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

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

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

What Causes a CrisisWhat Causes a Crisis

StressStress

FearFear

AngerAnger

PainPain

Emotional strainEmotional strain

Physical strainPhysical strain

TensionTension

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

Internal Physical ChangesInternal Physical Changes

PainPain

FatigueFatigue

HungerHunger

IntoxicationIntoxication

WithdrawalWithdrawal

CravingsCravings

ADHDADHD

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

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

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

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

Crisis PhasesCrisis Phases

Pre-crisisPre-crisis

EscalationEscalation

Active CrisisActive Crisis

Post CrisisPost Crisis

Pre-CrisisPre-Crisis

Emotionally StableEmotionally Stable

Problem Solving AbilitiesProblem Solving Abilities

Exhibits state of functioning normallyExhibits state of functioning normally

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

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

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

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

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

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”

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

Internal Active CrisisInternal Active Crisis

FrustrationFrustration

AngerAnger

AnxietyAnxiety

AgitationAgitation

HopelessnessHopelessness

Stress overwhelmingStress overwhelming

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”

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

Key Removing ConceptsKey Removing Concepts

May become hypersensitiveMay become hypersensitive

The threat of lossThe threat of loss

Logical choicesLogical choices

Acting outActing out

Post Crisis Phase Post Crisis Phase

Decrease of energyDecrease of energy

Abilities may dropAbilities may drop

InterventionsInterventions

Legal ConsequencesLegal Consequences

Making threatsMaking threats

Aggressive behaviorsAggressive behaviors

Reality checksReality checks

ArrestArrest

Criminal chargesCriminal charges

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

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

Crisis Development Crisis Development Four phases in developmentFour phases in development

Pre-crisisPre-crisis

EscalationEscalation

Active crisisActive crisis

Post crisisPost crisis

StarStar

Making effective decisionsMaking effective decisions

Being uniqueBeing unique

Think, See, RespondThink, See, Respond

Prevent conflictPrevent conflict

StarStar

Making effective decisionsMaking effective decisions

Being uniqueBeing unique

Producing effective interventionProducing effective intervention

Think , see ,then respondThink , see ,then respond

Prevent conflictPrevent conflict

The ClientThe Client

Old Old

YoungYoung

The EnvironmentThe Environment

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