Nursing Process for client with Anger
Introduction
Anger is a human experience of great significance for nursing practice. The awareness of anger and related emotions such as hostility, resentment, and rage has been identified elsewhere as being of help to the nurse in explaining and intervening in certain client behaviors. Equally important to the therapeutic nurse-client relationship is the study of those client behaviors which generate anger in other. The anger generated often interferes with the therapeutic aim of a mutual problem-solving process.
Anger is a feeling or emotion that is a learned means of neutralizing or avoiding the anxiety which arises in response to interpersonal threat. Anger is “learned” in the sense that it is empathized from significant others during the process of socialization. Anger is an inherent response to the inevitable frustrating issues that arise between parent and child during the socialization process. Young children notice that when they challenge the authority of significant adults, the most remarkable degrees of anger can be generated in the adult. Furthermore, children sense that anger seems to wield much more power than anxiety.
Anger is a inborn emotional reaction to loss. In its most basic response, its stimulates the individual to retrieve or recover what was lost or to obtain what he or she wants to have. This can include the newborn infant who “ loses” the nipple while nursing; the 6 month old infant drops his or her toy; the 2 year old who whants a cookie ; he adolescent who is angry about not being trusted to borrow the family car; the famiy that must go on welfare; or the individual who is forced into early retirement.
The physiologic responses to the emotion depend on the emotion depend on the type of anger being experienced. There are two predominant patterns of anger: active, organized anger and helpless anger. Active anger is physical an mental state in which the individual feels energized to use the angry feeling to correct the “wrong” or to retrieve what was lost. The person experiences the loss as a challenge that he or she has the power or strength to address. During the state of active or organized anger a person feels in mental control, there is a heightening of skin color, respirations become fuller, and the blood pressure and pulse are decrease.
Helpless anger, on the other hand, is a distressing feeling. The individual perceives that he or she in unable to address the cause of his or her anger feels disempowered. This experiences is similar to thatof powerlessness described below . in the state of helpless anger, the individual feels emotionally overwhelmed and disorganized. Breathing become rapid and shallow; the pupil dilate; systolic and diastolic blood pressure are elevated; the person appears pale because skin temperature is decrease due to vasoconstriction of the peripheral capillaries.
Nursing Process for Client With Anger
1. Assessment
Basically, the assessment on the client's anger directed at all aspects of biopsikososial-cultural-spiritual.
Biological Aspects
Physiological responses arising from activities of the autonomic nervous system reacts to epineprin secretion, which increases blood pressure, takhikardi, red face, dilated pupils and increased frequency of urine expenses. There are the same symptoms of anxiety such as increased alertness, muscle tension as like jaw clenched, his fists, rigid body, and quick reflex. This is because energy is released when anger increases.
Emotional aspects
Individuals who are uncomfortable angry, feel helpless, annoyed, frustrated, want to fight, furious, hostile, hurt, abuse and demanding. Attention behavior and the emergence of self-conflict needs to be assessed as running away, truant from school, stealing, causing fires, and sexual deviation.
Intellectual aspects
Most of the individual's life experiences gained through the intellectual process. Sensory role is very important to adapt to the environment which then processed in the intellectual process as an experience.
Social aspects
Include social interaction, culture, the concept of a sense percayadan dependence. The emotion of anger is often stimulates anger from others. And lead to rejection from others. Some clients channeling anger with the values and criticize other people's behavior, so that others felt hurt. The process can isolate the individual himself away from others.
Spiritual aspect
Beliefs, values, and moral individuals influenced angry expression. These aspects affect the individual's relationship with the norms that may have caused resentment manifested in amoral and a sense of innocence. Individuals who believe in God the mighty one, always ask for the needs and guidance to him.
2. Nursing diagnosis
Several possibilities of nursing diagnosis:
1. Difficulty expressing anger without hurting others, in connection with not knowing how to phrase that can be accepted, manifested in anger with a loud voice to people around.
2. Communication disorders in relation to the feelings of anger toward the situation and the services they received that is manifested by insulting or blaming the nurse, such as "you should be here since 1 hour ".
3. Adjustments are not effective with respect to not be able to confront the anger, manifested by speaking harsh words excessive.
4. Adjustments are not effective in relation to the rejection manifested anger with the words: “I was never angry ".
5. Has the potential to rage at other people in connection with desire as opposed to hospital treatment, manifested by refusing to hospital rules and wanted to hit someone else.
6. Has the potential to rage at other people in connection with the control functions of the brain affected by neurological disorders of the brain that is manifested by confusion and interpersonal hypersensitivity to stimuli.
7. The prolonged strength angry with respect to the new diagnosis, new situations and a lack of information.
3.Nursing intervention and implementation
Self-care awareness Nurses often assume that the client is the source of problems for him when the client angry. For nurses who have knowledge of the anger will be able to assist clients to overcome anger. For staff should be aware that the client can not express anger with hostile and member support for such expression. Nurses need to understand their own feelings and reactions to client anger.
Limitation expression of angry, Loomis (1970), cited from stuart and sundeen (1987:579) revealed 3 restriction expression of anger:
1. Expressing hope to clients in a positive way.
2. Help clients explore the reasons and purpose of the client's behavior.
3. Together with the client to set alternative way of expressing anger.
Angry and demanding clients often generate feelings of helplessness and frustration in the nurse. These feeling can be effectively manage by recognizing the meaning of client responses and maintaining composure in the most stressful circumstances. Anger typically symbolizes underlying feelings of helplessness and should be personalized.
Major interventions include approaching the client in a calm and firm manner, using direct eye contact and active listening skill. It is critical the nurse be able to assess verbal and nonverbal cues to detect imminent physical aggression in the angry client. The likelihood physical of aggression increase when client feel they are ignore or discounted. Hurried and unconcerned response to the client may create or increase his or her feelings of anger, powerlessness, and dependency. Setting firm limits on how anger can be expressed is indicated if the client strike out or throws things. Speaking in a firm, accepting, and caring tone is critical to minimizing acting-out behaviors. Normally, physical or verbal aggression indicated that the client is feeling out of controls. Nurse can help the client regain control by remaining calm and accepting and using firm, consistent limit setting. In addition, the client’s emotional needs can be assessed by encouraging verbalization of feelings and providing a safe environment that reduce stress and enhance adaptive coping skill.
Do and don’t for coping with the angry client
WHAT TO DO | WHY |
Keep your own emotions in check; speak in a calm, reasuring way | Gaining control over your feelings les you think rationally. Only then can you help the client. If you became angry. You’ll probably incite the client even more. |
Watch the client body language | The client’s body language gives you clues to his or her potential for physical aggression. Pacing indicates agitation, for example: a clenched fist may mean imminent physical violence. |
Let the client air feelings | When thr client airs his or her feelings, anger and tension decrease, enabling the client to deal with the situation rationally. |
Determined the source of the client’s anger | Knowing the source of anger enables you to recognized that the anger is not directed toward you. |
Involved the client in his or her treatment | Involving the client in daily care decrease his or her feelings of helpless and dependency. |
Provide controls or limits as needed. | Setting limits on the client’s behavior provides some controls. The client often welcomes these limits. |
WHAT NOT TO DO | WHY |
Don’t shout or argue with the client. Avoid touching the client or invadingthe client’s space. | Shouting, arguing, and touching the client can estelate anger. These behaviors prevent you from dealing effectively with the client and can make him or her become physically violent. Touching the client or invading him or her space can be threatening to the client and make him or her feel cornered. This may result in retalitation toward you. |
Don’t let the client stand between you and the door | Maintain easy access to the door in case the client be cornes violent and you need to get out quickly. |
Don’t patronize or talk down to the client | Patronizing the client increase anger and potential for aggression. |
Don’t discount the client’s feelings. | Dismissing the client’s feeling interest with establishing a therapeutic nurse-patient relationship. |
Control of violence
Nurses need to develop the ability to handle the client's behavior that are not controlled. With empathy and careful observation and client behavior, nurses can anticipate client's outburst.
Biological aspects
Provides a way to channel the energy of anger in a constructive way through physical activity such as running in the morning, lifted weights, and other activities that help muscle relaxation such as sports. At the hospital can be modified by the mobility of both passive and active instance with a walk in the park, exercise leg movement, mendoronng wheelchair.
Emotional aspects
The nurse can help clients who are not familiar with such anger by stating "uneasy father or mother angry". This helps Kien knows his angry feelings.
Intellectual aspects
When someone suddenly angry, he needs to be directed at the boundary orientation "now and here", in this situation the nurse may:
1. Overcoming the intensity of anger clients.
2. Encouraging expression of angry clients.
3. Making physical contact with clients.
4. Include clients in groups.
5. Checking the client's physical condition.
6. If you need to keep a distance to protect yourself.
7. Give a report at the next duty nurse.
Social aspects
Playing the role of enabling the client to explore feelings of anger by doing:
1. Assessed Angry past experiences
2. Play a role in expressing anger.
3. Develop ways of expressing anger constructively.
4. Learn how to integrate the experience.
5. Sharing your feelings with members of the group play.
Spiritual aspect
If the client was angry with God or a supernatural force in the belief that illness is a punishment from God, then the nurse member incentive for clients to express feelings or the religious leaders call if the nurse does not feel inadequate. Nurses can be expressed with great interest and therefore caused a discussion about the spiritual values that include some remote client has reached his goal of losing the closest and the death of someone.
4. Evaluation
Evaluation of angry clients to change behavior based on observation of subjective response clients. Maynard and Vhitty, 1979 (quoted from Stuart and Sundeen, 1987:582) recommends several questions on the evaluation:
1. How do you feel about the experience?
2. How other people respond to it?
3. Is there a chance of confrontation for him?
Focus of evaluation is how the expression of anger, rage accuracy, suitability of the object, the degree of similarity factor expression triggers angry with clients and awareness of the process is experienced, so if the angry phase is complete when the client can pass through the next phase to be able to accept the situation and the degree of illness using the adjustment effective.
Positive function angry
- The function of energy: anger can increase the energy.
- Function expression: the assertive expression of anger healthy
- Self promotional function: angry to show pride memproyeksinkan positive self concept
- Function defensive: anger is an ego defense in response to increased anxiety due to external conflict after angry relief.
- Potentiating function: anger can increase the potential.
- Function of discrimination: a person to distinguish expressions: anger, sadness, joy.
References
1. Dean Rieck. 21 September 2009. Turn an angry client into a loyal client (with one word). Procopytips
2. Iyus yosep. 2007. Keperawatan jiwa. Refika Aditama: Bandung
3. Patricia D. Barry. 1998. Mental Health and Mental illnesss six edition. Lippincott: Philadelphia.
4. Robert G. Rose, PhD.2002.When Clients Get Angry . www.roseporterfieldgroup.com
5. Otong, Deborah Antai. 1995. Pshyciatric Nursing Biological and Behavioral concept. Saunders Company: Philadelphia.
6. Wendy S. Meyer.2007. Calming Angry & Upset Client. www.csvets.com
7. Yudith haber R.N,M.A.dkk.1982. Comprehensive psychiatric nursing.USA: Mc Graw Hill book company.
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