aggressive behaviors and management

1. DEALING WITH AGGRESSIVE/
COMBATIVE BEHAVIORS

2. AGGRESSIVE BEHAVIOR
 Behavior where people attempt to stand up for
themselves or exert power over others in ways
that are hostile and violate the right of others.

3. Example:
 Sarah and Misha are two friends playing in the
backyard. Sarah readches over and grabs one of
Misha’s toys without asking, which upsets Misha.
This is not the first time that Asrah has taken one
of Misha’s toys without permission, which anger
Misha even more. Misha walks up to Sarah,
pushes Sarah and take back her toy. By pushing
Sarah, Misha has demonstrated one type of
aggressive behavior.

4. Passive Aggressive Behavior
 Which seek to disguise feelings of anger, in that
they:
 are usually intentional and meant to harm
someone, either psychologically or physically or
destroy someone’s belongings.
Can be divided toward another person or the
self, such as a teenager who likes to injure her
self by cutting her wrists

5. Passive aggressive behaviors:
 Silent treatment
-In its standard form, the silent treatment consists
of completely ignoring another person, refusing to
answer any questions from the person, and
perhaps even refusing to acknowledge their
presence.
 Subtle insults
-A subtle insult may also consist in a hidden or
semi-hidden reference to your weakest points.
-May be in the form of sarcasm

6.  Sullen behavior
-It's uncomfortable being around people who are
subtly grumpy, sulky, gloomy, sour, or moody. It's
almost as bad as being around people who
behave like this explicitly. For example, a
person—if he or she feels like answering you at
all—may choose to reply to your innocent
comment, question, or remark in a slightly
negative way. A sullen person won't smile, not
even when a colleague tells a joke and the rest of
the office is laughing out loud. People who exhibit
sullen behavior may subtly complain about
everything around them, making everyone in
the workplace feel uncomfortable and sad without
quite knowing why they feel that way.

7.  Stubbornness
-Being stubborn can be a beneficial personality trait
in some situations, especially when taking a stand
and holding onto your position are important. But
sometimes stubbornness is merely a way
to punish someone. The indirectly stubborn
person will typically defend his position or
viewpoint rigorously and have good arguments, so
you cannot simply dismiss what he is saying on
the basis of a lack of reasoning. At the same time,
it is clear that he defends his position only
because he knows that it will annoy you or the
others who have to listen to him.

9. TYPES OF AGGRESSIVE
BEHAVIORS
 Reactive aggressive behaviors
-unplanned and impulsive and are usually a
response to feelings of anger, fear, or a need to
retaliate against someone.
Example:
A patient’s father hit the hand of a nurse when the
nurse fails to start an IV line for the 3rd time.

10.  Proactive aggressive behavior
-calculate and planned actions that have some
motive other than harming someone

11. Tips on Dealing with Aggressive
Patients
 Watch out for aggressive tendencies
 Stay calm
 Keep your body language neutral
 Maintain eye contact
 Demonstrate your empathy
 Ask questions
 Keep your distance
 Never say no to a violent patient
 Know where panic alarms are located

12. CODE VIOLET
OBJECTIVE:
 To bring the violent behavior under control.
 To ensure safety of patients and staff.

13.  POLICY
 Whenever a violent situation involving patient(s) arises,
the Head Nurse or designate should contain the situation
with the assistance of other nurses in the unit.
 Nurse must not attempt to control a violent patient alone.
 If the nurses on the unit are unable to contain the
situation, the Head Nurse or designee should call upon
the assistance of the nurses from other units or when
necessary, a Code Violet should be instigated and
physician must be informed.
 All efforts must be done to protect patient and staff from
harm during the crisis.
 Any occurrence of violent situation should be
documented (incident report, documentation on patient’s
file for reference purposes.
 The Head Nurse/in Charge must ensure that a full review
of the incident by the clinical treatment team takes place
as soon as possible. (OVR)

14.  5.1 Assess the situation.
 5.1.1Determine how many patients are involved and
identify.
 5.1.2 Determine the reason causing the violent
behavior.
 5.1.3 Check for the presence of weapon.
 5.1.4 Inform the physician. Give details of the situation.
 5.2 Help patient bring violence under control.
 5.2.1 Initiate conversation in the presence of the
attending physician.
 5.2.2 Give the patient space. Do not make any sudden
movement.
 5.2.3 Avoid touching an agitated patient or stand too

15.  5.3 Talk and listen to the patient. Acknowledge his
state of agitation and give him opportunity to
ventilate anger verbally.
 5.3.1 Keep other patients away from the crisis area.
 5.4 If the situation cannot be controlled by the
nurses in the unit charge nurse may initiate a Code
Violet.
 5.5 Call for help of Police or Ministry of Interior
(MOI) staff if violent patient has weapon and
refuses to surrender it to the nurses.

16.  5.6 With doctor’s order, bring patient to the
seclusion room.
 5.7 Administer prescribed tranquilizer AS PER
DOCTOR’S ORDER
 5.8 Let doctor examine the patient for any possible
injury. Administer first aid if deemed necessary.
 5.9 Write incident report and document in the
nursing progress notes.