NCLIP

Anger, Abuse, and Violence

3 min read

Anger, Abuse, and Violence

Key Points

  • Anger is an emotion; aggression is behavior that may follow when regulation fails.
  • Abuse can be physical, psychological, sexual, financial, or neglect-related and may follow recurring cycles.
  • Risk factors include stress, trauma history, social inequity, substance misuse, and relationship instability.
  • Nurses are frontline for screening, safety planning, de-escalation, documentation, and mandated reporting.

Pathophysiology

Anger and aggression emerge from interactions among emotional dysregulation, perceived threat, stress load, trauma exposure, and environmental triggers. Chronic activation of fear-threat systems can increase impulsive reactions and violence risk.

Abuse and violence create long-term psychiatric and physical sequelae, including PTSD symptoms, depression, anxiety, hypervigilance, substance-use risk, and chronic health complications.

Classification

  • Emotion-behavior distinction: Anger (internal state) versus aggression (harmful action).
  • Abuse cycle model: Tension building, acute violence, reconciliation/honeymoon, calm.
  • Response domains: Prevention, early recognition, de-escalation, acute containment, and recovery support.

Nursing Assessment

NCLEX Focus

Prioritize immediate safety while assessing violence risk, abuse indicators, and trigger patterns.

  • Assess escalation cues (tone, posture, pacing, verbal threats, trigger events).
  • Assess abuse indicators, injury patterns, and consistency of explanations.
  • Assess trauma, substance use, and psychosocial stressors linked to aggression.
  • Assess victim safety risks, support network, and barriers to disclosure.
  • Assess setting-level risks (staffing, wait times, environmental overstimulation).

Nursing Interventions

  • Use verbal de-escalation with calm tone, validation, and clear boundaries.
  • Implement safety-first protocols and request support early for escalating risk.
  • Document objectively and complete mandated reporting per jurisdictional requirements.
  • Engage clients in personalized trigger and de-escalation plans.
  • Apply trauma-informed, nonjudgmental care to victims and at-risk individuals.

Restrictive-First Error

Seclusion or restraint should be last-resort emergency interventions after less restrictive methods fail.

Pharmacology

PRN medication may support acute agitation management when clinically indicated, but should be combined with de-escalation, monitoring, and follow-up reassessment to prevent recurrent escalation.

Clinical Judgment Application

Clinical Scenario

A client in the emergency psychiatric setting becomes verbally threatening, paces aggressively, and reports feeling unfairly treated after prolonged wait time.

Recognize Cues: Escalation markers and perceived injustice are active triggers. Analyze Cues: Risk of progression to physical aggression is rising. Prioritize Hypotheses: Priority is immediate safety and rapid de-escalation. Generate Solutions: Set behavioral boundaries, reduce stimuli, and offer structured choices. Take Action: Implement de-escalation protocol, involve team support, and reassess continuously. Evaluate Outcomes: Confirm reduced agitation, restored communication, and updated prevention plan.

그래프 뷰

백링크