Understanding Aggression and Violence in Healthcare Settings

Anger

A normal human emotion triggered by frustration, injustice, o

Aggression

A maladaptive behavioral response to anger that can include

Violence

Extreme form of aggression where there is the deliberate use

Common settings for hospital violence

Emergency rooms, psychiatric units, geriatric wards, and inte

Comorbidities associated with violence

Patients with PTSD, bipolar disorder, depression, or psychosis

Inflammation and aggression

Anger and chronic hostility have been linked to increased infl

Genetic and neurobiological risks

Certain genes and brain injuries (especially to limbic and fron

Neurotransmitter involvement

Imbalances in serotonin, dopamine, and GABA are implicated

Behavioral theory

Aggressive behavior can be a learned response reinforced ov

Social learning theory

Individuals may imitate aggressive behavior observed in othe

Trauma-informed assessment

Incorporates awareness of a patient s past trauma to avoid re

Signs of escalation

Pacing, clenched fists, intense staring, loud voice, suspicious

De-escalation techniques

Use calm tone, nonthreatening body language, active listenin

Risk for violence nursing diagnosis

Applies when patient exhibits behaviors or history indicating

Impaired impulse control

Lack of ability to resist emotional impulses, leading to unpred

Stress overload

Excessive stress beyond coping capacity, often seen in patie

Outcomes of aggression care

Patient demonstrates self-control, uses verbal expression to h

Health promotion

Teaching patients relaxation techniques, problem-solving, an

Seclusion definition

The involuntary isolation of a patient in a locked room for the

Mechanical restraint definition

Physical or mechanical device that restricts freedom of move

Criteria for restraints

Used only when patient poses immediate danger to self or ot

Restraint legal guidelines

Requires physician order, continual monitoring, documentatio

Restraint monitoring

Includes circulation, skin integrity, respiratory status, and em

Debriefing after restraint

Discusses with the patient what led to the incident, how it co

Pharmacologic management

Includes use of antipsychotics (e.g., haloperidol), mood stabi

Special populations

Patients with cognitive impairments or poor coping may requ

Cognitive deficit patients

May misinterpret environment, become frustrated easily, and

First priority after restraint

Ensure physical safety and address immediate medical and p

Valid reason for restraint

Physical aggression toward staff or others; not justified for ve

Clinical triggers of aggression

Paranoia, hallucinations, previous trauma, overstimulation, a

General assessment for aggression

Observe patient's verbal and nonverbal cues, tone of voice, p

Trauma-informed care in assessment

Approach the patient with awareness of past trauma; avoid la

Self-assessment for nurses

Nurses must be aware of their own emotional responses to a

Assessment: risk factors for aggression

Include history of violent behavior, psychiatric comorbidities

Assessment: verbal cues of escalation

Yelling, cursing, rapid speech, paranoid or accusatory statem

Assessment: nonverbal cues of escalation

Clenched fists, pacing, restlessness, increased muscle tensio

Assessment: affect and thought content

Evaluate for signs of paranoia, delusions, hallucinations, or d

Assessment questions: patient perception

Ask open-ended questions like 'What s making you feel this w

Assessment of coping mechanisms

Identify whether the patient uses healthy coping strategies s

Assessment of support systems

Determine if the patient has family, friends, or community su

Indicators for seclusion or restraint

Patient poses imminent threat to self or others, is not respon

Clinical assessments during restraint

Monitor circulation, respiratory status, level of distress, and m

Post-incident assessment

After restraint, debrief the patient to identify triggers, alterna

Assessment of chronic risk

Evaluate for ongoing risk by reviewing history of aggression,

Mr. Otis case: key assessment points

History of PTSD, intermittent psychosis, and recent paranoia.