Question

Discussion Topics, Mohr

Chapter 32, Anger and Aggression

Discussion Topics	Learning Objective
1. Anger is an emotion that everyone experiences at some time in their life. What situations usually make you angry? How do you handle your anger? Are you satisfied with your ability to control your anger? If not, what could you improve? Have you ever felt angry with a client? Analyze this situation. What was the specific client behavior? What did you say to the client? How does this situation remind you of other situations in which you became angry? What other emotions did you feel? What are some factors that could increase the risk of anger, aggression, and violence in the psychiatric setting? What role does the inpatient healthcare environment play when conflict aggression and violence occur?	1, 2
2. Kyle is a 42-year old man that has been admitted to a psychiatric-mental health facility with bipolar disorder. Kyle became frustrated and aggravated when he and another client were playing a game and he was losing. He picked up a book and threw it at another client. Compare and contrast the different cognitive behavioral interventions for an aggressive client. Discuss the controversies associated with the use of restraint and seclusion. Discuss the legal issues associated with restraint and seclusion.	3, 4
3. You are a nurse working in a psychiatric-mental health facility. One of the clients you are caring for is becoming increasingly angry and aggressive. What signs of escalating aggressiveness would you look for? What actions would you take to ensure your safety and the safety of other clients?

Answer 1

1. Yes ,I have got angry many times in life till now . Its one of my weakness . I get irritated and angry when a person mess up my work , when they don't do their work properly on behalf of my absence. Its just that when people don't do there responsibility or duty properly and it affects my work ,I get angry on them .

When I get angry I just tell them that it's not the way to do the work and then I don't talk to them until my mind calms down .

No, I am not satisfied by the way I handle my anger . As I have said above its one of my weakness and negative point . I want to improve my tactics to deal with my anger and I have started doing meditation and yoga to control my anger so that I can deviate or use that energy in a positive way for some other work .

Yes , I have got angry on one patient who was continuously irritating me by telling abusive words just because I haven't allowed him to smoke and he wasn't a psychiatric patient ,was an elderly patient . Initially I didn't said anything to him based on my ethics and keeping mind my duty and his age , but when he wasn't allowing me give his medications and injection ,he was just using bullahit terms that too in higher volume ,I got angry and informed the chief incharge and consultant about this . That patient was not interested in the treatment and was given LAMA. It was an bad and a memorable experience in my professional life . In this case it was totally patients fault and as compared to other situations where I become angry is nothing infront of this .

I was feeling very bad and disrespected at the time ,that we nurses serve the patient as one of our family members and in return this behaviour is not accepted .

Factors which could increase the risk of anger , aggression are :-

- seeing a person whom you don't like

- violence

- forcing an activity

- working against the normal behaviour

- memory of some bad experiences

The role of inpatient healthcare environment while a conflict aggression and violence is a very critical and important part of patient care . This includes :-

- healthcare member should be with the patient

- patients should not be left alone

- patients should be under strict monitoring

- all hazardous and injurious equipments from the patients surrounding should be removed .

- use of restraints only under doctors order and if the patient is not getting controlled by medicines

- if restraints are used then hourly evaluation of the restraint.sites for assessment of any neurovascular complications .

2. The different cognitive behavioral interventions for aggressive patients are :-

Cognitive behavioral interventions are done to assess the psychological problems at cognitive level and do the analysis of thoughts , feelings , experiences , memories etc . It is short term psychological therapy to change way of thinking

Types are:-

- Structured cognitive behavioral training

- Moral reconation therapy

- Street inoculation training

Restraints are the physical ,chemical restraints used to restrain a patient during any procedure to maintain proper Position and alignment . In psychiatric ward it is used to prevent the patient from injuring themselves and others .

Seclusion is a process of keeping a patient in a separate room away from the ward patients . Both of these interventions are used when the patient creates violence and is not controlled by medicines and on doctors order .

Use of restraints and seclusion is a controversial matter and is done under doctor order and pre consent is taken from Patient and family and 24 hourly neurovascular assessment is done . The controversy is that it should not be used until the patient cause violence and harm himself or other. Sometimes healthcare professionals use restraints when the patient is not following their order and also without doctor's order and consent which is not encouraged and is also against the principles and rules .

Restraints and seclusion must be used but only when individual is trying to harm himself or others.

The legal issues associated with restraints and seclusion are :-

- under doctors order only it will be applied

- consent has to be taken from the patients relative and duly signed by doctor and witness

- new consent and written order must be taken every 24hour to continue restraints

- Patients should not be left alone

- Monitoring of patient every one hourly has to be done .

3. Signs of escalating angression are:-

- increasing the volume of speech

- keeping quit

- destruction of articles

- snatching the bed

- talking irrelevant and abusive

For the safety of ourself and other patients of the patient becomes violent ,the duty doctor would be informed on call and ask for restraints application .