Nursing Care: Abuse, Aggression, Violence & De-escalation

What is abuse?

Systematic strategies used to obtain dominance and control over others.

What are the types of abuse?

Psychological, Physical, Emotional, Economic, Sexual.

How does anger differ from aggression?

Anger is an internal intense emotion, while aggression is an external action intended to harm.

What are some harmful effects of unrestrained aggression?

Hypertension, headaches, insomnia, digestive issues, and possibility of harm to self and others.

What are common displays of anger?

Cursing, sarcasm, yelling, breaking objects, or making a fist.

What is displacement in the context of aggression?

Expressing anger toward a different target, such as a partner or child, instead of the actual source of anger.

What is undoing in the context of abusive behavior?

Emotionally abusing a partner but then compensating with gifts or kind gestures.

What are some risk factors for abuse, aggression, and violence?

History of violence, mental health disorders, being a victim of crime, witnessing abuse, poor self-esteem, and adverse childhood experiences.

What are Adverse Childhood Experiences (ACEs)?

Potentially traumatic events experienced by a child before age 18 that can affect them later in life.

What is intimate partner violence?

Physical, sexual, stalking, or psychological aggression by a current or former partner or spouse.

What are the three phases of intimate partner violence?

1. Build-Up, 2. Acute Battering, 3. Honeymoon/Reconciliation.

What occurs during the Build-Up phase of intimate partner violence?

Tension increases, breakdown in communication occurs, and arguments escalate.

What characterizes the Acute Battering phase?

Abusive acts filled with rage and intensity, often involving law enforcement.

What happens during the Honeymoon/Reconciliation phase?

The perpetrator becomes affectionate and apologetic, promising to change.

Who is most at risk for elder abuse?

Individuals who are dependent on others for daily care, including those with cognitive impairments or physical disabilities.

What constitutes rape?

Forced sexual intercourse, including both psychological coercion and physical force.

What is the difference between rape and sexual assault?

Rape involves forced sexual intercourse, while sexual assault involves unwanted sexual contact.

What is stalking?

Unwanted attention, such as threats or harassment, often involving individuals known to the victim.

What are common approaches used by stalkers?

Following, obtaining entry into the victim's space, and making nuisance calls or messages.

What is statutory rape?

An adult having sex with an individual younger than 18 years of age, even if the minor consents.

What types of threats can survivors experience?

Verbal, fondling, or grabbing.

What is an important consideration for the physical location of an interview?

The presence of who will be there is important.

How should nurses approach survivors during interviews?

Gradual and nonthreatening.

What are some common emotional responses of survivors during interviews?

Memory loss, emotional reactivity, and telling several versions of their story.

What is the role of a forensic nurse?

To provide care for survivors of violence and assist in investigations.

What is client-centered care?

Equitable and sensitive care that develops a therapeutic relationship.

What can aggression in clients signify?

Distress or unmet needs.

What should be prioritized when managing agitation in clients?

Safety and preventing harm to self and others.

What is the first step in de-escalation techniques?

Verbal de-escalation should be used first if possible.

What should nurses do to manage an agitated client?

Remove the client from what may be annoying them and allow space.

What is the purpose of restraints in nursing?

To mitigate danger to self, client, or others when less restrictive measures fail.

What must be included in a prescription for restraints?

Reason for restraint, length of time, type of restraint, and criteria for removal.

What are some considerations for clients in seclusion?

Clients should not be left alone and must be assessed hourly.

What should be documented regarding seclusion and restraints?

All viewpoints and descriptions of episodes involving seclusion and restraints.

What are some pharmacologic interventions for managing aggression?

Antipsychotics, mood stabilizers, anticonvulsants, and antidepressants.

What is the role of a Sexual Assault Nurse Examiner (SANE)?

To conduct forensic examinations of sexual assault survivors.

What is the importance of situational awareness in nursing?

To avoid escalating situations and ensure safety.

What should be done if restraints are applied?

Range of motion exercises should be executed every 2 hours.

What is a key aspect of evaluating outcomes after using restraints?

Debriefing and discussing any misperceptions with the client.

What should be done to promote a therapeutic environment?

Clients need to feel safe and supported.

What is the significance of understanding a client's history?

To recognize previous occurrences of violence or abuse.

What factors can influence a client's propensity for violence?

Age, gender, socioeconomic status, and recent stressors.

What is the purpose of debriefing after a restraint episode?

To provide support and identify different approaches to prevent future incidents.

How should nurses respond to clients exhibiting aggressive behavior?

Respond in a calm manner and avoid displaying anger.

What is the role of physical activity in de-escalation?

It can help manage agitation and reduce aggressive acts.

What should nurses do to respect a client's personal space?

Engage respectfully and maintain a calm demeanor.