Anger/Aggression Management

1. Anger/Aggression Management Nursing 202

2. Anger need not be a negative expression. • Anger is a 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. • Anger becomes a problem when it is not expressed and when it is expressed aggressively.

3. Anger * Anger isan emotional state that varies in intensity from mild irritation to intense fury and rage. • Anger causes physiological changes (e.g., increased heart rate, blood pressure, and levels of biogenic amines. • 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 • Anger has positive and negative functions

4. Aggression • 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.

5. Predisposing Factors to Anger and Aggression • 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.

6. 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. • Anger and aggression can be learned through operant conditioning.

7. 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

8. Aggressive behavior may have some correlation to alterations in brain chemicals. These include • Hormonaldysfunctionassociated with hyperthyroidism • Alterations in the neurotransmitters epinephrine, norepinephrine, dopamine, acetylcholine, and serotonin; these chemicals may play a role in facilitation or inhibition of aggression.

9. 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.

10. 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 minor tranquilizers/sedatives • Availability of firearms

11. Characteristics of anger • Anger can be identified by a cluster or characteristics that include • Frowning • Clenched fists • Low-pitched words forced through clenched teeth • Yelling and shouting

12. Characteristics of anger • Intense or no eye contact • Easily offended • Defensive • Passive-aggressive • Emotional overcontrol and flushed face • Intense discomfort • Tension

13. Aggression • Aggression can be identified by a cluster of characteristics that include • Pacing • Restlessness • Tense face & body • Verbal or physical threats • Threats of homicideor suicide • Increased agitation • Overreaction to environmental stimuli • Panic anxiety, leading to misinterpretation of the environment • Disturbed thought processes • Suspiciousness • Disproportionate anger

14. Assessing Risk Factors • Prevention is the key issue in management of aggressive or violent behavior. • Three factors are important considerations in identifying extent of risks • Past history of violence • Client diagnosis • Current behavior

15. Past history of violence is considered the most widely recognized risk factor for violence in a treatment setting. • The most common client diagnoses associated with violence include • Schizophrenia • Organic brain disorders • Mood disorders • Antisocial, borderline, and intermittent explosive personality disorders • Substance use disorders • Certain current behaviors are predictive of impending violence and have been termed the “prodromal syndrome.” 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

16. Nursing diagnoses

17. Planning/Implementation • Remain calm. • Set verbal limits on behavior. • Keep 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