NURS310 Lecture Notes - Lecture 8: Tachypnea, Benzodiazepine, Hypotension
22 Jun 2018
School
Department
Course
Professor
Aggression
Objectives
The student will:
Describe common causes for escalating aggression
Describe nurse characteristics necessary to effectively de-escalate aggression
Describe the phases of escalating aggression
Describe de-escalation strategies for intervening with aggressive behaviour
Aggression Defined
Emotion that results in verbal or physical attack
Broader term than violence
Reactive or hostile aggression is violence
Aggression maybe instrumental for self-protection or to achieve a goal (Varcarolis)
Workplace Violence Defined
Any act where a person is abused, intimidated, threatened or assaulted in their work (Canadian
Centre for Occupational Health and Safety, 2017)
Includes threatening behaviors, verbal or written threats, verbal abuse, physical attacks such as
hitting, shoving, pushing or kicking, spreading rumors, swearing, psychological trauma, property
damage, harassment and bullying (Canadian Centre for Occupational Health and Safety, 2017)
Includes intent to harm (Varcarolis, 2014)
Statistics
Incidence workplace violence RN’s – AB & BC – 2001 Survey
Nearly half (46%) experienced 1 or more types of violence in the last 5 shifts worked
Emotional abuse 38%, threat of assault 19%, physical assault 18%, verbal sexual harassment
7.6%, sexual assault 0.6%
Emotional abuse – sources were evenly distributed (patients, families, co-workers, physicians)
(Duncan, et.al., 2001)
RPN Survey Saskatchewan (2008) – Physical Attacks
70% reported physical attacks
Of these, only one individual felt that this was not a typical incident in their workplace.
All physical attacks were attributed to patients
3rd Year Nursing Students – rates of physical aggression
An unpublished survey at a nursing school revealed that after two years into nursing education
all students (n = 63) had experienced at least one aggressive incident by a patient in the work
placement in the last 12 months
The mean of all reported occurrences was 40 for patient aggression and 11 for aggression
perpetrated by relatives (Nau, Dassen, Halfens & Needham, 2007)
Workplace Bullying
Workplace Bullying – RPN Survey Saskatchewan
27.8% of the study participants reported being bullied or mobbed
Of these, 84% identified a co-worker or supervisor as the perpetrator of the abuse
Consequences of Workplace Violence - All Types
The Canadian Initiative on Workplace Violence (2007) - depression, increased stress, anger,
decreased self-worth, fear, headache, nausea, weight loss, irritability, and self-doubt
find more resources at oneclass.com
find more resources at oneclass.com
Stadnyk (2008) - anxiety, depression, interpersonal sensitivity, and somatic complaints (i.e.
headaches, chest pain, muscles aches)
Bullying - There was a relationship between bullying and probable PTSD such that nurses who
were bullied were also more likely to have PTSD (Stadnyk, 2008)
Bullying or Horizontal Violence Consequences
Stress, fear, and loss of confidence in the victim (Thomas, 2010)
Increased costs for sick time and health-care plans
Increased absenteeism
Lower productivity
stress-related illness and high turnover
Decreased capacity to offer effective nursing care
Increased costs for recruitment and retention
Diminished sense of professional competence with potential to compromise patient/client
health outcomes
Patient Aggression
Co-Morbidity
Greater association for violence when there is alcohol and drug abuse
Those who have acute mental health disorders in withdrawal or co-occurring substance use are
at greatest risk for violent acting out (Varcarolis, 2014)
Etiology
Assessment
Adaptive vs Maladaptive
Aggression or violence
Assessment – Pre-assaultive
Feelings – frustration, fear, anxiety, embarrassment, shame, rejection, irritability,
hypersensitivity or perceived criticism
Voicing – lack of control, defiance, need for support of anger from others
Behaviors – hyperactivity, impulsivity, withdrawal, confusion, delusions, intoxication,
rumination, sullenness, pacing
Assessment - Assaultive Stage
Voicing – verbal abuse, voice loud, negative or hostile response
Thinking - Diminished ability to - recognize anger, diffuse own anger - Inability to differentiate
between assertiveness and aggression - wish or intent to harm - Weapon
Behaviors
Rapid breathing or shortness of breath
Direct intense prolonged eye contact, eg. Staring or avoidant eye contact
Increased tension and anxiety - exaggerated gestures, eg. clenched fists or tensing of muscles
Hyperactivity, eg. pacing (most important predictor)
Assault
Self Assessment
• Responding with fear and a sense of being vulnerable - may result in patients being seen as
more threatening than they actually are.
• Anxiety can also result in avoiding crucial assessment questions about past violence or may
lead to assumptions
find more resources at oneclass.com
find more resources at oneclass.com
Document Summary
Describe nurse characteristics necessary to effectively de-escalate aggression. Describe de-escalation strategies for intervening with aggressive behaviour. Emotion that results in verbal or physical attack. Aggression maybe instrumental for self-protection or to achieve a goal (varcarolis) Any act where a person is abused, intimidated, threatened or assaulted in their work (canadian. Includes threatening behaviors, verbal or written threats, verbal abuse, physical attacks such as hitting, shoving, pushing or kicking, spreading rumors, swearing, psychological trauma, property damage, harassment and bullying (canadian centre for occupational health and safety, 2017) Incidence workplace violence rn"s ab & bc 2001 survey. Nearly half (46%) experienced 1 or more types of violence in the last 5 shifts worked. Emotional abuse 38%, threat of assault 19%, physical assault 18%, verbal sexual harassment. Emotional abuse sources were evenly distributed (patients, families, co-workers, physicians) (duncan, et. al. , 2001) Of these, only one individual felt that this was not a typical incident in their workplace.
