ch 16 anger

molding

-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 child's life.

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

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

assessing risk factors

-Prevention is the key issue in the management of aggressive or violent behavior. -Three factors are important considerations in identifying extent of risks: --Past history of violence --Client diagnosis --Current behavior --Considered the most widely recognized risk factor for violence in a treatment setting.

Certain 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

biochemical factors

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

introduction

-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.

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

characteristics of anger

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

aggression

-Is one way that individuals express anger -Is a behavior that is intended to threaten or injure the victim's security or self-esteem -Can cause damage withwords, fists, or weapons, but it is virtually always designed to punish

characteristics of aggression

-Loud voice, shouting, use of obscenities -Argumentative -Increased agitation -Overreaction to environmental stimuli -Panic anxiety leading to misinterpretation of the environment -Disturbed thought processes -Suspiciousness -Disproportionate anger

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 -positive and negative functions.

The most common client diagnoses associated with violence include:

-Substance use disorders -Schizophrenia -Major depression -Bipolar disorder -Neurocognitive disorders -Antisocial, borderline, and intermittent explosive personality disorders

Techniques for dealing with aggression include:

-Talking down -Physical outlets -Medications -Call for assistance -Restraints -Observation and documentation -Ongoing assessment -Staff debriefing

anger

-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).

environmental factoras

-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 anabolic steroids --Availability of firearms

After repeated requests for a client to unpack and get settled on the psychiatric unit, the client states, "I have no intention of unpacking and staying on this unit." To avoid a confrontation, the nurse unpacks the client's belongings. Which nursing behavior is exemplified? A. Positive role modeling B. Negative operant conditioning C. Assertiveness D. Aggressiveness

Correct answer: B This situation illustrates negative operant conditioning. The client's negative behavior has been reinforced and rewarded by the nurse's action of unpacking for the client.

A client has not received what was expected for lunch and directs an angry verbal outburst at the nurse. Which is an accurate description of this display of emotion? A. Anger is a primary emotion that is automatically experienced. B. Anger is a psychological arousal. C. The expression of anger can come under personal control. D. The expression of anger and aggression are closely related

Correct answer: C The expression of anger can come under personal control and is a learned behavior.

An angry client states to the nurse, "You red- headed skinny witch. You can't tell me what to do." Which appropriate intervention would the nurse implement during this outburst? A. Reprimand the client for poor judgment and derogatory remarks. B. Respond to angry expressions with matching verbalizations. C. Offer support by the use of empathy and therapeutic touch. D. Ignore initial derogatory remarks.

Correct answer: D During expressions of anger and aggression, ignoring initial derogatory remarks can be an appropriate nursing intervention. Lack of feedback often extinguishes an undesirable behavior.