200 Unit 3 CURRENTSOCIAL ANDEMOTIONALCONCERNS
- Do not take the client’s anger or aggressive
behavior personally or as a measure of your
effectiveness as a nurse.
➤ KEY POINTS
- Anger, expressed appropriately, can be a
positive force that helps the person solve
problems and make decisions. - Hostility, also called verbal aggression, is
behavior meant to intimidate or cause
emotional harm to another and can lead to
physical aggression. - Physical aggression is behavior meant to
harm, punish, or force into compliance
another person. - Most clients with psychiatric disorders are
not aggressive. Clients with schizophrenia,
bipolar disorder, dementia, head injury, anti-
social or borderline personality disorders, or
conduct disorder, or those intoxicated with
alcohol or other drugs may be aggressive.
Rarely, clients may be diagnosed with
intermittent explosive disorder. - Treatment of aggressive clients often
involves treating the comorbid psychiatric
disorder with mood stabilizers or anti-
psychotic medications.- Assessment and effective intervention with
angry or hostile clients can often prevent
aggressive episodes. - Aggressive behavior is less common and less
intense on units with strong psychiatric lead-
ership, clear staff roles, and planned and ad-
equate events such as staff–client interaction,
group interaction, and activities. - The nurse must be familiar with the signs,
symptoms, and behaviors associated with the
triggering, escalation, crisis, recovery, and
postcrisis phases of the aggression cycle. - In the triggering phase, nursing interventions
include speaking calmly and nonthreaten-
ingly; conveying empathy; listening; offering
PRN medication; and suggesting retreat to a
quiet area. - In the escalation phase, interventions in-
clude using a directive approach; taking
control of the situation; using a calm, firm
voice for giving directions; directing the
client to take a time out in a quiet place;
offering PRN medication; and making a
“show of force.” - In the crisis phase, experienced, trained staff
use the techniques of seclusion or restraint
to deal quickly with the client’s aggression. - During the recovery phase, interventions
include helping clients to relax, assisting
them to regain self-control, and discussing
the aggressive event rationally. - In the postcrisis phase, the client is reinte-
grated into the milieu. - Important self-awareness issues include
examining how one handles angry feelings
and deals with one’s own reactions to angry
clients.
For further learning, visit http://connection.lww.com.
- Assessment and effective intervention with
I NTERNET R ESOURCES
Resource Internet Address
◗APA: Warning Signs http://helping.apa.org/warning signs/
◗LifeSkills Resource Center http://www.rpeurifoy.com
◗Anger Alternatives http://www.angeralternatives.anthill
◗Anger Management Institute http://www.manageanger.comCritical Thinking Questions
1.Many community-based residential programs
will not admit a client with a recent history of
aggression. Is this fair to the client? What fac-
tors should influence such decisions?
2.If an aggressive client injures another client
or a staff person, should criminal charges be
filed against the client? Why or why not?