Aggression

Kelvin Moono
09/03/23
 INTRODUCTION
• 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
 General objective

• At the end of the lesson, students should be able to

acquire knowledge and have an understanding on
how to manage clients with aggressive behaviors
 Specific Objectives

1. Define aggression

2. State the characteristics of aggressive behavior

3. State the types of aggression

4. State the predisposing factors of aggression

5. Outline the nursing management of a patient with aggression

 DEFINITION

• Aggression refers to behaviour that is

intended to cause harm or pain( Lyttle.J
1986)
 
 CHARACTERISTICS OR AGGRESSIVE
BEHAVIOUR

• Aggressive behavior can either be verbal or non verbal

• 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 (something that disturbs your mood or life
in a way that you do not like)
 CHARACTERISTICS OF
AGGRESSIVE BAHVIOR CONTD
• Gestures may be emphatic and often seem
threatening.
• e.g. they may point their finger, 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.
 TYPES OF AGGRESSION

Instrumental aggression
• Aggression aimed at obtaining an object,
privilege or space with no deliberate intent
to harm another person
 
Hostile aggression
• Aggression intended to harm another
person, such as hitting, kicking, or
threatening to beat up someone.
 Relational aggression
• A form of hostile aggression that
does damage to another's peer
relationships, as in social exclusion or
rumour spreading
 
 MOYER CLASSIFICATION

Moyer (1968) presented an early and

influential classification of seven different
forms of aggression, from a biological and
evolutionary point of view.
 MOYER CLASSIFICATION
CONT`D
1. Predatory aggression: Attack on prey by a predator.
2. Inter-male aggression: Competition between males of
the same species over access to resources such as
females, dominance, status, etc.
3. Fear-induced-aggression: Aggression associated with
attempts to flee from a threat.
4. Irritable aggression: Aggression induced by frustration
and directed against an available target
 MOYER CLASSIFICATION
CONT`D
5. Territorial aggression: Defence of a fixed area
against intruders, typically conflicts.
6. Maternal aggression: A female's aggression to
protect her offspring from a threat. Paternal
aggression also exists.
7. Instrumental aggression: Aggression directed
towards obtaining some goal, considered to be a
learned response to a situation
 Predisposing factors to
aggressive behaviour
Genetic factors
• Aggressive behaviour is more likely to be
inherited and as such it is considered as
being familial.
Neurophysiological disorders
• Epilepsy of temporal lobe and frontal lobe origin
results in episodic aggression and violent
behaviour.
• Tumours in the brain, particularly in the areas of
the limbic system and the temporal lobe, trauma to
the brain, resulting in cerebral changes and the
disease such as encephalitis have been implicated
in the predisposition to aggression and violent
behaviour.
Psychological factors
• According to Sigmond learning theory,
aggression is primarily a learned form of
social behaviour.
• The learning of aggressive behaviour occurs
by observation and modelling.
• For example, a child watches an angry parent
strikes out another person. Learning aggressive
behaviour also takes place by direct experiences.
Social factors
• Frustration: The single most potent means of
inciting human beings to aggression is frustration.
• Direct provocation: Evidence indicates that
physical abuse and verbal taunts from others often
elicit aggressive actions.
Environmental factors
• Noise: several studies have reported that persons
exposed to loud, irritating noise direct stronger
assaults against others than those not exposed to
such environmental.
 MANAGEMENT

Management is approached in 3ways;

Use of medication.
Restraint.
 Seclusion.
General Principles of Management
• The safety of patient, clinician, staff, other patients
and potential intended victims is of most importance
while looking after aggressive patients
• The doors should be open outwards and not be
lockable from inside or capable of being blocked from
inside.
• While working with impulsively aggressive or violent
patients in any setting one must take care to reduce
accessibility to patients of movable (harmful) objects
as well as jewellery and other attire that might add to
the risk of injury during an assault, including neckties,
necklaces, earrings, eyeglasses, lamps and pens.
• Adequate nurse training and the availability of
appropriate supervision are critical safeguards in the
treatment of potentially dangerous patients.
• The nurse may choose to communicate a few key
observations in a calm and firm but respectful manner,
putting space between self and patient; avoiding physical
or verbal threats, false promises and build rapport with
client.
• For nurse treating patients with a high risk for violence
behaviour, training in basic self defence techniques and
physical restraint techniques are useful.
 MANAGEMENT CONT`D

Use of medication
The psychiatrist will do a mental state examination on
the patient in the psychiatric unit and immediately
commence the patient on drugs after taking ;
• full history from the relatives and doing a-full physical
examination (head to toe)to detect what could not have
been detected by the physician on the general wards.
• Antipsychotic medication –often it is the
sedating property of antipsychotic
medication that produce the calming
effect for the client.
• Atypical antipsychotic are also
commonly used.
• But only Ziprasidone is available in
intramuscular form.
 • Haloperidol-1 mg or 0.5 mg IM Risperidone0.5mg-1mg-
In dementia and schizophrenia.
• Trazodone–50-100mgin older clients with sun downing
syndrome and aggression.
• Benzodiazepines- used due to the sedative effect
and rapid action.
• Most commonly lorazepam, oral or injection.
• Other sedating agents used include Valproate,
chloral hydrate and diphenhydramine.
 Nursing care

• Nursing care is directed towards safe

guarding the patient and fellow patients,
to impose limits on the patients behaviour
and to promote the development of more
appropriate behavioural pattern.
 NURSING CARE CONT`D

• Despite displays of aggressive behaviour, the

patient is vulnerable.
• There is often a risk of exhaution,malnutrition and
injury occurring during episodes of aggressive
behaviour.
 Nursing care cont`d

Environment
The aggressive patient lacks internal control so
external controls should be imposed by the nurse
if escalation of potentially harmful behaviour is to
be avoided.
 Nursing care cont`d

Environment continued
Restraint
• These are conditions that are put in place to
limit the patient from causing any harm, such
as holding him to prevent him from causing
injury, and releasing him only when he is
calm.
 Nursing care cont`d

Seclusion
• All patients who are a threat to others are
put in a special room alone away from the
other patients as a form of punishment so
that the bad behaviour is not sustained and
also to protect them from injuring
themselves and others.
Position
• Nurse them in any position in which they are
comfortable.
• Do not restrain to the extent of causing more
harm to the patient.
• Excessive restrain may provoke hostility,
resentment and retaliatory excess in behaviour.
Rest
• The aggressive patient may be too restless
to sleep.
• There is danger of exhaustion and
debilitation if adequate sleep is not ensured
as the aggressive patient will ignore fatigue
signals from his body and will continue to
push himself beyond safe limits.
 NURSING CARE CONT`D

• His aggressiveness is also likely to disturb the rest

of fellow patients.
• Avoid noise to allow this patient to rest
 Nursing care cont`d

Observations
• Observation of temperature, pulse respirations and
blood pressure
• Observe the patients nutritional status
• Assess the mental state for any improvement.
• Observe for side effects of the drugs.
Psychological care
• Psychological care is given to the
relatives to allay anxiety.
• As soon as the patient stabilises,
explain the condition to allay anxiety
and gain patients co-operation.
Exercises
• The patient should only be allowed to exercise
when the condition stabilises.
• In the acute phase ,he needs enough rest because a
lot of energy is consumed in aggression.
Nutrition
A normal diet which is well balanced is
given to promote good nutritional state.
Avoid any foodstuffs that contain caffeine
such as coffee to prevent the patient from
being alert , because we want him to rest.
Medication
Ensure that the patient takes the
drugs as
prescribed to enhance recovery.
 Nursing care cont`d

Advice
The patients relatives will be advised to be very
understanding and to offer support to the
patient. Advise the patient to avoid any
substances that can destabilise the mind, such
as alcohol to prevent reoccurrence of
aggression.
• Advice the patient also to avoid smoking to
prevent him from having another episode of
aggressive behaviour.
• On discharge advice the patient and relatives to
keep review dates so that follow up is not
missed to monitor patients recovery at home.
 evaluation

EVALUATION
1. Explain aggression
2. Mention the characteristics of aggression
3. State the types of aggression
4. What are the predisposing factors of aggression
5. How can a patient with aggressive behaviour be
managed?
 Summary

• Aggression is a behavioral characteristic that refers to forceful action or procedures

with intentions to dominate or master. It tends to be hostile, injurious, or destructive,
and is often motivated by frustration, for an individual, aggressive behavior is
considered understandable and normal under appropriate circumstances, but when it
is frequent, intense, lasting, and pervasive, it is more likely to be a symptom of a
mental disorder.

• Aggression between groups, can be in the form of healthy competition, but can
become harmful when unfair or unjust disadvantage or frustration is perceived,
leading to hostility.
 references

1. Adedotun, A. (2005). Basic Psychiatry and

Psychiatric Nursing. Ile-Ife: Basag Enterprises.
2. Sreevani, R. (2004). A Guide to Mental Health and
Psychiatric Nursing. New-Delhi: Jaypee Brothers
Medical Publishers (P) Ltd.
3. The ICDIO Classification of Mental and Behavioural
Disorders, Clinical Description and Diagnostic
Guidelines. (2007). World Health Organization.
Oxford University Press
 Assignment

• Using your personal experiences or experiences of people you know or

know of, write downany examples you can think of that represent

a) instinct based aggression

b) frustration-based aggression

c) social learning experiences of aggression

• instruction: typed, times new roman font 12, spacing 1.5. havard
referencing. Due date 14th march, 2023
 References cont`d
4. Blackburn, R. (1993). Clinical Programmeswith Psychopaths.
In Clinical Approaches to the Mentally Disordered Offender
(eds. K. Howells& C. R. Hollin).Chichester: Wiley.
5. De Ronchi D, Faranca I, Forti P, Ravaglia G, Borderi
M,Manfredi R, (2000). Development of acute psychotic
disorders and HIV-1 infection. Int. J Psychiatry Med:173-183.
6. Haworth, E. & Cournos, F. (2006). Psychiatric aspects of
HIV / AIDS. 1sted. Philadelphia: Lippincott Williams &
Wilkins.