prevention & management of aggressive behavior by evelyn stone, rn., bsn. m.ed
TRANSCRIPT
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PREVENTION & PREVENTION & MANAGEMENT OF MANAGEMENT OF
AGGRESSIVE BEHAVIORAGGRESSIVE BEHAVIOR
By By
Evelyn Stone, RN., BSN. M.Ed.Evelyn Stone, RN., BSN. M.Ed.www.qprofessionalmenatalhealthservicewww.qprofessionalmenatalhealthservice
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Identifying Crisis BehaviorIdentifying Crisis Behavior
Learn to stop a crisis before it startsLearn to stop a crisis before it starts
What exactly is a crisisWhat exactly is a crisis
Maintaining a Safe EnvironmentMaintaining a Safe Environment
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What is a Crisis?What is a Crisis?
Emotional eventEmotional event
Radical change in a person’s lifeRadical change in a person’s life
Crucial timeCrucial time
Impending changeImpending change
Undesirable outcomeUndesirable outcome
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What Causes a CrisisWhat Causes a Crisis
StressStress
FearFear
AngerAnger
PainPain
Emotional strainEmotional strain
Physical strainPhysical strain
TensionTension
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What are Trigger Events?What are Trigger Events?
Initiates reactionInitiates reaction
Precipitates a reactionPrecipitates a reaction
Internal physical changesInternal physical changes
Internal mental status changesInternal mental status changesExternalExternal
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Internal Physical ChangesInternal Physical Changes
PainPain
FatigueFatigue
HungerHunger
IntoxicationIntoxication
WithdrawalWithdrawal
CravingsCravings
ADHDADHD
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Internal Mental Status ChangesInternal Mental Status Changes
Hallucinations/DelusionsHallucinations/Delusions
ConfusionConfusion
DepressionDepression
AnxietyAnxiety
Fear of Losing ControlFear of Losing Control
Perception of ThreatPerception of Threat
Psychotic DistortionPsychotic Distortion
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External TriggersExternal Triggers
Threat of loss of freedomThreat of loss of freedomChallengeChallengeLoss of AutonomyLoss of AutonomyLoss of PrivacyLoss of PrivacyFear of FailureFear of FailureChallenge to Family/relationshipChallenge to Family/relationshipLoss of jobLoss of jobChallenge to Goals/NeedsChallenge to Goals/Needs
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Triggers (continued)Triggers (continued)
Aggression occurs when one feels Aggression occurs when one feels threatenedthreatened
Emotionally brittle persons are prone to Emotionally brittle persons are prone to angeranger
Triggers are often repetitiveTriggers are often repetitive
Persons who are angry interpret closeness Persons who are angry interpret closeness as a threatas a threat
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Factors of TriggersFactors of Triggers
Some act out to get attention from staffSome act out to get attention from staff
Individuals with conduct disorder may Individuals with conduct disorder may conspire so that one client acts out to conspire so that one client acts out to create a diversioncreate a diversion
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Crisis PhasesCrisis Phases
Pre-crisisPre-crisis
EscalationEscalation
Active CrisisActive Crisis
Post CrisisPost Crisis
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Pre-CrisisPre-Crisis
Emotionally StableEmotionally Stable
Problem Solving AbilitiesProblem Solving Abilities
Exhibits state of functioning normallyExhibits state of functioning normally
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Internal ExperiencesInternal Experiences
The client feels normalThe client feels normal
Mood and Emotions are consistent with the Mood and Emotions are consistent with the situationsituation
Feel SadFeel Sad
May feel DepressedMay feel Depressed
Angry if treated unfairlyAngry if treated unfairly
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External ExperiencesExternal Experiences
Client is able to communicate & interact Client is able to communicate & interact with friends, family and otherswith friends, family and others
May be very talkative, quiet or extrovertedMay be very talkative, quiet or extroverted
Normally shyNormally shy
Will be able to complete routine taskWill be able to complete routine task
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Escalation PhasesEscalation Phases
De-escalate the clientDe-escalate the client
Avoid development of a crisisAvoid development of a crisis
When client is in vulnerable stateWhen client is in vulnerable state
Something in the environment cause emotional Something in the environment cause emotional distressdistress
Physical DistressPhysical Distress
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Internal Escalation PhaseInternal Escalation Phase
Discomfort within themselvesDiscomfort within themselves
Uncomfortable with the environmentUncomfortable with the environment
Client may feel needs are not being metClient may feel needs are not being met
May feel threatened in some wayMay feel threatened in some way
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Internal Escalation (continued)Internal Escalation (continued)
Pacing Pacing
Talking louder than normalTalking louder than normal
FidgetingFidgeting
Rapid breathingRapid breathing
Rapid speechRapid speech
Veins protrudingVeins protruding
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External Escalation PhaseExternal Escalation Phase
Ability to communicate is impactedAbility to communicate is impacted
Signs & Symptoms of stress, anger & Signs & Symptoms of stress, anger & anxiety anxiety
Others may see s/s the client is about to Others may see s/s the client is about to “act out” or “lose it”“act out” or “lose it”
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Active Crisis PhaseActive Crisis Phase
Staff is to de-escalate client and make a Staff is to de-escalate client and make a safe environment safe environment
Client feels emotionally stimulatedClient feels emotionally stimulated
Client feels hopeless and overwhelmedClient feels hopeless and overwhelmed
StaffStaff
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Internal Active CrisisInternal Active Crisis
FrustrationFrustration
AngerAnger
AnxietyAnxiety
AgitationAgitation
HopelessnessHopelessness
Stress overwhelmingStress overwhelming
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External Active Crisis PhaseExternal Active Crisis Phase
Communication is impairedCommunication is impaired
Screaming, crying, or hitting othersScreaming, crying, or hitting others
Attempting to harm selfAttempting to harm self
Kicking doors, hitting walls or trying to run Kicking doors, hitting walls or trying to run awayaway
Viewed as “Out of Control”Viewed as “Out of Control”
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Past IssuesPast Issues
Refrain from discussing past issuesRefrain from discussing past issues
‘‘Here & Now”Here & Now”
Defuse the crisisDefuse the crisis
Stabilize the immediate crisisStabilize the immediate crisis
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Key Removing ConceptsKey Removing Concepts
May become hypersensitiveMay become hypersensitive
The threat of lossThe threat of loss
Logical choicesLogical choices
Acting outActing out
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Post Crisis Phase Post Crisis Phase
Decrease of energyDecrease of energy
Abilities may dropAbilities may drop
InterventionsInterventions
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Legal ConsequencesLegal Consequences
Making threatsMaking threats
Aggressive behaviorsAggressive behaviors
Reality checksReality checks
ArrestArrest
Criminal chargesCriminal charges
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Three Abilities Affected by CrisisThree Abilities Affected by Crisis
Coping abilityCoping ability
Ability to listen or communicate rationallyAbility to listen or communicate rationally
Changes in emotional equilibriumChanges in emotional equilibrium
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Natural ConsequencesNatural Consequences
Stay up late & may be tired in the morningStay up late & may be tired in the morning
If you don’t eat your breakfast, you may be If you don’t eat your breakfast, you may be hungryhungry
Being rude to others, may cause others to Being rude to others, may cause others to avoid interacting with youavoid interacting with you
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Crisis Development Crisis Development Four phases in developmentFour phases in development
Pre-crisisPre-crisis
EscalationEscalation
Active crisisActive crisis
Post crisisPost crisis
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StarStar
Making effective decisionsMaking effective decisions
Being uniqueBeing unique
Think, See, RespondThink, See, Respond
Prevent conflictPrevent conflict
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StarStar
Making effective decisionsMaking effective decisions
Being uniqueBeing unique
Producing effective interventionProducing effective intervention
Think , see ,then respondThink , see ,then respond
Prevent conflictPrevent conflict
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The ClientThe Client
Old Old
YoungYoung
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The EnvironmentThe Environment
learlear
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