how to deal with agressive behavior

8/7/2019 how to deal with agressive behavior

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Department of Nursing Educational ServicesDepartment of Nursing Educational Services

HOW TO DEAL WITH

AGGRESSIVE BEHAVIOURS


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By the end of the session participants will beable to:

Explore each others feelings about anger. Define anger

Describe the cycle of development of angerand its expression. List characteristics of aggressive client. Recall physical dimensions of anger. Rationalize the necessity of anger.

Select techniques to over come anger. Identify reasons of patient aggression. Describe the techniques to deal with angry

client.

OBJECTIVES:-


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EXERCISE:-

Changing your feelings.

The things I get angry about are?

What do I do when I get angry?

The assumptions I am making that causeme to be angry are?

(David W. Johnson 1933)


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DEFINITIONS

Anger is a normal, healthy emotion thatserves as a warming signal and alerts us topotential threat or trauma.

Aggression is a behavior intended tothreaten or injure the victims security orself-esteem. It means to go against, to

assault, or to attach. It is a responsewhich aims at inflicting pain or injury onobjects or person. (Townsend 2003)


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THE DEVELOPMENT AND EXPRESSION OF ANGER.Threat or need

Stress

Anxiety

Anger

No resolution of anger Getting it off chest or clearing theair

Chronic hostility

Inward anger Outward anger

Depression Aggression violencephysical illness

(Adopted from Rawlins, R. P 1993)


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PREDISPOSING FACTORS TO ANGERPREDISPOSING FACTORS TO ANGER

AND AGGRESSIONAND AGGRESSION

Role modeling

Operant conditioning

Neurophysiological Disorders

Biochemical factors

Socioeconomic factors

Environmental factors


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CHARACTERISTICS OF CLIENTCHARACTERISTICS OF CLIENT

WITH AGGR

ESSIO

NWITH AGGR

ESSIO

N Tense muscles clenched fists

Facial reddening

Loud or rapid speech Laboured or rapid breathing

Intense facial expression of fear, angeror hostility

Insulting remarks or threats.

Violent gestures.


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Verbal or physical threats

Pacing

Throwing or striking objects or people

Self-mutilation


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PHYSICAL DIMENSIONS OFPHYSICAL DIMENSIONS OF

ANGER

ANGER

Low / high BP

Palpitations

Headache

Vertigo

Excessive sleep or no sleep

Shivering


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IS ANGER NECESSARYIS ANGER NECESSARY

By expressing anger feelings appropriately werelease negative feelings. Thus making anger

is a very useful emotion. Blocked anger results in rage, anxiety, fear,

guilt or depression.

Anger is spontaneous energy that promotesnew learning.

Expression of anger is necessary but up to acertain point. Beyond this point, anger is notonly unnecessary, it is destructive.


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The key in understanding angerThe key in understanding anger

Why that person is angry &acknowledging their anger.

Understanding does not mean agreeingwith that person.

Understanding the emotion behind the

angry expression can soften the urge tooverpower or argue.


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TECHNIQUES TOOVER COME ANGERTECHNIQUES TOOVER COME ANGER

The only way we can control our anger is bymaking a firm commitment that we will not get

angry. We are responsible for our behavior,regardless of what the other person says or does.

Other techniques are:Other techniques are: Change positions (if we are standing then sit

and vice versa) Deep breathing exercises

Calming statements to self (its ok, calmdown, its not that bad) Slowly count till 10 Pleasant thoughts.


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WHY PATIENTS HAVE FEELINGSWHY PATIENTS HAVE FEELINGS

OF AGGRESSIONOF AGGRESSION

Patients may react aggressively in anattempt to regain control.

Hospitalized patients may feelthreatened by unpredictable events suchas unexpected CT SCAN or acatheterization.

Decreased control over decision making

Painful and intrusive procedures The combination of severe illness and

the nature of the hospital environment.


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Feelings of neglected as patients.

The warmth of human touch is oftenmissing.

Violence against staff.

Patients are treated as mindless orignorant objects for expert staff.

Out dated working systems oroverworked staff.

Convenience of the consultant ormedical staff, not the patients.


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DEALING WITH ANGRY CLIENTDEALING WITH ANGRY CLIENT

Maintain a calm, direct and non-challengingattitude.

Be clear and listen to the client. Stand at a distance of at least an arms length. Say what you plan to do (for example Im

here to put in I/V, heres the bedpan) Answer questions and receive consent before

proceding. Do only the identified task and leave the

room. Prevent physical harm e.g. restraint. Set limits


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Focus on what you can control. Stay calmviewing the angry persons behavior,

objectively allows you to hear the hiddenmessage that they are trying to send.

Nurses should be protecting themselves ratherthan attempting to fight.

Get buddied with another staff. Develop a contextual understanding of the

presenting problems.

Talk about the situation after the intense

emotion has passed. Be open-minded and avoid defensiveness. If

some of patient complaints are merit.

Document interactions and clients behaviors.


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Learn to deal with anger by:Learn to deal with anger by:

A acknowledging its presence

N noticing its symptoms

G guarding against its triggers

E expressing it appropriately

R resisting the desire to meet anger with

anger


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EXER

CISEEXER

CISE Constructive attitudes I can adopt to

change these feelings to more positive

ones are.


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Remember:

Whenever you say something, it leaves a

scar. It does not matter how many timesyou say yo the wound you cause throughyour words stays, & is just as bad as aphysical one.

We all grow, you can learn to grow withyour anger by accepting it as a normal &

natural emotion & allow yourself to diefrom it, a little at a time.


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References:References:

Townsend,M.C.,(2003). Psychiatric MentalHealth Nursing: Concepts of care 4th (ed.).

Philadelphia.Anderson, K. (2000). Nursing,30 (6), 82.


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ReferencesReferencesLaight, S. (1995). The Aggressive ward visitor: a critical

incident analysis. Nursing Times, 91 (48), 40 41.

Anderson, L. N., & Minarik P. (1999). Responding todifficult patients. American Journal ofNursing99

(12), 26 33.

Johnson. D. W. 91987). Humar relations and yourcareer. Englewood cliffs. New Jersey.

Rawlins, R. P; Williams, S. R., & Beck, C. K. (1993).Mental health psychiatric nursing. A holistic life-cycle approach. 3rd (ed.). Mosby, Philadelphia.


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Thank You

how to deal with agressive behavior

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