00138 Risk Of Violence Aimed At Others

Domain 11: security/protection
Class 3: violence
Diagnostic Code: 00138
Nanda label: violence risk addressed to others
Diagnostic focus: violence aimed at others
Approved 1980 • Revised 1996, 2013, 2017

NANDA Nursing Diagnosis Definition

Nanda nursing diagnosis « risk of violence aimed at others is defined as: likely to show behaviors in which the person demonstrates that it can be physical, emotionally and/or sexually harmful to others.

Risk factors

  • Cognitive dysfunction
  • Easy access to weapons
  • Inephic impulse control
  • Negative Body Language
  • Antisocial violent behavior pattern
  • Indirect violence pattern
  • Pattern of violence aimed at others
  • Threat pattern of violence
  • Suicide behaviors

Risk population

  • People with a history of child abuse
  • People with a history of cruelty towards animals
  • People with incendiary history
  • People with a history of traffic infractions
  • People with a history of inappropriate use of substances
  • People with a history of witnessing family violence

Associated problems

  • Neurological deterioration
  • Pathological poisoning
  • Perinatal complications
  • Prenatal complications
  • Psychotic disorder

Suggestions of use

This diagnosis is used for patients who need nursing interventions with the purpose of protecting third parties and preventing or reducing episodes of violence. The diagnosis of disabling family coping could be more useful in situations in which there is domestic violence. If necessary to focus on anxiety or low self -esteem, consider the use of suggested alternative diagnoses.

Suggested alternative diagnostics

  • Committed family coping
  • Ineffective coping
  • Anxiety (specify the level: mild, moderate, serious, critical)
  • Low chronic self -esteem
  • Low situational self -esteem

NOC Results

  • Impulses self -control: Self -limitation of compulsive or impulsive behaviors
  • Aggentrol of aggression: self -limitation of harmful, combat or destructive behaviors, towards others
  • Self -control of abusive behavior: self -limitation of abuse and careless behaviors towards others

Evaluation objectives and criteria

  • • Demonstrates self -control of aggression, which is manifested by the following indicators (specifying 1 to 5: never, sometimes, sometimes, often or usually):
    • Abstiene de:
      • Verbal outbursts
      • Hit others
      • Violate the vital space of others
      • hurt others; hurt animals
      • Destroy belongings
      • Identify when you feel angry, frustration or aggression
      • Communicate your feelings appropriately
  • • Demonstrates self -control of the impulses, which is manifested by the following indicators (specify from 1 to 5: never, rarely, sometimes, often or usually):
    • Identify feelings or behaviors that lead him to act impulsively
    • Identify consequences of impulsive acts towards oneself and others
    • Avoid high -risk environments and situations
    • seek help when you experience impulses
  • Other examples

    • • Identify factors that cause violent behaviors
    • • Identify alternative ways to face problems
    • • Identify community support systems
    • • Does not abuse physical, emotionally or sexually of others

    NIC Interventions

    Note : Nursing interventions focus on identifying and modifying risk factors, as well as violence aimed at other people.

    • Due to the large number of risk factors, it is not possible to include all interventions.
    • Support in protection against abuse: identification of acts and high -risk dependence relationships, to prevent physical or emotional damage from being inflicted
    • Support for anger control: facilitation of anger expression in an adaptive way, without violence
    • Training for impulse control: Help the patient to control their impulsive behaviors, through the application of problem -solving strategies in social and interpersonal situations
    • Behavior management: Help a patient handle negative behaviors
    • Environment management: Violence prevention: supervision and modification of the physical environment to reduce potential aggressive behaviors aimed at itself, to others or the environment

    Nursing Activities

    Valuations

    • • Identify behaviors that indicate imminent violence against third parties; Specify behaviors
    • • (NIC) Support for anger control: monitor the potential for inappropriate aggression and intervene before its manifestation
    • • (NIC) Environment Management: Violence Prevention:
      • Monitor the safety of the articles carrying visitors
      • Watch the patient while using potential weapons (for example, razor sheet)

    Patient and family education

    • • (NIC) Support for anger control: instruct in the application of tranquilizing measures (for example, breaks, deep breath)

    Collaboration activities

    • • Clarify the usefulness of staying 72 hours in the psychiatric unit for evaluation and treatment, in case of other people’s abuse
    • • Talk to the doctor about the application of appropriate restriction measures when it is necessary to prevent damage to third parties
    • • Follow the hospital or institution policy, regarding the legal responsibility to report abuse to the authorities
    • • Organize a multidisciplinary meeting on patient care to develop a care plan

    Others

    • • Motivate the patient to express their anger with words
    • • Identify situations that cause violence; Specify situations
    • • Provide positive feedback when the patient accepts that his behavior does not exceed the limits
    • • (NIC) Support for anger control:
      • Apply a calm and safe style
      • Limit exposure to frustrating situations until the patient is able to express anger adaptively
      • Encourage the patient to seek help with nursing staff or other responsible persons, during periods of great tension
      • Avoid physical injuries if anger addresses itself or others (for example, limiting and withdrawing potential weapons)
      • Teach methods to control the experimentation of intense emotions (training in assertiveness, relaxation techniques, write a newspaper, distractors)
      • Identify consequences of an inappropriate expression of anger
      • Establish an expectation that the patient can control their behavior
      • Help in the design of appropriate methods to express anger towards others (for example, assertiveness and use of emotional phrases)
    • • (NIC) Environment Management: Violence Prevention:
      • Assign an individual room to the potentially violent patient towards other people
      • Assign to the patient a room near the nursing center
      • Limit access to windows, unless they are closed or armored, when it is required
      • Place the patient in the less restrictive environment that allows the necessary level of observation
      • Designate a safe area (for example, insulation room) to place the patient when violently behaves
      • Provide plastic hooks for clothing instead of metal hooks, when required
      • Provide paper dishes and plastic utensils at meals

    At home

    • • Previous activities can be used or adapted for home care
    • • Perform an initial evaluation and continuous evaluations, to detect possible child abuse, of the couple or an older person
    • • Observe the presence of verbal aggressions, since they can be abuse indicators
    • • If abuse is suspected, implement an emergency plan to guarantee patient safety; Inform the competent authorities
    • • Evaluate whether the patient is consuming prescribed psychotropic medications
    • • If an awkward situation arises due to the aggressiveness of a patient, even if there is no manifest threat, it should not be remained at home
    • • If aggressiveness is manifested, explain to the patient that aggressive behavior could cause the institution to suspend services. Notify the institution and make future visits with other staff members or outside the home

    Babies and Children

    • • Evaluate abuse signals; Inform the competent authorities
    • • Channel to home visits for young children
    • • Evaluate whether adolescent women have suffered violence in romantic dates
    • • Evaluate the abuse of pregnant adolescents, especially if the couple is greater than her for four years or more

    Older people

    • • Evaluate the presence of dementia and delusions
    • • Evaluate the potential or real abuse of older people, including economic exploitation, physical abuse and malnutrition
    • • If abuse is suspected, inform the protection services for the elderly
    • • Evaluate the presence of agitation, anger, irritability, changes in psychological functions and functional skills (for example, decreased mobility)