PREVENTION & MANAGEMENT OF AGGRESSIVE BEHAVIOR

PREVENTION & MANAGEMENT OF AGGRESSIVE BEHAVIOR By Evelyn Stone, RN., BSN. M.Ed. www.qprofessionalmenatalhealthservice

Identifying Crisis Behavior • Learn to stop a crisis before it starts • What exactly is a crisis • Maintaining a Safe Environment

What is a Crisis? • Emotional event • Radical change in a person’s life • Crucial time • Impending change • Undesirable outcome

What Causes a Crisis • Stress • Fear • Anger • Pain • Emotional strain • Physical strain • Tension

What are Trigger Events? • Initiates reaction • Precipitates a reaction • Internal physical changes • Internal mental status changes • External

Internal Physical Changes • Pain • Fatigue • Hunger • Intoxication • Withdrawal • Cravings • ADHD

Internal Mental Status Changes • Hallucinations/Delusions • Confusion • Depression • Anxiety • Fear of Losing Control • Perception of Threat • Psychotic Distortion

External Triggers • Threat of loss of freedom • Challenge • Loss of Autonomy • Loss of Privacy • Fear of Failure • Challenge to Family/relationship • Loss of job • Challenge to Goals/Needs

Triggers (continued) • Aggression occurs when one feels threatened • Emotionally brittle persons are prone to anger • Triggers are often repetitive • Persons who are angry interpret closeness as a threat

Factors of Triggers • Some act out to get attention from staff • Individuals with conduct disorder may conspire so that one client acts out to create a diversion

Crisis Phases • Pre-crisis • Escalation • Active Crisis • Post Crisis

Pre-Crisis • Emotionally Stable • Problem Solving Abilities • Exhibits state of functioning normally

Internal Experiences • The client feels normal • Mood and Emotions are consistent with the situation • Feel Sad • May feel Depressed • Angry if treated unfairly

External Experiences • Client is able to communicate & interact with friends, family and others • May be very talkative, quiet or extroverted • Normally shy • Will be able to complete routine task

Escalation Phases • De-escalate the client • Avoid development of a crisis • When client is in vulnerable state • Something in the environment cause emotional distress • Physical Distress

Internal Escalation Phase • Discomfort within themselves • Uncomfortable with the environment • Client may feel needs are not being met • May feel threatened in some way

Internal Escalation (continued) • Pacing • Talking louder than normal • Fidgeting • Rapid breathing • Rapid speech • Veins protruding

External Escalation Phase • Ability to communicate is impacted • Signs & Symptoms of stress, anger & anxiety • Others may see s/s the client is about to “act out” or “lose it”

Active Crisis Phase • Staff is to de-escalate client and make a safe environment • Client feels emotionally stimulated • Client feels hopeless and overwhelmed • Staff

Internal Active Crisis • Frustration • Anger • Anxiety • Agitation • Hopelessness • Stress overwhelming

External Active Crisis Phase • Communication is impaired • Screaming, crying, or hitting others • Attempting to harm self • Kicking doors, hitting walls or trying to run away • Viewed as “Out of Control”

Past Issues • Refrain from discussing past issues • ‘Here & Now” • Defuse the crisis • Stabilize the immediate crisis

Key Removing Concepts • May become hypersensitive • The threat of loss • Logical choices • Acting out

Post Crisis Phase • Decrease of energy • Abilities may drop • Interventions

Legal Consequences • Making threats • Aggressive behaviors • Reality checks • Arrest • Criminal charges

Three Abilities Affected by Crisis • Coping ability • Ability to listen or communicate rationally • Changes in emotional equilibrium

Natural Consequences • Stay up late & may be tired in the morning • If you don’t eat your breakfast, you may be hungry • Being rude to others, may cause others to avoid interacting with you

Crisis Development • Four phases in development Pre-crisis Escalation Active crisis Post crisis

Star • Making effective decisions • Being unique • Think, See, Respond • Prevent conflict

Star • Making effective decisions • Being unique • Producing effective intervention • Think , see ,then respond • Prevent conflict

The Client • Old • Young

The Environment • lear

PREVENTION & MANAGEMENT OF AGGRESSIVE BEHAVIOR