Anger/Aggression Management

Nursing 202

• 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.

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

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 with words, fists, or weapons, but it is virtually always designed to punish.

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 child’s life.

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.

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

• 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.

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.

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

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

Characteristics of anger

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

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

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

• 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

Nursing diagnoses

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