“HOW TO DEAL WITH

AGGRESSIVE BEHAVIOURS”

Department of Nursing Educational Services

OBJECTIVES:-
By the end of the session participants will be
able to:
 Explore each others feelings about anger.
 Define anger
 Describe the cycle of development of anger
and its expression.
 List characteristics of aggressive client.
 Recall physical dimensions of anger.
 Rationalize the necessity of anger.
 Select techniques to over come anger.
 Identify reasons of patient aggression.
 Describe the techniques to deal with angry
client.
EXERCISE:-

Changing your feelings.

 The things I get angry about are?

 What do I do when I get angry?

 The assumptions I am making that cause

me to be angry are?
(David W. Johnson 1933)
DEFINITIONS

 Anger is a normal, healthy emotion that

serves as a warming signal and alerts us to
potential threat or trauma.

 Aggression is a behavior intended to

threaten or injure the victim’s security or
self-esteem. It means ‘to go against,’ ‘to
assault,’ or ‘to attach.’ It is a response
which aims at inflicting pain or injury on
objects or person. (Townsend 2003)
 THE DEVELOPMENT AND EXPRESSION OF ANGER.
Threat or need

Stress

Anxiety

Anger

No resolution of anger Getting it off chest or clearing the air

Chronic hostility
Inward anger Outward anger
 
Depression Aggression violence
physical illness
(Adopted from Rawlins, R. P 1993)
PREDISPOSING FACTORS TO ANGER
AND AGGRESSION
 Role modeling
 Operant conditioning
 Neurophysiological Disorders
 Biochemical factors
 Socioeconomic factors
 Environmental factors
CHARACTERISTICS OF CLIENT
WITH AGGRESSION
 Tense muscles clenched fists
 Facial reddening
 Loud or rapid speech
 Laboured or rapid breathing
 Intense facial expression of fear, anger
or hostility
 Insulting remarks or threats.
 Violent gestures.
 Verbal or physical threats
 Pacing
 Throwing or striking objects or people
 Self-mutilation
PHYSICAL DIMENSIONS OF
ANGER
 Low / high BP
 Palpitations
 Headache
 Vertigo
 Excessive sleep or no sleep
 Shivering
IS ANGER NECESSARY

 By expressing anger feelings appropriately we

release negative feelings. Thus making anger
is a very useful emotion.
 Blocked anger results in rage, anxiety, fear,
guilt or depression.
 Anger is spontaneous energy that promotes
new learning.
 Expression of anger is necessary but up to a
certain point. Beyond this point, anger is not
only unnecessary, it is destructive.
The key in understanding anger

 Why that person is angry &

acknowledging their anger.
 Understanding does not mean agreeing
with that person.
 Understanding the emotion behind the
angry expression can soften the urge to
overpower or argue.
TECHNIQUES TO OVER COME ANGER
 The only way we can control our anger is by
making a firm commitment that we will not get
angry. We are responsible for our behavior,
regardless of what the other person says or does.

Other techniques are:

 Change positions (if we are standing then sit
and vice versa)
 Deep breathing exercises
 Calming statements to self (it’s ok, calm down,
it’s not that bad)
 Slowly count till 10
 Pleasant thoughts.
WHY PATIENTS HAVE FEELINGS
OF AGGRESSION

 Patients may react aggressively in an

attempt to regain control.
 Hospitalized patients may feel
threatened by unpredictable events such
as unexpected CT SCAN or a
catheterization.
 Decreased control over decision making
 Painful and intrusive procedures
 The combination of severe illness and
the nature of the hospital environment.
 Feelings of neglected as patients.
 The warmth of human touch is often
missing.
 Violence against staff.
 Patients are treated as mindless or
ignorant objects for expert staff.
 Out dated working systems or
overworked staff.
 Convenience of the consultant or
medical staff, not the patients.
DEALING WITH ANGRY CLIENT

 Maintain a calm, direct and non-challenging

attitude.
 Be clear and listen to the client.
 Stand at a distance of at least an arm’s length.
 Say what you plan to do (for example I’m here
to put in I/V,
 here’s the bedpan)
 Answer questions and receive consent before
proceding.
 Do only the identified task and leave the room.
 Prevent physical harm e.g. restraint.
 Set limits
 Focus on what you can control. Stay calm
viewing the angry persons behavior,
objectively allows you to “hear” the hidden
message that they are trying to send.
 Nurses should be protecting themselves rather
than attempting to fight.
 Get buddied with another staff.
 Develop a contextual understanding of the
presenting problems.
 Talk about the situation after the intense
emotion has passed.
 Be open-minded and avoid defensiveness. If
some of patient complaints are merit.
 Document interactions and clients behaviors.
Learn to deal with anger by:
 A acknowledging its presence
 N noticing its symptoms
 G guarding against its triggers
 E expressing it appropriately
 R resisting the desire to meet anger with
anger
EXERCISE
 Constructive attitudes I can adopt to
change these feelings to more positive
ones are.
Remember:
 Whenever you say something, it leaves a
scar. It does not matter how many times
you say yo the wound you cause through
your words stays, & is just as bad as a
physical one.

 We all grow, you can learn to grow with

your anger by accepting it as a normal &
natural emotion & allow yourself to die
from it, a little at a time.
References:
Townsend,M.C.,(2003). Psychiatric Mental
Health Nursing: Concepts of care 4th (ed.).
Philadelphia.
Anderson, K. (2000). Nursing,30 (6), 82.
 References
Laight, S. (1995). The Aggressive ward visitor: a critical
incident analysis. Nursing Times, 91 (48), 40 – 41.

Anderson, L. N., & Minarik P. (1999). Responding to

difficult patients. American Journal of Nursing 99
(12), 26 – 33.

Johnson. D. W. 91987). Humar relations and your

career. Englewood cliffs. New Jersey.

Rawlins, R. P; Williams, S. R., & Beck, C. K. (1993).

Mental health – psychiatric nursing. A holistic life-
cycle approach. 3rd (ed.). Mosby, Philadelphia.
Thank You