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EXAM 2 MENTAL HEALTH
Anger & Disruptive Disorders
| Question | Answer |
|---|---|
| Hostility | Verbal aggression. Expressed through verbal abuse, lack of cooperation, violation of rules or norms, threatening behavior. May be expressed when a person feels threatened or powerless |
| Physical Aggression | Attack on, or an injury to another person or destruction of property. Meant to harm or punish another person or force into complacence |
| Anger | Often perceived as a negative feeling. However, it is not healthy to deny or try to eliminate. Inappropriate expression leads to aggression/hostility. |
| Catharsis | Activities that are supposed to provide a release for strong feelings such as anger and rage. Not recommended as anger is just displaced or even increased and not alleviated. Rage rooms, punching bags, and yelling are not safe or recommended for clients with a history of anger. Instead recommend activities that will decrease such as walking or talk therapy. |
| Anger Management/Control Strategies | Serving as a model and using role-playing assertive communication, and cognitive behavior techniques |
| Cognitive Behavior Techniques for Anger Management/Control | Distraction, problem-solving, and changing one's perspective or reframing can be effective |
| Assertive Communication | Incudes statements that use "I" and express your feelings and are specific to the situation |
| Diagnoses Associated with Anger | Paranoid delusions, auditory hallucinations, depression, dementia, delirium, head injuries, intoxication, personality disorders, and antisocial disorders, Oppositional Defiant Disorder (ODD), Conduct Disorder, Disruptive Behaviors, and Intermittent Explosive Disorder (IED) |
| Intermittent Explosive Disorder | Rare psychiatric diagnosis characterized by discrete episodes of aggressive impulses that result in serious assaults or destruction of property |
| Workplace Bully Regulations were put in place by… | The Joint Commission on Accreditation of Healthcare Organizations (JACHO) in July 2008, and then was added too in 2016. |
| In July 2008 JACHO Issued a Sentinel Event Alert Concerning | The intimidating and disruptive behaviors that undermine a culture of safety and lead to errors, decreased patient satisfactions, preventable adverse outcomes, increased health care costs, and loss of qualified personnel. Undesirable behaviors include outbursts, physical threats, and passive activities such as refusing to perform an assigned task or an uncooperative attitude. |
| In 2016 JACHO added | A code of conduct outlining the acceptable and inappropriate/unacceptable behavior. A process for managers to handle disruptive or unacceptable behavior. Education of all team members on expected professional behavior, and zero tolerance for unacceptable behaviors, meaning all persons are held accountable |
| Techniques for Preventing Crisis | Manage the environment. Have planned activities (groups, cards, casual convo), schedule one to one interactions (showing genuine interest). Offer opportunity for problem-solving conflict resolution (assertive communication, negotiation). Consider safety of other patients (psychosis, hyperactive, intoxicated = close supervision) |
| De-Escalation Techniques in the Triggering Phase | Approach in a nonthreatening, calm manner. Convey empathy, encourage verbal expression of angry feelings. Use clear, simple, short statements. Allow client time to self-express. Suggest a quiet area, or move patients. Offer PRN meds if orders. Suggest physical activity or relaxation techniques, such as walking |
| De-Escalation Techniques in the Escalation Phase | Take control. Provide directions in a firm, calm voice. Direct client to time-out in a quiet room or area. Communicate that aggressive behavior is not acceptable. Offer medication if refused in triggering phase. Show of force by calling for assistance. |
| De-Escalation Techniques in the Crisis Phase | Take charge of the situation for safety. Restraints. Only staff with training should participate in restraint. Four to six trained staff members are needed. Inform client that behavior is out of control and staff is taking measures for safety |
| Techniques in the Recovery Phase | Talk about the situation or trigger. Help client relax or sleep. Help explore alternatives to aggressive behavior. Assess and document any injuries, debrief staff. Encourage other clients to talk about feelings (do not discuss aggressive client in detail with other clients) |
| Techniques in the Postcrisis Phase | Remove patient from restraint or seclusion as soon as criteria is met. Calmly discuss the behavior (no lecturing or chastising). Give client feedback for regaining control. Reintegrate client as soon as they are able to participate |
| Nursing Process Working with Patients with Anger Problems (Factors that Influence Aggression) | Not feeling heard, lack of space/privacy, not enough activity/groups, not enough staff support, not enough quality sleep. |
| What is the best predictor of future behavior | History of violent or aggressive behavior is the best predictor of future behavior. |
| Nursing Process Working with Patients with Anger Problems (Early Identification) | Monitor for cues in what the patient is saying, change of voice (pitch, volume, rate, rhythm), change in facial expressions, change in behavior. The patient may be pacing, have muscle tension, increased breathing, sweating, yelling, getting loud, restless |
| What is the number one priority/goal of treatment | SAFETY no injury to self, others, and no destruction of property |
| Triggering Phase | An event or circumstance that initiates the client's response, which is usually anger or hostility. Symptoms can include restlessness, anxiety, irritability, pacing, muscle tension, rapid breathing, perspiration, loud voice, and anger. |
| Escalation Phase | Responsive behaviors indicating movement towards the loss of control. Symptoms include pale or flushed face, yellowing, swearing, agitation, threatening, demanding, clenched fists, threatening gestures, hostility, loss of ability to problem solve or think clearly |
| Crisis Phase | Emotional and Physical loss of control. Symptoms include loss of emotional and physical control. Throwing objects, kicking, hitting, spitting, biting, scratching, shrieking, screaming, and inability to communicate clearly |
| Recovery Phase | The client regains physical and emotional control. Symptoms include the lowering of voice, decreased muscle tension, clearer and more rational communication, physical relaxation |
| Postcrisis Phase | Client attempts reconciliation with others and returns to the level of functioning before the aggression. Symptoms include remorse, apologies, crying, quiet, and/or withdrawn behavior |
| Nursing Process in Patients with Anger Problems (Outcome) | Patient will not harm self or threaten others. Refrain from intimidating/frightening behaviors. Describe feelings and concerns without aggression. Comply with treatment |
| Kleptomania | Impulsive repetitive theft of items not needed by a person, either for personal use or monetary gain |
| Pyromania | Repeated, intentional fire-setting |
| Oppositional Defiant Disorder (ODD) | Enduring pattern of uncooperative, defiant, disobedient, and hostile behavior towards authority figures, without major antisocial violations |
| Conduct Disorder | Persistent behavior that violates societal norms, rules, laws,, and the rights of others. These children and adolescents have significantly impaired abilities to function in social, academic, or occupational areas. |
| Disruptive Behavior | Problems with the person's ability to regulate his or her own emotions or behavior. They are characterized by persistent patterns of behavior that involve anger, hostility, and/or aggression towards people and property. Includes both ODD, and IED. |
| Signs & Symptoms of Oppositional Defiant Disorder (ODD) | Uncooperative, defiant, disobedient, hostile behavior towards authority figures. Limited ability to make a connection between behaviors and consequences. Will present with low self-esteem/self-concept, decreased social skills, poor problem-solving skills, deceitful, aggressive, deficient in flexibility of thinking and decision making |
| Signs & Symptoms of Intermittent Explosive Disorder (IED) | Repeated episodes of impulsive, aggressive, violent behavior, angry verbal outbursts, that last less than 30 minutes. Often express remorse, guilt, and embarrassment after outburst. The outbursts typically come on quickly without warning, and can be triggered by a minor issue/event/occurrence, and results in rage, aggression, and even assault or destruction of property. |
| Signs & Symptoms of Conduct Disorder | Aggression to people and animals, destruction of property, deceitfulness and theft, serious violation of laws and rights of others. May engage is reckless and risky behaviors (sex, drinking alcohol, smoking, drug experimentation, theft, burglary, vandalism). Can be mild, moderate, or severe. Does not care about doing well in school, sports, etc. No empathy or remorse. |
| Principles of Limiting Setting | Help to avoid power struggles, and promotes consistency with parents and staff. Limits need to be set, and enforced with consistency. Inform them of the limit, explain consequences, and state expected behavior. This leads to improvement of coping skills, self-esteem, promotes social interaction, provides client and family education, and consistent daily routines,. |
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