Anger/Aggression Management

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Anger/Aggression Management

• Nursing 202

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• 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.

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Anger

• Anger is an 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

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Aggression

• Is one way that individuals express anger
• Is a behavior that is intended to threaten or
  injure the victims security or self-esteem
• Can cause damage with words, fists, or weapons,
  but it is virtually always designed to punish.

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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 childs life.

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• 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.

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• 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

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

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• 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.

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• 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

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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

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Characteristics of anger

• Intense or no eye contact
• Easily offended
• Defensive
• Passive-aggressive
• Emotional overcontrol and flushed face
• Intense discomfort
• Tension

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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

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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

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• 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

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Nursing diagnoses
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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