Nursing Process For Client With Anger.Wulan
Anger Concept
Anger is an example of an intense emotion that trigers the sympathetic nervous system, which in turn stimulates adrenaline production and the flight-or-fight response. Neurobiological responses usually return to normal levels when anger abates. When people internalize anger or fail to manage it effectively, their bodies keep producing biological responses to stress. The sustained stimulation of the autonomic nervous system in these people results in continual production of catecholamines, which are potent vasopressors. Major catecholamines are norepinephrine and epinephrine. These substances affect all body systems, including the cardiovascular, gastrointestinal, and immunological systems, and chronic production can damage tissues regardless of their origin (Alexander, 1939).
Anger or anger is an emotion that ranged from irritability to aggression experienced by all people. Usually anger is a reaction to an unpleasant stimulus or threaten ( Widjaya Kusuma, 1992: 423).
Anger by Stuart and Sunden (1987: 363) is a nagging feeling that arises as a response to the anxiety that is felt as a threat (Budi Keliat, 1996: 5).
Anger is a feeling of exasperation that arise as a response to the anxiety that is felt as a threat (in Stuart and Sundeen, 1987: 563). Disclosure of anger with a direct and constructive at the time of going to relieve the individual and helping other people to understand her true feelings. however, cultural factors should be considered so that the benefit of both parties can be achieved.
Repressed anger, or pretended not to upset the client himself would complicate and interfere with interpersonal relationships. many situations in life that lead to anger, such as a disturbed body function that must be signed in the hospital, self control was taken over other people, have a pain, the role that can not be done because in the hospital, nursing services late and many other things that can improve emotion.
Characteristics of Anger
According to Beck (Keliat,1996), basically angry characteristic that happens to someone, can be seen from several aspect, biopsychosocio cultural spiritual aspects.
1. Biology Aspects
Physiological responses arising from the activities of the autonomic nervous system reacts to the secretion of epinephrine, which increases blood pressure, tachycardia (increased heart rate frequency), red face, pupilm widened, and the frequency of urine increased expenses. There are the same symptoms of anxiety such as increased vigilance, muscle tension, such as jaw clenched, his fists, rigid body, and reflex ceopat. This is because energy is released when anger increases. In addition, there is someone who does not love or anger toward tertyentu body parts such as belly bulge, the calf is too large, the body is too short, so it can motivate someone to change atitudes towards aspects of himself.
2. Emotional Aspects
Someone who is angry feel uncomfortable, feel helpless, upset, frustration, resentment, want to fight, rage, hostility, hurt, blaming, 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.
3. Intellectual Aspects
Most of the experience of one's life through an intellectual process. Sensory role is very important to adapt to the environment which then processed in the intellectual process as an experience. Therefore, to note how one's anger, identify the causes anger circumstances, how information is processed, classified, and integrated. In sensory dysfunction may be a deviation occurs, leading to perceptions of one's anger.
4. Social Aspects
Include social interaction, culture, the concept of trust and dependence. The emotion of anger is often stimulates anger from others, and caused the rejection of others. Some people channel anger with the judge and criticize other people's behavior, so that others felt hurt. This process can cause a person to withdraw from others. In meeting the needs, someone needs interact with others. The experience of anger can interfere with interpersonal relationships, so some people choose to ddeny or pretend not angry to maintain these relationships. The way a person expresses anger, reflecting the cultural background.
5. Spiritual Aspects
Beliefs, values, and moral influence one's expression of anger. These aspects affect one's relationship with its environment. It is depend owned norms can lead to anger and manifested in amoral and a sense of innocence. Someone who believes in God Almighty, always begging for help and guidance. However, generally requires a person needs from others or the environment causing frustration if not met, and then comes anger.
The Causes Of Anger
The cause of anger is coming from outside and from within that person. Thus outlined, which caused anger because it consists of physical and psychological factors.
1. Physical Factors
The causes that affect other physical factors:
- Excessive tiredness. For example people who are too tired from hard work, be more irritable and easily offended.
- Certain subtances that can cause anger. For example, if the brain not getting enough oxygen, people are more easily upset.
- Sex hormones can affect a person’s anger. We can see in some women who are menstrusting, anger is a major characteristic.
2. Psychological Factors
Psychological factors that lead to anger is closely related to one's personality. Especially regarding the so-called "self-concept is wrong" is assuming a person against his own fault. Self concept that one person produces a balanced and mature. Because someone will judge him very different from all the existing reality.
Some self-concept who is wrong :
- Low self-Pain (MC = Minderaardigheid Complex) is assessing themselves lower than the truth. This person will easily offended by all things considered as a humble, natural consequences, it is easy to anger.
- Arrogant (Superiority Complex), the judge himself more than the actual reality. So is the nature of the reverse nature of low self-esteem. People who are proud too demanding much praise for him. If the expected are not met, he was naturally very angry.
- Selfish or too self-absorbed, the rate itself is very important than reality. People who are so easily upset would always knock on the social interaction that is apathy (indifference), so that these selfish people who do not feel properly treated socially. They are usually covered with prolonged anger.
Angry Response Range
Anger responses can fluctuate within the range of adaptive maladaptive.
Response Range anger
| Adaptive Response Maladaptive Response |
| Statement Assersion Frustrated Passive Aggressive Ballistic |
Passive aggressive assertive frustated
• Assertion is angry or feeling expressed disagree without hurting other people will not cause problems.
• Frustrated is the response that occurs due to failure to achieve goals because of unrealistic or obstacles in the process of achieving goals.
• Passive are individuals unable to express his feelings.
· Aggressive behavior that accompanies the anger and the urge to act in a destructive and is still controlled.
• Ballistic is a feeling of anger and hostility accompanied by loss of strong self-control.
The Process Of Anger
Stress, anxiety, anger, is a part of everyday life which must be faced by every inndiv8idu. Stress can cause feelings of anxiety and threatened unpleasant. Anxiety caused resentment. Response to anger can be expressed in 3 ways:
1. Verbally express
2. Pressing, and
3. Challenging
Of these three ways the first way is to constructively are two other ways that are destructive. By running away or challenge will lead to enmity, and if the way it is used continuously, can be expressed anger at oneself or the environment and will appear as depression or aggression and psikomatik fit.Anger preceded by a stressor that comes from internal or external. Internal stressor such as illness, hormonal, resentment, irritation while external stressor could have come from teasing, insults, abuse, loss of valuables, deceived, eviction, disaster, and so on. This will result in loss of or interference with the individual systems (disruption and loss). The most important thing is how an individual explain every incident is sad or annoying (personal meaning).
When someone gives a positive meaning, for example: traffic is the time to rest, the disease is sin penggugur facilities, the atmosphere is noisy persyarafan trained ear (auditory nerve), then he will make a positive activity (compensatory act) and achieved a sense of relief (resolution). If he fails to consider the meaning of everything as a threat and not be able to do positive activities (sports, sweep, or read poetry when he was angry and so forth) will display feelings of helplessness and misery (helplessness). It would trigger the emergence of anger (anger). Anger diekspreksikan out (Expressed Outward) with a constructive activity (constructive action) to resolve the issue. Anger diekpresikan out (Expressed Outward) with destructive activities (destructive action) can lead to feelings of guilt and remorse (guilt). Buried anger will lead to psychosomatic symptoms (painful symptom).
The Positive Function of Anger
According to IYUS Yosep (2009), anger has a positive function, namely:
1. Energy Function
The point here is that when one gets angry, there will be a physiological response that can result from the activities of the autonomic nervous system reacts to increased secretion of epinephrine that increases blood pressure, takhikardi, red face, dilated pupils, and increased urinary frequency, which in turn will increase energy expenditure.
2. Expressions Function
Someone has a wide range of expression of feeling. In anger the person's expression of something that did not like. The function is said to be angry expression still healthy if done assertive is to not do violent things.
3. Self promotional function
Some individuals try to let go of his angry feelings to show that individual self-esteem. Individuals believe that if someone else mention the things that sensitive part of her life, so if there is evidence of anger will increase her self-esteem in the eyes of others.
4. Defensive function
Anger is an ego defense in response to increased anxiety due to external conflicts such as conflicts with family, conflict with a boyfriend, conflicts with friends, and so on. Individuals confident after the anger out there about him will feel relieved, because the conflict is expressed. In addition, if someone is angry erasaan usually because of the threat from the outside that someone is trying to show it as a defense of himself.
5. Potentiating function
Anger can increase the potential.
6. The function of discrimination
In expressing his feelings, individuals have the variety of expressions. One of them is anger. With an expression of anger it will be easier to distinguish whether the expression of someone that was sad, angry, or happy.
The Angry Client
Angry and demanding clients often generate feelings of helplessness and frustation in the nurse. These feelings can be effectively managed by recognizing the meaning of client responses and maintaining composure in the most stressful circumstances. Anger typically symbolizes underlying feelings of helplessness and should not be personalized.
Major interventions include approaching the client in a calm and firm manner, using direct eye contact and active listening skills. It it critical that the nurse be able to assess verbal and nonverbal cues to detect imminent physical aggression in the angry client. The likelihood of aggression increases when clients feel they are ignored or discounted. Hurried and unconcerned responses 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 strikes out or throws things. Speaking in a firm, accepting, and caring tone is critical to minimazing acting out behaviors. Narmally, physical or verbal aggression indicates that the client is feeling out of control. Nurses 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 enhances adaptive coping skills (Antai-Otong,1988a).
Patient Education Plan
Appropriate Expression of Anger
| Content | Instructional Activities | Evaluation |
| Help the patient identify anger Give permission for angry feelings Practice the expression of anger Apply the expression of anger to a real situation Identify alternatives ways to express anger Confrontation with a person who is source of anger | Focus on non verbal behavior Role play non verbal expression of anger Label the feeling using the patient’s preferred words Describe situations in which it is normal to feel angry Role play fantasized situations in which anger is an appropriate response Help identify a real situation that makes the patient angry Role play a confrontation with the object of the anger Provide possitive feedback for succesfull expression of anger List several ways to express anger with and without direct confrontation Role play alternative behavior Discuss situations in which altrnatives would be appropriate Provide support during confrontation if needed Discuss experience after confrontation takes place | The patient can demonstrate an angry body posture and facial expression The patient describes a situation in which anger would be an appropriate response The patient participates in role play and identifies behaviors associated with expression of anger The patient identifies a real situation that results in anger The patient is able to role play expression of anger The patient participates in identifying alternatives and plans when each might be useful The patient identifies the feeling of anger and appropriately confronts the object of the anger |
Nursing Process
Assessment
Basically, the assessment on the client's anger directed at all aspects, namely biospiritual-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 the frequency of urine increased. This is because energy is released when anger increases.
· Emotional Aspects
Individuals who are uncomfortable angry, feel helpless, upset, frustration, resentment, 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.
· Aspects of Intellectual
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 trust and dependence. The emotion of anger is often stimulates anger from others.
· Spiritual Aspects
Beliefs, values, and moral influence expression of angry individuals. These aspects affect the individual's relationship with the environment. Individuals who believe in God the Almighty, needs and always ask for His guidance.
Nursing Diagnosis
Possible nursing diagnoses angry clients
1. Violent behavior
2. Suicide risk
3. Social isolation
Nursing Action Plan
1. Violent behavior.
a. Nursing actions for clients
Destination
- The client can identify the causes of violent behavior.
- The client can identify the signs of violent behavior.
- Clients can mention types of violent behavior has ever done.
- The client may mention a result of the violent behavior he was doing.
- Clients can mention how to control violent behavior.
- The client can control the behavior of physical violence, spiritual, social, and psikofarmaka therapy.
Action
1. Construct a trusting relationship
In a trusting relationship needs to be considered that the client feels safe and comfortable when interacting with the nurse. Actions that should nurses do in an effort to develop a trusting relationship is the therapeutic greetings, as well as making the contract subject, time, and place each time meeting with clients.
2. Discuss with the client's cause violent behavior that occurred in the past and present.
3. Discuss the feelings of the client if there is cause of violent behavior.
4. Discuss with the client about the signs and symptoms of violent behavior, whether physical, psychological, social, spiritual and intellectual.
5. Discuss with the client's verbal behavior usually established at the time of angry kind to yourself, others and the environment.
6. Discuss with clients the impact of angry behavior.
7. Discuss with the client how to control the violent behavior of both physical (at the mattress or pillow and take a deep breath), medicine, social or verbal (by expressing his anger in asretif), or spiritual (prayer or to pray according to the client confidence).
Nursing actions for the family
Destination : Families can take care of clients at home.
Action
à Discuss with the family of violent behavior including causes, signs and symptoms, behavior that appears, and the consequences of such behavior.
àTrain families to care for family members with violent behavior.
- Encourage families to always motivate clients to do what has been taught by a nurse.
- Teach the family to give praise to the client when family members can do the activity correctly.
- Discuss with your family what to do when the client shows signs of violent behavior.
à Discuss with your family Kien conditions that need to be reported immediately to the nurse, such as throwing or hitting objects / people.
2. Risk of suicide
a. Nursing actions that threaten the client or attempted suicide
- Goal: The client remains secure and safe
- Action: Protecting the client
The nurse can do the following things to protect clients who threatened or attempted suicide.
- Stay accompany clients to be moved to safer places.
- away from all dangerous objects (such as knives, razors, glasses, belts, etc.).
- Ensure that the client actually take his medicine, if the client is getting the drug.
- Explain gently on the client that the nurse will protect the client until the client forget about suicide.
b. Nursing actions for the client's family attempted suicide
- Destination: Families participate protect family members who threatened or attempted suicide.
- Actions:
àEncourage families to participate and monitor the client should never leave the client alone.
àEncourage families to help nurses stay away from dangerous items around the client.
àDiscuss with the family to keep the client in order not to own daydreaming.
à Explain to families the importance of clients taking medication regularly.
3. Social isolation
a. Nursing actions for clients
- Fostering a relationship of trust
- Recognizing the causes of social isolation.
- To know the advantages and disadvantages to interact with others.
- Conducting interaction with others in stages.
b. Nursing actions for the family
- The family knows the problem of social isolation and its impact on clients.
- Families find the cause of social isolation.
- Family attitude to help clients overcome their social isolation.
- The family knows the correct treatment for the client.
- The family knows where the reference and health facilities available to clients.
Evaluation
Nurse Response
Nurse Response To Anger Clients
In the mental health study, patients with antisocial personality and deviant behavior showed disapproval, intolerance, and general moral disorder that is greater than other patients. As one who needs help, clients are seen as having weak morals. But on the other hand they are actually able to overcome the problem if he wants to try. Like humans who want to be appreciated and successful business when dealing with people was helping, but then it abuse, or refuse even harassing,nurses angry. If in interpersonal situations that do not obtain satisfactory results can lead to anger, disappointment, indifference, and despair.
As with other clients which the client's behavior seen as a defense mechanism that can be understood, which can be reviewed in the therapeutic process. Clients with personality disorders and behavioral deviations are expected to oppose it / eliminate habits of self-defense mechanism. Considering this, the nurses, especially students, and beginning to prepare everything. They can be fooled by the charm, intelligence, and promises the client in this case they may blame themselves and disappointed.
Nurse response to such cases in general, influenced the socio-cultural backgrounds. Nurse with experience with similar cases in the family can lead to resentment experienced trauma or no attention to the needs of clients. Therefore, it needs the glory and self-critical evaluation. It is most effective in helping clients is to often improve the client's own self through self-awareness and understanding of human attitudes.
Response to family
The nurse can also give the same response to the family as the client. Some things need to be assessed:
1. Family inheritance from generation to generation. This could be one of the causes of the anger experienced by the client.
2. Pattern of family relationships that facilitate the client's deviant behavior.
3. Lack of attention and family education.
4. Too overprotective
REFERENCES
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Keliat, B. A. 1999. The process of Mental Health Nursing, Volume I. Jakarta: EGC.
Stuart, G. W. and Sundeen.1995. Principles and Practice of Psyciatric Nursing (5 th ed.). St. Louis: Mosby.
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