AGGRESSION CYCLE

Behavior

Nursing Intervention

Triggering
Restlessness, muscle tension, anxiety, voice quality changes Flushed face, screaming, anger, agitation, threatening gestures Loss of physical and emotional control Decreased body tension, accusations, voice lowers Crying, apologies, reconciliation, repression

Empathic support Encourage deep breathing Use clear calm, simple statements Ask patient to maintain control Facilitate problem solving PRN: quiet area / prn meds Take charge and provide calm and firm direction Give patient time out in a quiet room Give prn meds as ordered Show of determination Prn involuntary seclusion, restraints or medications as ordered Provide intensive nursing care Assess patient for injuries Process incident with staff and other patients

Escalation

Crisis

Recovery

Post Crisis

Process the incident with the patient Discuss alternative to the situation and feelings Gradually decrease the degree of seclusion or restraints

RESTRAINTS

R equires physicians order; consent E mergency, get MDs order ASAP S hortest duration, least restrictive T o protect patient and others R enew order q 24hrs A ssess q 15-30 mins I ndividualized Supervision N ever use as punishment T otal documentation S eclusions as last step

ABUSE & VIOLENCE

CYCLE OF BATTERING

Tension- Building

Tolerance to the victim is dereasing Physical violence Begs for forgiveness, often use charms Goes back to this stage after several weeks or months

Acute Battering

Honeymoon

Tension Building

CHILD ABUSE

Intentional injury to a child RA 9262 RA 7610 Manefestation

Unresponsive to parent or adult Fearful to physical contact Inconsistent history or injury Lack of reaction to frightening events Uncooperative during care Accepts pain Becomes aggressive Unusually affectionate & outgoing Superficial relationship Extreme behavior

RED FLAGS OF CHILD ABUSE

Unexplained bruises Bruises of different stages Injuries reflecting shape of article used Unexplained burns Rope burns on arms, leg and neck Injuries inconsistent w/ information Unexplained lacerations, or fractures Immersion burns

ELDER ABUSE
Maltreatment of older adults by family members, significant others and caregivers 75 y/o older Physical, sexual, psychological, neglect, financial exploitation and denial of suffice medical treatment

SEXUAL ASSAULT

Rape act of aggression not passion

Date

rape & marital rape

DOMESTIC VIOLENCE

Home violence RA 9262 VAWC RA 7610 Special protection of children against child abuse 98% women- 23 y/o Father most frequent abuser THE CYCLE WILL GO ON UNLESS
The man takes responsibility of the behavior and genuinely change The woman leaves the violent situation and or takes legal steps to halt the violence and abuse

INTERVIEWING ABUSE VICTIMS

Sensitive questioning Ask relevant questions. Avoid WHY!! Avoid using words such as alleged rape Should be done in a private room

PHYSICAL EXAMINATION AND EVIDENCE COLLECTION

Brief concrete explanation Determine what the survivor wants (advocate) PROVIDE PRIVACY when exposing sensitive areas BE GENTLE

TREATMENT MODALITIES
Milieu Therapy Cognitive therapies Individual psychotherapy Group therapy Behavioral therapy

MILIEU THERAPY

Scientific structuring of the environment

COGNITIVE THERAPY

Recognizing and modifying automatic thoughts

INDIVIDUAL PSYCHOTHERAPY
One-on one Nurse-client relationship

GROUP THERAPY
Psychotherapy Task Family Educational Support Self- help

BEHAVIORAL

Classic and operant conditioning Shaping Modeling Extinction Premack principle Extinction Contingency contracting Token economy Time-out Reciprocal inhibition Overt sensitization Covert sensitization Systematic desensitization Flooding