Lecture Notes: Aggression, Violence, and Abuse

Introduction

• Presented by Cathy from Level Up RN.
• Focus on aggression, violence, and abuse.
• Includes a quiz at the end for knowledge check.

Aggression and Violence

• Likely encounters for nurses include aggressive or violent patients.
• Important to be prepared for such situations.
• Relevant for NCLEX, nursing school exams, and real-life scenarios.

Predictors of Violence

• Pacing
• Agitation
• Threatening remarks
• Combative posture

De-escalation Techniques

• Use a calm voice.
• Allow plenty of personal space.
• Provide clear limit setting and redirection.
• Encourage relaxation techniques and positive activity (e.g., exercise).
• Move patient to a quiet area with decreased stimuli under close observation.
• Remove other patients and have sufficient staff available.
• Remove dangerous items from the environment.

Safety Measures

• Administer pharmaceuticals (e.g., haloperidol, lorazepam) if necessary.
• Use restraints or seclusion if needed.
• Avoid wearing necklaces (prevent grabbing).
• Know facility layout and keep the patient away from the door.
• Prioritize personal safety.

Types of Abuse

• Physical Abuse: Intentional use of physical force (hitting, kicking, burning, shaking).
• Emotional Abuse: Behaviors harming another's self-worth or emotional well-being.
• Sexual Abuse: Forcing a person to engage in sexual acts without consent.
• Neglect: Failure to provide basic needs (housing, food, education, medical care).
• Economic Abuse: Financial dependency enforced by misuse of funds in a trusted relationship.

Cycle of Abuse

1. Tension-building Phase

   • Abuser becomes judgmental, threatening, unpredictable, possibly verbally abusive.
   • Victim feels they are "walking on eggshells"; attempts to reason or calm the abuser fail.

2. Explosive Phase

   • Occurrence of physical, emotional, and/or sexual abuse.
   • Victim may or may not contact authorities.

3. Honeymoon Phase

   • Abuser apologizes, gives presents, promises change.
   • Victim may drop charges or believe in change.
   • Cycle likely repeats.

Risk Factors

• Perpetrator Risk Factors:

  • Poor education
  • Low socioeconomic status
  • Substance abuse
  • Family history of violence
  • Low self-esteem

• Victim Risk Factors:

  • Intimate Partner Violence: Being a woman, pregnancy.
  • Child Abuse: Unwanted/unplanned children, special needs children, presence of domestic abuse.
  • Elder Abuse: Chronic health challenges (e.g., dementia) affecting caregiving.

Quiz Questions

1. Question: Failure to provide basic needs is considered what type of abuse? Answer: Neglect.

2. Question: Which phase in the cycle of violence involves the victim walking on eggshells? Answer: Tension-building phase.

3. Question: Increased risk of child abuse when domestic violence is present, true or false? Answer: True.

Conclusion

• Upcoming video will cover signs of abuse and nursing care for abuse.
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