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Nursing 202
• Anger need not be a negative expression.
• Anger is a normal human emotion that, when
handled appropriately and expressed assertively,
can provide an individual with a positive force to
solve problems and make decisions concerning
life situations.
• Anger becomes a problem when it is not expressed
and when it is expressed aggressively.
* Anger is an emotional state that varies in
intensity from mild irritation to intense fury and rage.
• Anger causes physiological changes (e.g., increased heart
rate, blood pressure, and levels of biogenic amines.
• Anger is
– Not a primary emotion; learned
– Typically experienced as an automatic inner response to hurt,
frustration, or fear
– A physiological arousal, instilling feelings of power and generating
– Significantly different from aggression
– Capable of being under personal control
• Anger has positive and negative functions
• Is one way that individuals express anger
• Is a behavior that is intended to threaten or
injure the victim’s security or self-esteem
• Can cause damage with words, fists, or
weapons, but it is virtually always designed to
Predisposing Factors to Anger and
• Role-modeling is one of the strongest forms of
• Role models can be positive or negative.
• Earliest role models are the primary caregivers.
• As the child matures, role models can be
celebrities or any other influential individual in
the child’s life.
Operant Conditioning
• Operant conditioning occurs when a specific behavior is
positively or negatively reinforced.
– A positive reinforcement is a response to the specific
behavior that is pleasurable or produces the desired
– A negative reinforcement is a response to the specific
behavior that prevents an undesirable result from
• Anger and aggression can be learned through operant
Neurophysiological Disorders
• Several disorders of, or conditions within, the
brain have been implicated in episodic aggression
and violent behavior. They include
– Temporal or frontal lobe epilepsy
– Brain tumors
– Brain trauma
– Encephalitis
• Aggressive behavior may have some correlation to
alterations in brain chemicals. These include
– Hormonal dysfunctionassociated with hyperthyroidism
– Alterations in the neurotransmitters epinephrine,
norepinephrine, dopamine, acetylcholine, and
serotonin; these chemicals may play a role in facilitation
or inhibition of aggression.
Socioeconomic Factors
• High rates of violence exist within the
subculture of poverty in the United States.
• Poverty is thought to encourage aggression
because of the associated deprivation,
disruption of families, and unemployment.
Environmental Factors
• Several environmental factors have been associated with
an increase in aggressive behavior. They include
– Physical crowding of people
– Discomfort associated with a moderate increase in
environmental temperature
– Use of alcohol and some other drugs, particularly cocaine,
amphetamines, hallucinogens, and minor
– Availability of firearms
Characteristics of anger
• Anger can be identified by a cluster or
characteristics that include
– Frowning
– Clenched fists
– Low-pitched words
forced through
clenched teeth
– Yelling and shouting
Characteristics of anger
Intense or no eye contact
Easily offended
Emotional overcontrol and flushed face
Intense discomfort
• Aggression can be identified by a cluster of
characteristics that include
Tense face & body
Verbal or physical threats
Threats of homicideor suicide
– Increased agitation
– Overreaction to environmental stimuli
– Panic anxiety, leading to
misinterpretation of the environment
– Disturbed thought processes
– Suspiciousness
– Disproportionate anger
Assessing Risk Factors
• Prevention is the key issue in management
of aggressive or violent behavior.
• Three factors are important considerations
in identifying extent of risks
– Past history of violence
– Client diagnosis
– Current behavior
• Past history of violence is considered the most widely recognized risk factor for
violence in a treatment setting.
• The most common client diagnoses associated with violence include
– Schizophrenia
– Organic brain disorders
– Mood disorders
– Antisocial, borderline, and intermittent explosive personality
– Substance use disorders
• Certain current behaviors are predictive of impending violence
and have been termed the “prodromal syndrome.” They include
Rigid posture
Clenched fists and jaws
Grim, defiant affect
Talking in a rapid, raised voice
Arguing and demanding
Using profanity and threatening verbalizations
Agitation and pacing
Pounding and slamming
Nursing diagnoses
Remain calm.
Set verbal limits on behavior.
Keep diary of anger.
Avoid touching the client.
Help determine source of anger.
Ignore derogatory remarks.
Help find alternative ways of releasing tension.
Observe for escalation of anger.
When behaviors are observed, first ensure that sufficient staff is
• Techniques for dealing with aggression include: Talking down,
Physical outlets, Medications, Call for assistance, Restraints,
Observation and documentation Ongoing assessment, Staff