Aggression

environmental

can be common in hospitals

• unmet needs
• poor relationship with caregivers
• stress (new surroundings)
• noise/over stimulation
• overcrowding
• change in routine: sleep, food
• lack of structure
• social isolations
• restrictions

medical

• dementia/Alzheimer's
• delerium
• depression
• psychosis
• seizures
• infections
• pain
• medication induced or withdrawal
• recent stroke (frontal lobe)
• head trauma
• constipation
• sleep disorders

cognitive

• when cognitive function decreases, verbal and physical aggression increases

trigger phase

• red/white faced
• restlessness/pacing
• exaggerated or violnect gestures
• wringing hands, psychomotor agitation
• clenched fists and jaw
• withdrawing
• invading personal space

response to trigger phase

• offer support
• demonstrate an empathetic, non-judgmental approach in an attempt to alleviate anxiey
• consider offering prn medication
• early intervention can avert 80-90%of crisis situations

escalation phase

• challenging authority
• button pushing
• verbal threats
• loud, belligerent
• over enunciation of words
• pressured speech

response to escalation phase

• use assertive body language while maintaining personal space
• use person's name
• isolate situation
• remove potential weapons
• allow them to vent; listen for the hidden/real message
• explain you want to help
• provide reassurance and verbal efforts to calm
• give people choice, giving the positive first
• trust your instincts, and take all threats seriously

crisis phase

• punching, kicking
• throwing
• spitting
• grabbing
• pulling hair, pinching, biting are all repetitive

response to physical aggression

• do not intervene alone; summon help and use a team approach
• isolate situation
• remove potential weapons
• remove by-standers
• maintain a safe distance
• always stay closest to the exit