Psych Chapter 20 Reading Notes

A group of psychiatric nurses working in a community mental health center are participating in a training program for preventing and managing aggressive behavior offered regularly by the center. Which statement by the nurses indicates that the program was successful in achieving its outcome?

"We have the most up-to-date information on the best ways to handle this problem."

desired outcomes of anger management interventions

1. effectively modulate the physiological arousal of anger 2. alter any irrational thoughts fueling the anger 3. modify maladaptive anger behaviors

An angry client has just thrown a chair across the room and is racing to pick up another chair to throw. Which is the most appropriate action by the nurse?

Call for an emergency response from trained personnel.

The nurse in the inpatient mental health facility is caring for a new client with a history of aggressive behavior. Which action would the nurse take to promote safety and prevent violent behavior from this client?

Create a therapeutic milieu.

A nurse is conducting an in-service program about anger, aggression and violence for a group of staff nurses. When describing the general aggression model, the nurse addresses situational factors. Which of the following would the nurse include? Select all that apply.

Cues triggering memories of similar situations Insults or slights involved in the aggression

The inpatient psychiatric nurse removes the restraints from a client who had an aggressive episode earlier and is currently calm and rational. The client asks if they can attend the group. Which response demonstrates insight into the postcrisis phase of anger and aggression?

Encourage the client to attend with the expectation that they will remain nonaggressive.

The nurse is interviewing a client with a history of physical aggression. Which should the nurse avoid?

Explaining the consequences the client will face if control is lost Giving the client an ultimatum is likely to foster hostile or aggressive behavior; the other measures are all appropriate for a client with a history of aggression.

A nurse technician reports to the nurse manager that a new nurse refuses to inventory client belongings during admission assessments and makes belittling statements to the clients about the nurse technicians. Which consideration(s) by the nurse reflects an understanding of lateral violence? Select all that apply.

Failure to address the behavior could affect joint commission accreditation. The organization should provide a process for managing the behavior.

The nurse is preparing teaching material for a client who agrees to attend an anger management program. Which information would the nurse explain that the client will learn during this program? Select all that apply.

Modify maladaptive anger behavior. Alter irrational thoughts fueling anger. Modulate physiological arousal of anger.

A nurse's response to aggressive behavior on the unit is influenced by which characteristic of the nurse?

Self-awareness of reactions to aggression by others

Which is one of the most common nursing diagnoses for clients experiencing intense anger and aggression?

The most common nursing diagnoses for clients experiencing intense anger and aggression are Risk for Self-Directed Violence and Risk for Other-Directed Violence. The other nursing diagnoses are not the most common and may or may not apply to the specific client. Outcomes focus on aggression control.

The nurse manager is concerned about the potential for violence on a mental health care area. Which action(s) would the manager take to eliminate the environmental risk for violence and potential injuries? Select all that apply.

Use plastic coat hangers. Keep the utility room locked. Monitor while client is using razors or other sharps. Provide meals on paper dishes and plastic utensils.

A nurse is considering using restraint and seclusion for a client who is acting out. Which is the primary guideline for the use of restraint and seclusion?

Use should be limited to emergencies in which the risk of a client physically harming self, staff, or others is imminent.

catharsis

a release of emotional tension

anger

a strong uncomfortable emotional response to a provocation that is unwanted and incongruent with one's values, beliefs, or rights

maladaptive anger

anger becomes maladaptive when it is too frequent, too intense, or managed in unhealthy ways: excessive outward expression or suppression

suppressed anger is related to

arthritis, breast and colorectal cancer, chronic pain, and hypertension. also a risk factor for postpartum depression

CBT is recommended for uncontrollable anger and focuses on

avoidance of stimuli, self-monitoring regarding cues of anger arousal, stimulus control, response disruption, and guided practice of more effective anger

What would be appropriate for a client who is not a suitable candidate for psychoeducational anger management interventions?

cognitive-behavioral therapy

people with poor anger control have more

conflict at work, change jobs more frequently, take more unwise risks, and have more accidents than people with adaptive anger behavior

excessive outward directed anger is linked to

coronary heart disease, metabolic syndrome, and myocardial infarction

strategies to interrupt patters

counting to 10 using a relaxation of breathing technique removing oneself from interactions or stimuli that may contribute to increase distress (such as cooling off walk or time out) doing something different (reading, watching tv, listening to music)

risks for aggressive and criminal behaviors in adulthood

early life adversity (such as inadequate maternal nutrition, birth complications, TBI, and lead exposure

violence

extreme aggression and involves the use of strong force or weapons to inflict bodily harm to another person and in some cases kill. violence connotes greater intensity and destruction than aggression. all violence is aggressive, but not all aggression is violent

general aggression model

framework that accounts for the interaction of cognition, affect, and arousal during an aggressive episode. in this model, an episode consists of person and situation factors in an ongoing social interaction.

instrumental aggression

goal directed aggressive behavior that is premeditated and unrelated to immediate feelings of frustration or threat. it is a means to secure a goal or reward

gender, culture, and ethnic differences

in the experience and expression of anger must be taken into consideration before planning interventions

there is increasing evidence that (biologic theory)

inhibition of activity of monoamine oxidase A is related to the development of impulsivity and aggression

brain structures most frequently associated with aggressive behavior (biologic theory)

limbic system, cerebral cortex particularly the frontal and temporal lobes

impulse aggression

occurs in situations of anger and anxiety when an individual lashes out

aggression

overt behavior intended to hurt, belittle, take revenge, or achieve domination and control. it can be verbal or physical. mentally healthy people stop themselves from this by realizing the negative consequences to themselves or their relationship.

A staff development coordinator is planning to teach the use of physical management techniques when clients become physically aggressive. The coordinator should stress the importance of which technique?

practice and teamwork

psychological theories for anger

psychoanalytic theorists view emotions as instinctual drives. suppression of these drives are viewed as unhealthy. behavioral theories suggest anger was viewed as a learned response to a stimulus rather than an instinctual drive. social learning theory. in Bandura social learning theory, focus on the role of learning and rewards in the expression of aggression and violence. children seeing aggressive behavior is learned for them as a way of getting what they want.

The charge nurse is conducting a de-briefing meeting with the staff to discuss a recent aggressive episode from a client that required seclusion. Which stage of aggression would the client be in when the staff members conduct the de-briefing meeting?

recovery During the triggering phase, the nurse's focus should be on encouraging the client to express their feelings to relieve the tension felt by the client. If the client's anger continues, the nurse should take charge in the escalation phase by directing the client and offering medications. In the crisis phase, the client may need emergency medications ordered and delivered, and to be placed in seclusion and/or restraints. As the client regains control in the recovery phase, the staff may have a de-briefing meeting to discuss the situation and how to improve in the future. In the postcrisis phase, the client is removed from seclusion and/or restraints and the client will be reintegrated in the milieu.

predictors of patient violence

schizophrenia, young age, alcohol use, drug misuse, and hostile dominant interpersonal styles

the physiology of anger involves

the cerebral cortex, the sympathetic nervous system, the adrenal medulla, the adrenal cortex, the cardiovascular system, and the immune system

impaired communication such as hearing loss and reduced visual acuity, disorientation, and depression have been found to be consistently associated with aggressive behavior among nursing home residents with dementia

true

restraint and seclusion should be a last resort to protect the patient or staff and it done, within 1 hour, the practitioner must reassess the patient

true

validate the patient and provide choices for their personal preferences. the best time to teach patients techniques for managing anger is when they are not experiencing a provoking event

true

approaches for caring for patients who are aggressive or violent

using nonthreatening body language respecting the patient's personal space and boundaries having immediate access to the door of the room in case you need to leave the room leaving the door open knowing where colleagues are and making sure they know where you are removing clothing that could be used for harm such as scarves, necklaces, or dangling earrings

Intermittent Explosive Disorder

when reoccurring anger outbursts cannot be linked to an underlying medical condition. SSRIs usually used to treat this