BAPTIST HEALTH SCHOOL OF NURSING NSG 3036A: PSYCHIATRIC-MENTAL HEALTH THERAPEUTIC INTERVENTION: ANGER AND AGGRESSION

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1 BAPTIST HEALTH SCHOOL OF NURSING NSG 3036A: PSYCHIATRIC-MENTAL HEALTH THERAPEUTIC INTERVENTION: ANGER AND AGGRESSION LECTURE OBJECTIVES: 1. Define anger and aggression. 2. Compare and contrast the functions of anger. 3. Discuss how modeling and conditioning affect the development of anger and aggression. 4. Identify predisposing and risk factors of anger and aggression. 5. Formulate appropriate nursing diagnosis for clients with anger and aggression problems. 6. Apply the nursing process to care for clients with angry and aggressive behavior. READING ASSIGNMENT: Townsend, Chapter 17 LECTURE OUTLINE: I. Anger Defined A. Normal, healthy emotion that serves as a warning signal and alerts us to potential threat or trauma 1. Not a primary emotion 2. Physiological arousal 3. Different from aggression 4. Expression of anger is learned 5. Capable of being under personal control B. Positive Functions of Anger 1. Energizes and mobilizes the body for self-defense 2. Can promote conflict resolution (if communicated assertively, not aggressively) 3. Arousal is a personal signal of threat or injustice against the self 4. Provides a feeling of control over a situation 5. Increases self-esteem and leads to mutual understanding and forgiveness C. Negative Functions of Anger

2 1. May result in impulsive behavior 2. Conflict could escalate and go unresolved 3. Can lead to aggression when coping response is displacement 4. Feeling of control may be exaggerated with intimidation of others 5. May mask feelings, weaken self-esteem, and lead to hostility and rage II. Aggression Defined A. A behavior intended to threaten or injure the victim s security or self-esteem 1. One way individuals express anger 2. To go against, to assault, or to attack 3. Behavior designed to punish 4. The goal may be to inflict pain or injury on objects or persons via words, fists, or weapons III. Predisposing Factors to Anger and Aggression A. Modeling 1. One of the strongest forms of learning 2. Children model their behavior at a very early age after their primary caregivers 3. May be positive or negative 4. Role models are not always in the home B. Operant Conditioning 1. Occurs when a specific behavior is reinforced 2. Positive Reinforcement: A response to the specific behavior that is pleasurable or produces the desired results 3. Negative Reinforcement: A response to the specific behavior that prevents an undesirable result from occurring C. Neurophysiological Disorders 1. Several disorders or conditions of the brain have been implicated in episodic aggression and violent behavior a. Temporal and frontal lobe epilepsy b. Brain tumors c. Brain trauma d. Encephalitis D. Biochemical Factors

3 1. Violent behavior may be associated with hormonal dysfunction caused by Cushing s disease or hyperthyroidism 2. Alterations in neurotransmitters may play a role in facilitation and inhibition of aggressive impulses (epinephrine, norepinephrine, dopamine, serotonin, and acetylcholine) E. Socioeconomic Factors 1. High rates of violence exist in the subculture of poverty in the U.S 2. Poverty is thought to encourage aggression and violence because of associated deprivation, disruption of families, and unemployment F. Environmental Factors 1. Physical crowding 2. Moderately uncomfortable temperatures (while extremely hot temperatures decrease aggression) 3. Use of ETOH, street drugs (particularly cocaine), amphetamines, hallucinogens, and minor tranquilizers 4. Availability of firearms IV. The Nursing Process A. Assessment 1. Assessing Anger a. Low pitched verbalizations forced through clenched teeth b. Frowning c. Yelling or shouting d. Intense eye contact or avoidance or eye contact e. Clenched fists f. Easily offended g. Defensive response to criticism h. Passive-aggressive behavior i. Flushed face j. Intense discomfort; continuos state of tension k. Emotional over control 2. Assessing Aggression a. Pacing, restlessness b. Tense facial expression or body language c. Verbal or physical threats d. Loud voice, shouting, use of obscenities, argumentative e. Intense agitation, with overreaction to environmental stimuli f. Panic anxiety, leading to misinterpretation of the environment g. Disturbed thought processes; suspiciousness h. Angry mood, often disproportionate to the situation 3. Assessing Risk Factors a. Assess for past history of violence, client diagnosis, and current behavior b. Prodromal syndrome: characterized by anxiety, verbal abuse, profanity, and

4 B. Diagnosis/Outcome Identification increasing hyperactivity (rigid posture; clenched fists and jaws; grim affect; talking in rapid raised voice; arguing and demanding; using profanity and threatening verbalizations, agitation and pacing; and pounding and slamming 1. Diagnosis a. Dysfunctional grieving b. Ineffective coping c. Risk for self directed or other directed violence 2. Outcome Identification: The client a. is able to recognize when he/she is angry b. is able to take responsibility for own feelings of anger c. demonstrates ability to control anger d. is able to diffuse anger e. uses tension in a constructive manner f. does not cause harm to self or others g. uses problem solving processes over violence C. Planning/Implementation 1. Remain calm when dealing with angry clients 2. Set verbal limits 3. Have the client keep a diary of angry feelings 4. Avoid touching the client when he or she becomes angry 5. Ignore initial derogatory remarks by the client 6. Help the client find alternative ways to release tension 7. Role model appropriate ways to express anger 8. Observe client for escalation of anger 9. Use physical outlets 10. Call for assistance if needed 11. Restrain if necessary 12. Perform ongoing assessment 13. Document and debrief D. Evaluation 1. Reassess to determine if nursing interventions have been successful 2 Does the client recognized when he is angry? 3. Has harm to the client and others been avoided?

5 4. Can the client problem solve without violence?