PROBLEMS WITH ANGER

Glossary terms

 Anger: Anger is defined as a strong uncomfortable emotional response to

provocation that is unwanted and incongruent with one’s values, beliefs or
rights.
 Aggression: Aggression refers to behavior that is intended to cause harm or
pain. Aggression can be either physical or verbal.
 Assertiveness: Behavior directed toward claiming one’s rights without
denying the rights of others
 Frustration: Feeling generated from the inability to meet a goal

A. Read the following article

Anger and Aggression

Aggression arises from an innate drives or occurs as a defense mechanism

and is manifested either by constructive or destructive acts directly towards self or
others. Aggressive people ignore the rights of other people. They   must fight for
their own interests and they expect same from others. An aggressive approach to life
may lead to physical or verbal violence. The aggressive behavior often covers a basic
lack of self-confidence. Aggressive people enhance to their self-esteem by
overpowering others and there by proving their superiority. They try to cover up
their insecurities and vulnerabilities by acting aggressive.

Characteristics of aggressive behavior

 Aggressive behavior is communicated verbally or non-verbally

 Aggressive people may invade the personal space of others
 They may speak loudly and with greater emphasis
 They usually maintain eye contact over a prolonged period of time so
that the other person experiences it as an intrusive
 Gestures may be emphatic and often seem threatening. (For example
they may point their figure, shake their fists, stamp their feet or make
slashing motion with their hands)
 Posture is erect and often aggressive people lean forward slightly
towards the other person. The overall impression is one of power and
dominance

In conclusion, anger is a normal human emotion that is crucial for individual’s

growth. When handled appropriately and expressed assertively, anger is a positive
creative force that leads to problem solving and productive change. When channeled
inappropriately and expressed as verbal aggression or physical aggression, anger is
 destructive and potentially life threatening force. Psychiatric nurses in particular,
work with patients who have inadequate coping mechanisms for dealing with stress.
Patients admitted to an inpatient psychiatric unit are usually in crisis, so their coping
skills are even less effective. During these times of stress acts of physical aggression
or violence can occur. Also nurses spends more time in the inpatient unit than any
other disciplines, so they are more at risk of being victims of acts of violence by
patients. For these reasons, it is critical that psychiatric nurses be able to assess
patients at risk for violence and intervene effectively with patients before, during
and after an aggressive episode.

1 Why do people acting aggressively?

2 How can anger be positive for us?
3 What should the nurses do to the patient with aggression to avoid the
risk of being victims of acts of violence by the patient?

B. Put the following words which describe temporary moods, states and feelings
into the correct sentences. Use each word once only.

sympathetic winded terrified embarrassed

homesick puckish giddy stiff
hoarse weary thrilled preoccupied
furious upset unconscious

1. My father was ……. when I told him that I had crashed his car. I don’t think I
have ever seen him so angry.
2. After walking for six hours, we were so ……. that we couldn’t go on.
3. I always feel ……. when I look down from the top of a high building.
4. My legs are really ……. after all that running we did yesterday.
5. The boxer hit his opponent so hard that he was knocked …….
6. I feel a bit ….… Do you mind if I help myself to a sandwich?
7. Alison was very ……. when she heard that her mother had been taken to
hospital.
8. When I first moved to Sweden I felt very ….… - I missed England so much.
9. She was really ….… when she heard that she had got the job.
10. I spoke to her, but she was too ….… to notice me.
11. After singing all evening I found that I could scarcely talk afterwards – my
voice was really ….…
12. My sister was ….… when her friend’s Alsatian started barking at her.
13. She was very ….… when I told her that I had lost my job.
14. I felt really ……. when my mother started telling my girlfriend about the
strange habits I used to have when I was a child.
15. The centre-forward was temporally ….… when he was kicked in the stomach
going for the ball.
 C. Translate the following into Bahasa Indonesia and discuss the content with your
partner

Patient education plan for appropriate expression of anger

Content Instructional activities Evaluation

Help the patient Focus on nonverbal behaviour.
identify anger Role plays nonverbal expression of angry body posture and
anger.
Label the feeling using the patients
preferred words
Give permission for Describe situations in which it is
angry feelings. normal to feel angry.
Practice the Role play fantasized situations in
expression of which anger is an appropriate
anger. response
Apply the -Help to identify a real situation that
expression of anger makes the patient angry.
to real situation. -Role plays a confrontation with the
object of the anger.
-Provide a positive feedback for
successful expression of anger.
Identify alternative -List several ways to express anger,
ways to express with and without confrontation.
anger -Role plays alternative behaviours.
-Discuss situations in which
alternatives would be appropriate
Confrontation with -Provide support during
a person who is a confrontation if needed.
source of anger. -Discuss experience after
confrontation takes place.
Patient demonstrates an
facial expression.
Patient describes a
situation to which anger
would be an appropriate
response.
Patient participates in role
play and identifies
behaviours associated
with expression of anger.
-Patient identifies a real
situation that results in
anger.
-Patient is able to role
play expression of anger.
Patient participates in
identifying alternatives
and plans when each
might be useful.
Patient identifies the
feeling of anger and
appropriately confronts
the object of anger.

D. Communication strategies
In handling the patients with anger and aggression, nurses have to:

 present a calm appearance

 speak softly
 speak in a non proactive and non judgemental manner
 speak in a neutral and concrete way put space between yourself and patient
 show respect to the patient
 avoid intense direct eye contact
  Demonstrate control over the situation without assuming an overly
authoritarian stance.
 Facilitate the patient’s stance.
 Listen to the patient
 Avoid early interpretations
 Do not make promises that cannot keep.

In pairs, make sample of sentences and expression from each point above.
Example:
Patient : Nurse! What would you now to me? I’m fed up with this
medication, I feel bad and no one understands me, get out of here
nurse… I don’t want to have chemo anymore..
Nurse : Ok… Don’t worry Sir.. I’m not going to give you anything right
now… I know that the medication has been too much and it is
painful…of course you feel bad about it… (show respect to the
patient)

PROBLEMS WITH NUTRITION

 Glossary terms

 Diet : Food and beverages provide the energy and nutrients you need to
improve health, manage disease, and reduce the risk of disease.
 Compulsive overeating: Consuming large volumes of food without purging
 Eating disorder : Gross disturbances in the patterns of ingesting food
 Anorexia nervosa is an illness of starvation, brought on by severe
disturbance of body image and a morbid fear of obesity.  People with
anorexia nervosa attempt to maintain a weight that’s far below normal for
their age and height. To prevent weight gain or to continue losing weight,
people with anorexia nervosa may starve themselves or exercise excessively.
 Bulimia nervosa is an eating disorder (binge-purge syndrome) characterized
by extreme overeating followed by self-induced vomiting, trying to get rid of
the extra calories in an unhealthy way. It may include abuse of laxatives and
diuretics.
 Binge: rapid consumption of large amounts of food in a short period of time
(usually less than 2 hours)
 Binge eating disorder: recurrent episodes of binge eating that lead to
feelings of distress. Not associated with purging

A. Read the following text without a dictionary, and try to get the message. Don’t
worry if you don’t know some of the words.

HEALTHY DIET: OMEGA 3 FATTY ACIDS

Omega 3 fatty acids have recently gained a lot of attention from media,
health practitioners and food distributors alike; but what exactly are omega 3
fatty acids, and what are the nutritional benefits of incorporating fatty acids into
a regular diet? The following nutrition facts regarding omega 3 benefits can help
you understand precisely what the omega 3 foods health buzz is all about.
Omega-3 fatty acids are considered essential fatty acids meaning that they
can only be obtained from food sources in your diet and cannot be manufactured
from other nutrients by the body. In other words, if you do not obtain sufficient
quantities directly from foods containing omega 3 fatty acids, your body cannot
compensate for this deficiency in your diet. Omega 3, as well as Omega 6 fatty
acids, are considered polyunsaturated fatty acids (PUFAs). Eating a diet that
balances the quantities of these two PUFAs is a crucial part of maintaining health
including normal growth and development as well as healthy brain functioning
(since omega 3 acids tend to be concentrated in the brain.)
A healthy balance of these essential fatty acids involves maintaining a ratio of
one omega 3 fatty acid to every four omega 6 fatty acids. The average American
diet is believed to contain exceeding amounts of omega 6 fatty acids, with a
typical ratio of one mega 3 to every 11-30 omega 6 fatty acids. This has made the
intake of sufficient levels of omega 3 fatty acids an important focus for the
American diet.
 There are three main types of omega 3 fatty acids that are derived from
foods and that are used by the body: EPA (Eicosapentaenoic Acid), DHA
(Docosahexaenoic Acid), and ALA (Alpha-Linolenic Acid). EPA and DHA Omega 3
fatty acids are most readily absorbed and used by the body; however, ALA fatty
acids which are mostly derived from vegetarian food sources are naturally
converted into EPA and DHA by the body.
The following are some common foods containing omega 3 fatty acids:
1. APA: dark green, leafy vegetables; (ground) flax seeds; hemp seeds; (raw)
walnuts; soybeans; pumpkin seeds; certain vegetable oils and oils derived from
omega 3 foods.
2. EPA and DHA: cold water fish including salmon, cod, mackerel, herring, halibut,
sardines, and tuna; fresh seaweed; organically raised animal products such as
free range eggs, chicken, and grass-fed beef.

Scan the text and complete the following statements.

1. We can get omega 3 fatty acid from …….

2. Omega 3 fatty acid is concentrated in our …….
3. The balance ratio of omega 3 fatty acid and omega 6 fatty acid is …….
4. The three main types of omega 3 fatty acid are …….
5. Salmon, cod, mackerel, herring, halibut, sardines and tuna are kind of …….

B. Complete the following table of part of speech.

No Noun Verb Adjective Adverb

1. Fatty/fat

2. Practitioner

3. Distributors

4. Nutritional/nutritious

5. Health

6. typical

7. naturally

C. Writing Section
Make one sentence for each of the following words
 1. Distribution (noun)
2. Fatten (verb)
3. Healthy (adjective)
4. Naturally (adverb)

D. Grammar Review
Change the following passive form into an active one.
1. Omega 3 fatty acids are considered essential fatty acids.
2. Omega 3 fatty acids can only be obtained from food sources.
3. Omega 3 fatty acid cannot be manufactured from other nutrients by the
body.
4. Omega 3 fatty acids are derived from foods.
5. The average American diet is believed to contain exceeding amounts of
omega 6 fatty acids.

E. Translate the following text into Bahasa Indonesia

Anorexia Nervosa

What is Anorexia Nervosa?

Anorexia Nervosa is a psychological illness with devastating physical
consequences. Anorexia Nervosa is characterised by low body weight and body
image distortion with an obsessive fear of gaining weight which manifests itself
through depriving the body of food. It often coincides with increased levels of
exercise. There are two main sub-types of anorexia:
Restricting type:  this is the most commonly known type of Anorexia Nervosa
whereby a person severely restricts their food intake.  Restriction may take many
forms (e.g. maintaining very low calorie count; restricting types of food eaten; eating
only one meal a day) and may follow obsessive and rigid rules (e.g. only eating food
of one colour).
Binge-eating or purging type:  less recognised; a person restricts their intake as
above, but also during some bouts of restriction the person has regularly engaged in
binge-eating OR purging behaviour (e.g. self induced vomiting, over-exercise, misuse
of laxatives, diuretics or enemas).
Who gets Anorexia Nervosa?
Anorexia Nervosa usually develops during adolescence and generally has an earlier
age of onset than Bulimia Nervosa and Binge Eating Disorder (the latter are often
developed during late adolescence or early adulthood). However like all eating
disorders, anorexia can develop at any age or stage of life for both males and
females. It is a myth that only adolescent girls experience anorexia. 
There is no single cause of anorexia but there are risk factors that increase the
likelihood of anorexia developing. These can be cultural, biological or psychological.

G. Share your knowledge

Dieting discussion questions
In pairs, interview each other about the following questions.
Student A
1. What do you think your ideal weight is? How did you choose that weight?
2. Is dieting becoming more widespread in your country (e.g. with children or men)?
Why do you think that is?
3. What things are more and less important than weight in the appearance of a man
and a woman?
4. Are anorexia and bulimia becoming more of a problem in your country? Why do
you think that is? Do you blame anyone in particular (e.g. television, skinny
fashion models)? What can be done about it?
5. Can you think of any fad diets (diets that quickly became popular and then quickly
faded away)? Why do you think people keep falling for fad diets?
6. What is your own experience of dieting?
7. Can food be an addiction?
8. Would you start smoking or decide not to quit if you knew it helped you lose
weight?
—————————————————————————————–
Student B
1. How important is your weight to you?
2. What weight is a man or woman “fat” from, in your opinion? When does that
become “obesity” (i.e. a medical problem)?
3. Is obesity becoming more of a problem in your country? Why do you think that is?
Do you blame anyone in particular (e.g. the parents, food companies, the
government)? What can be done about it?
4. What diets are most popular in your country at the moment? Why are they more
popular than others?
5. Are there any differences in attitudes to dieting across cultures and generations?
6. Do you think diets work? What is the most important factor of a diet that works?
7. What diets would you recommend? Does it depend on the type of person or their
aims?
8. Are there any similarities between dieting and giving up smoking?
9. If you knew a diet was unhealthy but made you lose weight, would you still use it?
Do you know anyone who would?