Running head: UNDERSTANDING ANGER 1

Anger, aggression, and acting out: Understanding and caring for the patient

Christian A Pass

Brigham Young University - Idaho

UNDERSTANDING ANGER 2

Anger, aggression, and acting out: Understanding and caring for the patient

Everyone experience anger at some time during their life, and that fact is a completely

normal part of human nature. A study performed by UC Davis found that one in five Americans

struggle with anger management. Albeit anger is a normal human emotion, the loss of control of

anger produces a problem (APA, 2015).

Anger

The management of anger consist of habits and learned skills that promote the reshaping of the

mind. Common and extremely helpful management mechanisms can consist of: Thinking before

speaking, expressing the anger once calm, getting exercise, and taking self-prescribed timeouts

(Mayo Clinic, 2017)

Aggression

Preston Ni, M.S.B.A, author of "How to Communicate Effectively and Handle Difficult

People writes that managing people with aggressive behavior can be broken down into 3

interventions that help keep the situation under control: Keep your cool and maintain composure,

keep your distance and your options open, and lastly, depersonalize, and shift from reactive to

proactive. Making sure you plan ahead instead of react to a patients aggression can mean the

difference between being safe, and getting hurt.

Acting out

Andrea Mathews L.P.C. N.C.C. writes in her article titled Acting out When we display

the inside of us, it can be fear of displeasing an authority figure, intense anger, or a

passive/aggressive mix of both. We are NOT acting in. In other words, an external event,

circumstance or person cannot create an action on our parts. Rather we are always acting from

inside out. Acting out is all feelings and emotions that are rooted in the problem, identifying the
UNDERSTANDING ANGER 3

problem and focusing on holding the tension as Carl Jung coined it, comes as the balm to

outburst behavior.

Interventions for the Pre-assaultive Stage

Recognizing that the patient is beginning to exhibit angry and aggressive behavior before

they escalate allows for a minimalizing effect on the situation; lack of control and planning can

lead to exacerbations and minimal jurisdiction over the situation. The idea is to remain in control,

to have previously set limits and consequences on behavior, and to deescalate the situation as

much as possible.

Assaultive Stage

Once a patient has become assaultive and de-escalation has been ineffective, the patient

may require any one or combination of medication, restraint, and seclusion. When implementing

any of these, the goal is safety of the staff and the patient, and using the least restrictive means

first.

Post-assaultive stage

Once the situation has de-escalated it is important for staff and the patient to review the

incident in order for all to identify triggers, stressors, things learned from the situation, and future

plans in responding and preventing more incidences.

Critical Incident Debriefing

The goal of critical incident debriefing is to review the case and to ensure that adequate

care was provided to the patient by staff and also to ensure that those in the workplace have an

opportunity to decompress and let feelings they may feel out into the open to be talked about.

Nursing is dynamic and ever changing, and this means that learning when different situations
UNDERSTANDING ANGER 4

happen, it will require sometimes very unique interventions, and adaptable staff to meet the

needs of the patients.

UNDERSTANDING ANGER 5

References

American Psychological Association. (n.d.). Controlling anger before it controls you.

Retrieved June 25, 2017, from

http://www.stepupprogram.org/docs/handouts/STEPUP_Controlling_Anger_Before_It_

Controls_You.pdf

Mathews, A. (2017, August 4). Acting Out | Psychology Today. Retrieved June 25, 2017, from

https://www.psychologytoday.com/blog/traversing-the-inner-terrain/201204/acting-out

Mayo Clinic Staff. (2017, March 3). Anger management: 10 tips to tame your temper - Mayo

Clinic. Retrieved June 25, 2017, from http://www.mayoclinic.org/healthy-lifestyle/adult-

health/in-depth/anger-management/art-20045434

Ni, P. (2014, September 14). How to Successfully Handle Aggressive and Controlling People.

Retrieved June 25, 2017, from https://www.psychologytoday.com/blog/communication-

success/201409/how-successfully-handle-aggressive-and-controlling-people