Important
- Abuse, trauma and violence affect many people of all ages and in all socio-economic
spheres
- Many of you will have personal knowledge and experience of abuse, trauma, and
violence
- Self awareness is a key aspect of practising effectively as a nurse
- Self Care essential
- Please utilize student health services as needed
Trauma Informed vs. Non Trauma Informed Care
Trauma Informed
- Understand that all behaviors have meaning
- Power/Control minimized - constant attention
- Caregivers/Supporters – Collaboration
- Staff understand that violence and conflict arise, most often, due to situational factors
- Recognition of culture practices that are re-traumatizing
- “Let’s talk and find you something to do”
Non-Trauma Informed
- Behavior seen as intentionally, volitional
- Keys, Security Uniforms, staff demeanor, tone of voice = Power!!
- Rule Enforcers – Compliance
- “Patient-blaming” is norm
Please Reflect
- What are your views about on mental illness and aggressive behaviour?
- What “word” “phrase” or “image” first comes to mind?
- What role do nurses have in supporting persons with their emotions and behaviours?
Anger
- Anger is a normal human emotion
- An internal event that involves thoughts, images, and bodily sensations
- Can serve as a warning that demands are greater than available resources
- Expression of anger may be of concern -threatening to the self or others
Aggression and Mental Health Care
- Majority of clients with mental illness do not display aggressive or violent behaviour
- Incidents often reflect select number of higher risk patients
- Needs attention as violence contributes to:
○ Physical injury and psychological trauma occupational health and safety hazard
○ Jeopardizes patient safety
○ Continued stigmatization
Theoretical Explanations: Anger, Aggression and Violence
, - Biological
○ Neurodegenerative
○ Cognitive Neuroassociation Model
○ Neurostructural Model - amygdala
- Neurochemical Model – Low Serotonin
- Psychological
- Sociocultural
- Interactional
Ann’s Journey
- Restraint use
- Restraint Prevention
- Violence Prevention
- Model of Care - Nursing Philosophy
Person - Related Factors
- Prior violence or aggressive behaviour
- Demographic factors (type vs. likelihood)
- Mental illness, substance use
- General medical conditions
- Perceived threat, fear, and loss of personal control
- Social marginalization
- Avoid Labels – risk does not = personal feature
Environmental - Factors Outside the Person
- Busy, existing crisis, shift change, inconsistent procedures
- Non-empathetic attitudes, new staff, inconsistent and poor communication, power
imbalances/struggles
- Crowded, lack of privacy, lack of activity/engagement?
- Is care culture one of strict enforcement and fragmented or respectful, consistent and
open?
Personal Management of Anger and Triggers
- Reflection - Know what triggers you and why
- Thinking before speaking
- Listen – Empathically and Actively
- Identify your “triggers” and try to “own them” vs. blaming the client or yourself
- Count in your head
- Turn away; breathing; talk to myself; talk to the client; name and own your feelings
- Knowing in advance your sensitivities, boundaries and limits.
Anger and Triggers
- Reframe the problem
- Don’t personalize the trigger
- Abuse, trauma and violence affect many people of all ages and in all socio-economic
spheres
- Many of you will have personal knowledge and experience of abuse, trauma, and
violence
- Self awareness is a key aspect of practising effectively as a nurse
- Self Care essential
- Please utilize student health services as needed
Trauma Informed vs. Non Trauma Informed Care
Trauma Informed
- Understand that all behaviors have meaning
- Power/Control minimized - constant attention
- Caregivers/Supporters – Collaboration
- Staff understand that violence and conflict arise, most often, due to situational factors
- Recognition of culture practices that are re-traumatizing
- “Let’s talk and find you something to do”
Non-Trauma Informed
- Behavior seen as intentionally, volitional
- Keys, Security Uniforms, staff demeanor, tone of voice = Power!!
- Rule Enforcers – Compliance
- “Patient-blaming” is norm
Please Reflect
- What are your views about on mental illness and aggressive behaviour?
- What “word” “phrase” or “image” first comes to mind?
- What role do nurses have in supporting persons with their emotions and behaviours?
Anger
- Anger is a normal human emotion
- An internal event that involves thoughts, images, and bodily sensations
- Can serve as a warning that demands are greater than available resources
- Expression of anger may be of concern -threatening to the self or others
Aggression and Mental Health Care
- Majority of clients with mental illness do not display aggressive or violent behaviour
- Incidents often reflect select number of higher risk patients
- Needs attention as violence contributes to:
○ Physical injury and psychological trauma occupational health and safety hazard
○ Jeopardizes patient safety
○ Continued stigmatization
Theoretical Explanations: Anger, Aggression and Violence
, - Biological
○ Neurodegenerative
○ Cognitive Neuroassociation Model
○ Neurostructural Model - amygdala
- Neurochemical Model – Low Serotonin
- Psychological
- Sociocultural
- Interactional
Ann’s Journey
- Restraint use
- Restraint Prevention
- Violence Prevention
- Model of Care - Nursing Philosophy
Person - Related Factors
- Prior violence or aggressive behaviour
- Demographic factors (type vs. likelihood)
- Mental illness, substance use
- General medical conditions
- Perceived threat, fear, and loss of personal control
- Social marginalization
- Avoid Labels – risk does not = personal feature
Environmental - Factors Outside the Person
- Busy, existing crisis, shift change, inconsistent procedures
- Non-empathetic attitudes, new staff, inconsistent and poor communication, power
imbalances/struggles
- Crowded, lack of privacy, lack of activity/engagement?
- Is care culture one of strict enforcement and fragmented or respectful, consistent and
open?
Personal Management of Anger and Triggers
- Reflection - Know what triggers you and why
- Thinking before speaking
- Listen – Empathically and Actively
- Identify your “triggers” and try to “own them” vs. blaming the client or yourself
- Count in your head
- Turn away; breathing; talk to myself; talk to the client; name and own your feelings
- Knowing in advance your sensitivities, boundaries and limits.
Anger and Triggers
- Reframe the problem
- Don’t personalize the trigger
