INTRODUCTION:

Anger is temporary madness said by Osho. Aggression arises from an innate drives or occurs as a defense mechanism and is manifested either by constructive or destructive acts directly towards self or others. Aggressive people ignore the rights of other people. They must fight for their own interests and they expect same from others. An aggressive approach to life may lead to physical or verbal violence. The aggressive behavior often covers a basic lack of self confidence. Aggressive people enhance to their self esteem by overpowering others and there by proving their superiority. They try to cover up their insecurities and vulnerabilities by acting aggressive.

MEANING:

· Anger: Anger is defined as a strong uncomfortable emotional response to provocation that is unwanted and incongruent with one’s values, beliefs or rights.

· Aggression: Aggression refers to behavior that is intended to cause harm or pain. Aggression can be either physical or verbal.

CHARACTERISTICS OF AGGRESSIVE BEHAVIOR:

· Aggressive behavior is communicated verbally or non verbally

· Aggressive people may invade the personal space of others

· They may speak loudly and with greater emphasis

· They usually maintain eye contact over a prolonged period of time so that the other person experiences it as an intrusive

· Gestures may be emphatic and often seem threatening. (For example they may point their figure, shake their fists, stamp their feet or make slashing motion with their hands) Posture is erect and often aggressive people lean forward slightly towards the other person.

TYPES OF AGGRESSION:

· Instrumental aggression-Aggression aimed at obtaining an object, privilege or space with no deliberate intent to harm another person

· Hostile aggression-Aggression intended to harm another person, such as hitting, kicking, or threatening to beat up someone.

· Relational aggression-A form of hostile aggression that does damage to another's peer relationships, as in social exclusion or rumor spreading

TYPES OF ANGER: 12 Most Common Types of Anger

The most common kinds of anger are classified under 12 headings.

· Behavioral Anger – This type of anger usually describes someone who is aggressive towards whatever triggered their anger… this can be another person. This can be someone who always seems to act out, or is troublesome. Sometimes the outcome is physical abuse or attacks against others.

· Passive Anger – People who use sarcasm or mockery as a way to hide their feelings, typically express this form of anger. They tend to avoid confrontations with people or situations.

· Verbal Anger – Anger that’s expressed mostly through words and not actions. Verbal abuse is used to criticize and insult people (put them down) and complain.

· Constructive Anger – This type of anger is a key factor in driving people to want to join movements and groups. It’s the feeling of being fed up with how things are going, and the need to make a positive change.

· Self-inflicted Anger – Anger that translates in causing harm to one’s own body. People who use this type of anger are acting out by punishing themselves for something they’ve done wrong. Some examples include starvation, cutting, and overeating.

· Volatile Anger – This form of anger occurs in varying degrees… it comes and goes. It can just appear out of nowhere, or build into something bigger. It can either explode or go unnoticed. It could even be expressed verbally or physically.

· Chronic Anger – Ever come across someone that’s seemingly angry for no reason, or mad all the time? More than likely, they were exhibiting this type of anger. People with chronic anger are just mad in general.

· Judgmental Anger – Putting other people down and making them feel bad about themselves, or abilities, is a form of judgmental anger. This person expresses their feelings by making those around them feel worthless.

· Overwhelmed Anger – This person relieves stress by shouting, and flying off the handle, when they can’t take situations and things that are happening around them, anymore. When things are just too overwhelming which is why it’s called ‘overwhelmed anger’.

· Retaliatory Anger – This is probably one of the most common, of the bunch. Retaliatory anger usually occurs as a direct response to someone else lashing out at you has that happened to you once or twice?

· Paranoid Anger – This anger comes about when someone feels jealousy towards others, because they feel other people have or want to take what’s rightfully theirs. Or they may act out because they feel intimidated by others.

· Deliberate Anger – Using anger to gain power over a situation or person. A person expressing this form of anger may not start out angry, but will get angry when something does not turn out the way they wanted. Or, someone doesn’t see eye to eye with something they planned.

THEORIES OF AGGRESSION:

1. Psychological Theory:

One psychological view of aggressive behavior suggests the importance of predisposing developmental or life experiences that limit the person’s capacity to select nonviolent coping mechanisms. Some of these experiences may include:

· Organic brain damage , mental retardation or learning disability, which impair the capacity to deal effectively with frustration.

· Severe emotional deprivation or overt rejection in childhood, or parental seduction, which may contribute to defects in trust and self esteem.

· Exposure to violence in formative years , either as a victim of child abuse or as an observer of family violence, which may instill a pattern of using violence as a way to cope

2. Sociocultural Theory:

Social and cultural factors also may influence aggressive behavior. Cultural norms help to define acceptable and unacceptable means of expressing aggressive behavior feelings.

Social determinants of violence are:

· Poverty and the inability to have basic necessities of life

· Disruption of marriages

· Production of single-parent families

· Unemployment

· Difficulty in maintaining interpersonal ties, family structure and social control.

3. Biological Theory:

Current biological research has focused on three areas of the brain believed to be involved in aggression:

· Limbic system

· Frontal lobes

· Hypothalamus.

Neurotransmitters have also been suggested as having a role in the expression or expression of the aggressive behavior.

PREDISPOSING FACTORS:

1 Genetic factors

2 Neurophysiological disorders

3 Psychological factors

4. Social factors:

· Frustration

· Direct provocation

· Television violence

· Computer games

5. Environmental factors:

· Air pollution

· Noise

· Crowding

6. Situational factors:

· Heightened physiological arousal

· Sexual arousal

· Pain

RECOGNIZING THE PHYSIOLOGICAL SIGNS OF ANGER:

The physiological signs and symptoms of anger are,

1 Unconscious tensing of muscles, especially in the face and neck.

2 Teeth grinding

3 Breathing rate increases dramatically

4 Face turns red and veins start to become visible due to an increase in blood pressure

5 Face turns pale

6 Sweating

7 Feeling hot or cold

8 Shaking in the hands

9 Goosebumps

10 Heart rate increases

11 Adrenaline is released into your system creating a surge of power.

NURSING PROCESS IN AGGRESSION:

Nurses provide care for patients with many types of problems; people who enter the health care system are often in great distress and exhibit many maladaptive coping responses. Nurses who work in the setting such as emergency rooms, critical care areas and trauma centre often care for people who respond to events with angry and aggressive behaviour that can pose a significant risk to themselves, other patients and health care providers. Thus preventing and managing behaviour are important skills for all nurses to have.

General Principles of Management:

· The safety of patient, clinician, staff, other patients and potential intended victims is of most importance while looking after aggressive patients

· The doors should be open outwards and not be lockable from inside or capable of being blocked from inside.

· While working with impulsively aggressive or violent patients in any setting one must take care to reduce accessibility to patients of movable objects as well as jewellery and other attire that might add to the risk of injury during an assault, including neckties, necklaces, earrings, eyeglasses, lamps and pens.

· Adequate caregiver training and the availability of appropriate supervision are critical safeguards in the treatment of potentially dangerous patients.

· The caregiver may choose to present a few key observations in a calm and firm but respectful manner, putting space between self and patient; avoiding physical or verbal threats, false promises and build rapport with client.

· For caregivers treating patients with a high risk for violence behaviour, training in basic self defense techniques and physical restraint techniques are useful.

Nursing Assessment:

· A violence assessment tool can help the nurse.

· Establish a therapeutic alliance with the patient.

· Assess patient’s potential for violence.

· Develop a plan of care.

· Implement the plan of care.

· Prevent aggression and violence in the milieu.

· Following the assessment, if the patient is believed to be potentially violent, the nurse should:

· Implement the appropriate clinical protocol to provide for the patient and staff safety

· Notify co-workers

· Obtain additional security if needed

· Assess the environment and make necessary changes.

· Notify the physician and assess the need for p.r.n medications.

Nursing Interventions:

Nursing interventions can be thought of existing in a continuum. They range from preventive strategies such as

· Self awareness

· Patient education

· Assertiveness training

· Communication strategies

· Environmental strategies

· Behavioral strategies

ANGER MANAGEMENT:

Anger management deals with the management of one’s anger so that the least possible damage is felt to self, others and the environment. This involves understanding one’s anger patterns and dealing with them effectively. One who can manage his own anger effectively can possibly manage the anger of others as well.

Stages of Anger Management:

Anger management can be divided into three stages

I. Managing Anger before it ever appears:

Manage your anger before it manages you. This is the ‘prevention is better than cure’ approach. This is actually the only effective technique for anger management. This involves two steps:

1. Understanding the root cause of anger in general and of anger and anger patterns in particular.

2. Preventive techniques

1. Understanding Anger:

· You become angry because something or someone has done something against your expectations.

· You become angry because you are psychologically a weak person.

· If your ego is hurt you may become angry. Understand that ego itself is a disease. Dissolve your ego as far as possible. If you have inferiority complex, or have a very deficient ego you will lose your temper very easily.

2. Preventive Techniques:

· Practice Relaxation, meditation or the like stress releasing or dissolving techniques.

· Practice Holistic Integration Technique (HIT) the simplest and natural Meditation Technique.
Or Use Guided Somato-Psychic Relaxation (GSPR) Technique.

· Try the Who Am I technique

· Improve yourself, develop yourself continuously. Break your Personal Rules of Living regarding anger. Be optimistic, positive and have hope

· Live in the present (here and now) as far as possible.

· Be aware of yourself, your anger patterns. Find the root cause of your anger – it will be fear or lust or attachment.

· Develop self-confidence

· Accept yourself as such. When you accept your negatives, deficits, you do not have any internal conflict at all

· Be simple, open and authentic

· Love yourself, love others. Unless you love and forgive yourself, you cannot love others or forgive others.

· Develop equal-mindedness in the opposites: good and bad, positive and negative, virtue and non-virtue.

· Avoid over sensuality.

· Avoid revenge, hate and hatred. Avoid mugging up stress.

· Don’t be perfectionist

· Avoid looking for the negatives in yourself and others.

II. Managing anger when you are angry:

There are no fool-proof techniques available for anger management at this stage. This is the most difficult stage to manage because you are the person who is angry and you are the person who is to manage yourself. Try one or more of the following:

· As soon as you are in control withdraw yourself from the situation to avoid irrepairable or irreversible damage to self, others, relationships, and the environment.

· When you recognize that you are angry, just stop doing what you have been doing. Walk around or sit calmly for a few minutes.

· Release the stress (stored due to anger) in a way in which there is least possible harm to self, others, and the environment.

· Breathe deeply. Inhale deeply and hold for a second or two. Then exhale deeply. Repeat a few times.

· Become aware that you are angry. Just observe yourself.

· If possible involve in some creative work that can pacify you.

· If possible, divert your attention to something else that can relax you; like humorous films, calming music, watering your garden, going to beach or park or the like.

· Postpone the expression of anger again and again.

· Get into the company of persons you love or who love you and understand you. Speak out to them, if possible.

· If you have love for children, their presence can pacify you.

· Even pets can sometimes pacify you.

· Laugh it out, if you can, by perceiving it in a humorous way.

· Perceive it creatively and constructively and take it as an opportunity to know yourself, your anger patterns and the situation or other people involved.

· As far as possible do not swear to yourself or shout like: ‘I will teach you/him/her a lesson. I will show you/him/her’ etc. This will act as a program and will be stored as negative energy.

· Use the Stop Technique.

III. Managing anger after your anger:

This stage involves 2 things:

1. Analyzing and finding out the root cause of your anger.

2. Repairing and restoring yourself, others and the environment involved in the anger incident.

1. Analyzing and Finding Out the Root Cause:

You may want or expect others to behave on one way or other and they may do the reverse. This might have made you angry. But why did you expect so? They are free to create their own psychological prisons (= programs) for themselves. If you have such expectations, come out of these. These expectations, if you look deeply into it are also your own fears in disguise. Attachment to these gives you a security feeling and when they are attacked you become angry. Realize these anxieties and fears.

Think of the damages and losses caused to yourself, others and the environment due to your anger. This awareness will lead to an automatic control slowly.

2. Repairing and Restoring:

· Repair Yourself

1. Practice relaxation, meditation or any releasing technique so that all pend up stress energy is either released or dissolved without disturbing yourself, others or the environment.

2. Use humor: read humorous books, watch cartoons or any humorous films etc.

· Repair Others and Your Relationships with Them

Apologize if it is appropriate. Do something to recharge your relationship with the persons affected by your temper.

· Repair the Environment

If you have disturbed the environment by throwing something, or destroying something, take time to reinstate them as far as possible.

CONCLUSION:

Anger is a normal human emotion that is crucial for individual’s growth. Buddha says “Holding on to anger is like grasping a hot coal with the intent of throwing it at someone else; you are the one who gets burned”. So, when anger is handled appropriately and expressed assertively, it is a positive creative force that leads to problem solving and productive change. But, when channeled inappropriately and expressed as verbal aggression or physical aggression, anger is destructive and potentially life threatening force.

REFERENCES:

1. Boyd MA .Psychiatric Nursing Contemporary Practice. Lippincott Publications, Philadelphia. 2001.

2. Keltner LN, Schwecke L H, Bostrom CE. Psychiatric nursing. Mosby publications, Philadelphia. 1999.

3. Kaplan HI, Sadock BJ. Synopsis of Psychiatry, Behavioral Sciences/ Clinical Psychiatry. William and Wilkinson Publishers, Hong Kong. 1998.

4. Stuart GW and Laria MT. Principles and Practices of Psychiatric Nursing. Mosby Publishers, Philadelphia. 2001.

5. Berk, L. Infants, children and adolescents. Allyn and acon, Boston. 1999.

6. Moyer, KE. Kinds of aggression and their physiological basis. Communications in Behavioral Biology 2A; 1968: 65-87

Received on 27.05.2014 Modified on 28.07.2014

Int. J. Adv. Nur. Management 2(3): July-Sept.,2014; Page 171-176