Client’s Response to Illness
Legal and Ethical Issues
Anger, Hostility, and Aggression
Anger, Hostility, and Aggression cont
Anger, Hostility, and Aggression cont
100
Age, growth, development Effect on coping with illness Expression of illness Erikson’s states of psychosocial development Adult developmental tasks Genetics, biologic factors Physical health, health practices Healthier = better coping with stress or illness Response to drugs Differences in ethnic groups related to metabolism, efficacy Slower metabolism = need for lower doses Self-efficacy Hardiness (commitment, control, challenge) Resilience Resourcefulness Spirituality
What is an individual response to illness
100
Civil commitment Laws determined by each state Knowledge of laws of state of practice necessary Detention in facility for 48 to 72 hours on emergency basis Then hearing to determine possible commitment to facility Persons held without consent presenting with imminent danger to self or others Proven at hearing if person is to be committed
What is Involuntary Hospitalization
100
Normal human emotion Handled appropriately, a positive force for resolving conflicts, solving problems, making decisions Body physically energized for self-defense (“fight-or-flight” response) Expression inappropriate or suppressed: negative force Physical or emotional problems; interference with relationships Possible hostility, aggression
What is Anger
100
Neurobiologic theories Possible role of neurotransmitters: decreased serotonin; increased dopamine, norepinephrine Structural damage to limbic system; damage to frontal or temporal lobes Psychosocial theories Failure to develop impulse control Inability to delay gratification
What are the Etiology of Hostility and Aggression
100
Most effective, least restrictive when implemented early in cycle of aggression Environmental management Planned activities; informal discussions Scheduled one-to-one interactions (letting patients know what to expect) Assistance with problem solving or conflict resolution to avoid expression of anger Safety of other patients Aggression management: triggering phase Approach in nonthreatening, calm manner Convey empathy; listening Encourage verbal expression of feelings Suggest patient go to a quieter area Use PRN medications Suggest physical activity such as walking
What are interventions
200
Beliefs about causes of illness Factors in cultural assessment Communication Physical space or distance Social organization Time orientation Environmental control Biologic variations Socioeconomic status, social class
What is Cultural factors influencing Illness
200
alleviate or increase feeling of anger
What is Catharsis
200
Is the following statement true or false? Hostility and aggression are terms that can be used interchangeably.
What is False Rationale: Hostility and aggression are two different terms. Hostility means verbal aggression. Physical aggression involves attack on or injury to another person or destruction of property.
300
Is the following statement true or false? Cultural factors include hardiness and resilience. False Wgat should it be
What is the patient’s beliefs about health and illness
300
right to request discharge at any time Release unless danger to self or others; if such danger present, then commitment proceedings instituted Patients no longer dangerous discharged from hospital
What is Voluntary hospitalization
300
verbal aggression, usually when feeling threatened or powerless
What is Hostility
300
Lithium: bipolar and conduct disorders; mental retardation Carbamazepine or valproate: dementia, psychosis, personality disorders Atypical antipsychotics: clozapine, risperidone, and olanzapine: dementia, brain injury, mental retardation, personality disorders Benzodiazepines: irritability and agitation in older adults with dementia Haloperidol and lorazepam: decrease agitation or aggression and psychotic symptoms
What are treatment meds modalities
300
Is the following statement true or false? A patient with a history of violent or aggressive behavior is more likely to exhibit similar behavior in the future
What is True why Rationale: A history of violent or aggressive behavior is one of the best predictors of future aggression
400
Communication slow with many pauses Rushing speaker or interrupting viewed negatively Flexible orientation to time Reluctance of family members to provide patient information (violation of patient’s privacy)
What is American Indians or Native Americans
400
Conditional release or outpatient commitment Continued participation in treatment on involuntary basis after release from hospital into community Examples: taking prescribed medications, keeping appointments with health-care providers for follow-up, attending specific treatment programs or groups
What is Mandated Outpatient Treatment
400
attack on or injury to another person; destruction of property
What is Physical aggression
400
The nurse should include this as part of the ? Factors influencing aggression in psychiatric environment/unit milieu Individual patients (history of violent or aggressive behavior in past and how patient handles anger) Patient’s behavior to determine phase of aggression cycle
What is part of nursing process (documentation)
400
Inform patient that behavior is out of control, and staff is taking control to provide safety and prevent injury Use of restraint or seclusion only if necessary
What is Aggression management: crisis phase
500
Greet with smile, direct eye contact, social comment about family or patient Family as collective decision maker (father, eldest son, uncle, husband as family spokesperson) Human concerns valued more than adhering to schedule Mental illness due to fear, manipulation, God’s will, or loss of country, family, or friends Mental illness has stigma; treatment sought only when all other remedies fail
What is Arab Americans
500
Legal guardianship; separate from civil commitment for hospitalization Grave disability Incompetency Inability to provide self with food, clothing, shelter Inability to act in own best interests Consent to be obtained from legal guardian who speaks for patient
What is Conservatorship/Guardianship
500
Paranoid delusions Auditory hallucinations Dementia, delirium, head injuries Intoxication with alcohol or other drugs Antisocial, borderline personality disorders Depression Intermittent explosive disorder Acting-out behaviors
What are Related Disorders of Anger, Hostility, and Aggression
500
patient will Not harm self or threaten others Refrain from intimidating/frightening behaviors Describe feelings, concerns without aggression Comply with treatment
What is outcome identifcation
500
Talk about situation or trigger Help patient relax or sleep Explore alternatives to aggressive behavior Provide documentation of any injuries Debrief staff
What is recovery phase
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