

• Cognitive Interventions
• Giving commendations
• Offering information
• Providing education
• Contracting

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Psychological Interventions

• Behavioral Interventions
• Using bibliotherapy
• Interrupting patterns
• Providing choices

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Social Interventions

• Reducing stimulation
• Anticipating needs
• Interactional processes

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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