-
Passive behavior
Subordinates own rights to his or her perception of the rights of others
-
Assertive behavior
Conveys a sense of self-assurance and communicates respect for others
-
Aggressive behavior
Ignores the rights of others
-
The best way to de-escalate someone is:
To be assertive
-
Violence results from:
Anger occurs as a response to:
Non-fatal assaults are more common in:
anger or fear
A preceived threat
Service industries
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BIOPSYCHOSOCIAL THEORIES
Biologic theories:
-
-
Genetic Abnormalities
Neuropsychologic injuries
-
-
-
-
-
- ◦Imbalances
- of hormones
- ◦Neurotransmitters
◦Trauma
◦Anoxia
◦Encephalitis
-
Increases in what two neurochemicals can cause aggression?
Decreases in what can cause aggression?
- Dopamine and norepinephering
- GABA (the calming chemical)
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BIOPSYCHOSOCIAL THEORIES
Psychosocial theories
-
-
-
Behavioral theory
- Psychoanalytic- freud
- Psychological
- Sociocultural
- Pavlov-conditioning
- humanistic and learned behavior
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AGGRESSION AND THE BRAIN
Hypothalamus:
What does it do?
What does dysfunction lead to?
◦Alarm system, controls pituitary function
◦Dysfunction leads to overreaction to stress and over activation of pituitary
-
AGGRESSION AND THE BRAIN
Hippocampus
What does it do?
What happens if it is dysfunctional?
◦Regulates the recall of recent experiences and new information
◦Dysfunction associated with impulsivity
-
AGGRESSION AND THE BRAIN
Amygdala
What does it do?
What if its dysfunctional?
◦Regulates emotion, memory storage, information processing
◦Dysfunction affects emotion and behavior, outbursts of fear, anger, rage, hypersexuality
-
AGGRESSION AND THE BRAIN
frontal cortex
What does it do?
What if its dysfunctional?
◦Generates thought and purposeful behavior
◦Dysfunction leads to impaired judgement, poor decision-making, personality changes, aggressive outbursts
-
Mental Disorders in which aggression often occur
- Antisocial
- Personality Disorder
Borderline Personality Disorder
Conduct Disorder-usually occurs before age 15, precursor to APD
Delusional Disorder
Dementia of the Alzheimer’s Type
Substance Abuse
Intermittent Explosive Disorder
Schizophrenia
-
What factors can determine self awareness?
(Which is important when intervening with an aggressive patient)
◦Family of origin- walk away, share feelings
◦Personal responses to anger & aggression
◦Self-assessment can lead to self-intervention- be prepared to know how you will respond
-
Risk factors for violence
- •History of violence-
- probably most important
- •Severity of
- psychopathology
- •Higher levels of
- hostility
- •Length of time in the
- hospital
- •Early age of onset of
- psychiatric symptoms
- •Frequency of
- admission to psychiatric hospitals
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NURSING PROCESS
Assess for clients balancing factors
-
-
-
If any of these are not intact, the person is at a higher risk for violence.
Perception of precipitating event/current situation
Support system
Usual coping patterns
-
NURSING PROCESS
Environmental factors
- Availability of
- dangerous objects
Overcrowding
Staffing
Supervision
-
NURSING PROCESS
Other considerations:
Impulse control
- Sensory-perceptual
- functioning
Cognitive functioning
Social skills
Helplessness
Powerlessness
-
Behavioral cues indicating violence
- ◦Flushing
- of face and neck
- ◦Frowning,
- glaring, smirking
- ◦Pacing
- Increased vigilance
-
Verbal ques indicating violence
- ◦Statements
- of fear or suspicion
-
Possible nursing diagnosises
- ◦Potential
- for violence, other directed
- ◦Ineffective
- individual coping
◦Anxiety
- ◦Chronic
- low self-esteem; Situational low self esteem
-
Preventative interventions
- education
- (about anger management, problem solving skills, communication skills),
- assertiveness
-
Anticipatory interventions
- communication (to be able to de-escalate client and calm them down),
- environment (therapeutic milieu),
- behavioral (behavioral contracts, setting limits),
- psychopharmacology
-
Containment
crisis management, seclusion and restraint- never a punnishment, always a last resort for safety.
-
Ensuring safety
Minimizing personal
risk
Nonthreatening
communication
Awareness of
environment
Availability of other
staff members
Awareness of clothing
and objects
-
Interventions
§Help patient
verbalize feelings
§Early recognition
§Appropriate release
(on an inanimate object)
§Do not take
personally
§Do not ignore
behaviors
§Clear, consistent
limits*(see next slide)
§Decrease stimuli
§Know your
surroundings
§Evaluate
hallucinations (know if there are command hallucinations going on
§Support
-
-
clients who are irritable or have poor impulse control (depakote, lithium
-
-
short term rather than long acting. Ativan is most common
-
-
personality disorders to manage aggressive behavior
-
Chronic aggression:
beta blockers,
-
anticonvulsants, Lithium, Trazadone (antidepressant, used for sleep, doesn’t alter the
-
-
Rationale for use of seclusion
◦Containment—Patients are
restricted to a place where they are safe from harming themselves and other
patients
◦Isolation—Patients can
distance themselves from relationships with others
◦Decrease
in sensory input—A
quiet atmosphere can provide relief from sensory overload
-
Self awareness
Remember, its a continuum. Calm and unthreatening is where we start
How do I feel about
this patient/setting?
How are my feelings
affecting my behavior?
Fear is a normal
response.
Avoid personalizing.
Use intuition.
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