INTRODUCTION

Anger is a human experience of great significance for nursing practice. The awareness of anger and related emotions such as hostility, resentment, and rage has been identified elsewhere as being of help to the nurse in explaining and intervening in certain client behaviors. Equally important to the therapeutic nurse-client relationship is the study of those client behaviors which generate anger in others. The anger generated often interferes which the therapeutic aim of a mutual problem-solving process

DEFINITION

• Anger is an emotion. The physical effects of anger include increased heart rate, blood pressure, and levels of adrenaline and noradrenaline. Some view anger as part of the fight or flight brain response to the perceived threat of harm. Anger becomes the predominant feeling behaviorally, cognitively, and physiologically when a person makes the conscious choice to take action to immediately stop the threatening behavior of another outside force. Anger can have many physical and mental consequence. (Wikipedia)
  
• Anger is a feeling or emotion that is a learned means of neutralizing or avoiding the anxiety which arises in responses to interpersonal threat. (Laura Coble Zamora)
  
• Anger is a feeling to be annoyed as response to anxiety or willingness that is not fulfilled as threat. (Stuart and Sunden)
  

  
  

NURSING PROCESS

1. Assessment

- verbal and nonverbal cues to detect imminent physical aggression in the angry client

- social environment : social interaction, culture, family for antisocial behavior

- emotional factor : client with angry often feel uncomfortable, annoyed, frustration, aggresion

Nurse can assist client which has not recognized his or her angry by expressing like " You seem not calm, Mr or you angry". This thing helps client to recognize client's angry feeling.

- intellectual factor : When client angry, she or he need to be aimed at orientation boundary " now and here", at situation like this nurse earns :

a. faces anger intensity of client

b. push angry expression of client

c. Makes contact physical of with client

d. investigates situation of physical of client

e. When necessary keeps distance to protect himself/herself

f. Gives report at nurse that is on duty is the next

-spiritual aspect : when angry client to God or strength of supranatural because is sure that its(the disease is penalization from God, hence nurse gives motivation that his(its soulful client or calls leader of religion if(when nurse feels not adekuat. Nurse can listen attentively causing enables happened discussion about values spiritual covering how far client has reached purpose of its(the life about losing of people closest and someone death.

2. Diagnosis

- difficulty to express of anger without hurting others refering to the doesn't know way of acceptable expression

- communications trouble referring to the angry feeling to service received

3. Intervention and implementation

1. Listen and show you're listening - Don't clam up or start defending yourself or arguing. Listen passively, at first, occasionally saying things like "I see" or "I hear you."

2. Take it seriously but not personally - Any negative response from a client is very important! But in most cases, while the anger may seem directed personally at you, it seldom is. Remember some of the reasons why you might be on the receiving end:

You're a handy scapegoat for something that someone else in your firm did.

The client is taking his or her anger at someone else - perhaps the boss? - on you. And in most cases without realizing it.

The client really sees a problem with your work but it is due to a misunderstanding.

The client really sees a problem with your work but it is because he or she doesn't correctly remember what was promised.

3. Let them finish - You could interrupt, but for what purpose? Until the person has vented he or she is not going to listen to you.

4. Don't match their anger or tone - be calm and show respect. Even in the very extreme case of physical self-defense people are told to never shout or curse back at an angry, shouting, cursing person. Being calm and polite does not make you look weak; it makes it clear that you, for one, are in control of yourself.

5. Express sympathy and an interest in problem-solving - Even if the criticism is completely off-base you can feel badly about the other person's distress.

6. Apologize for what you should apologize for - In most cases, even if you are 95% blameless, you are 5% at fault. Claim that 5% immediately.

7. Turn it into problem solving - If the client is angry, something needs to be fixed. This may be an emotionally laden problem but it is still a problem to be solved.

You may discover the basis for the anger; on the other hand you may never know if the anger was built-up resentment, a smokescreen for fear or even an attempt at manipulation. It doesn't really matter.

8. Don't take the automatic stance that you're wrong but do find some action step you can take - Listening, being sympathetic and taking some responsibility doesn't mean you were all wrong or that everything the client asks for is justified.

Dos and don'ts for coping with the angry client

What to do	Why
Keep your emotions in check;speak in a calm, reas-suring way	Gaining control over your feelings lets you think rationally. Only then can you help the client. If you become angry, you'll probably incite the client even more
Watch the client's body language	The client's body language gives you clues to his or her potential for physical aggression. Pacing indicates agitation, for example; a clenched fist may mean imminent physical violence
Let the client air feelings	When the client airs his or her feeling, anger and tension decrease, enabling the client to deal with the situation rationally
Determine the source of the client's anger	Knowing the source of anger enables you to recognize that the anger is not directed toward you
Involve the client in his or her treatment	Involving the client in daily care decreases his or her feelings of helplessness and dependency
Provide controls or limits as needed	Setting limits on the client's behavior provides some controls. The client often welcomes these limits.

What not to do	Why
Don't shout or argue with the client. Avoid touching the client or invading the client's space	Shouting, arguing, and touching the client can escalate anger. These behaviors prevent you from dealing effectively with the client and can make him or her become physically violent. Touching the client or invading his or her space can be threatening to the client and make him or her feel cornered. This may result in retaliation toward you
Don't let the client stand between you and the door	Maintain easy access to the door in case the client becomes violent and you need to get out quickly
Don't patronize or talk down to the client	Patronizing the client increases anger and potential for aggression
Don't discount the client's feelings	Dismissing the client's feelings interferes with establishing a therapeutic nurse-patient relationship

4. Evaluation

Focus of evaluation is way to express the client's angry, right angry, equality degree of angry expression with predisposition factor and awareness of client to process experienced by him or her.

Refference

Rose,Robert G.2002.When Client Get Angry.www.roseporterfieldgroup.com

Meyer,Wendy S.2007.Calming Angry&Upset Client.www.csvets.com

Stuart&Sundeen.1995.Principles&Practice of Psychiatric Nursing 5th ed.St.Louis, Missouri: Mosby-Year Book,Inc

Antai-Otong,Debora.1995.Psychiatric Nursing: Biological and Behavioral Concepts.Philadelphia Pennsylvania: W.B Saunders Company

Haber,Judit Dkk.1982.Comprehensive Psychiatric Nursing.USA: Mc.Graw-Hill Book Company

Keltner,Schwecke Bostrom.1995.Psychiatric Nursing 2nd ed.St.Louis Missouri: Mosby-Year Book, Inc

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WHY DO PEOPLE GET ANGRY?

Righteous anger - Sometimes people, including you and me and our clients, get angry because we have, quite simply, been treated badly. Sometimes anger is just that: you treated me wrong and I'm angry with you for doing that.



Smokescreen anger - Anger is not always about anger! Some people - men a bit more than women - display anger when they get frightened. If client Bill gets worried that his job review is going to be poor because the installation in his department is going slow he may call and berate you for the work not going well. He sounds angry: in fact the anger is a smokescreen for his fear and he doesn't even know it himself.



Manipulative anger - Sad but true, some people have learned that they can get their way by intimidating others with anger. The anger is an academy-award winning performance whose only purpose is to get you to give in on something. This form of anger leads to a lot of "scope creep" and can cost your firm revenue!



Displaced anger - Have you ever kicked a trashcan when you were mad at your boss? Have you ever snapped at your spouse when you were mad at your mother?
We all tend to displace anger from someone to whom we cannot show anger - for whatever reason - to someone we can, either because they are more vulnerable or simply available. It isn't fair, but it is fairly universal. A common displacement of anger is blaming the person on the other end of the phone for the actions of the entire company.


Built-up anger - When people deal appropriately with frustration they seldom show temper. But, most people do not deal appropriately with frustration. They let little things build up and then some small event sets them off.

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TYPE OF ANGER

Anger can be of one of two main types: Passive anger and Aggressive anger. These two types of anger have some characteristic symptoms.

1. Passive anger

Passive anger can be expressed in the following ways:

Secretive behavior, such as stockpiling resentments that are expressed behind people's backs, giving the silent treatment or under the breath mutterings, avoiding eye contact, putting people down, gossiping, anonymous complaints, poison pen letters, stealing, and conning.

Psychological manipulation, such as provoking people to aggression and then patronizing them, provoking aggression but staying on the sidelines, emotional blackmail, false tearfulness, feigning illness, sabotaging relationships, using sexual provocation, using a third party to convey negative feelings, withholding money or resources.

Self-blame, such as apologizing too often, being overly critical, inviting criticism.

Self-sacrifice, such as being overly helpful, making do with second best, quietly making long suffering signs but refusing help, or lapping up gratefulness.

Ineffectualness, such as setting yourself and others up for failure, choosing unreliable people to depend on, being accident prone, underachieving, sexual impotence, expressing frustration at insignificant things but ignoring serious ones.

Dispassion, such as giving the cold shoulder or phony smiles, looking unconcerned, sitting on the fence while others sort things out, dampening feelings with substance abuse, overeating, oversleeping, not responding to another's anger, frigidity, indulging in sexual practices that depress spontaneity and make objects of participants, giving inordinate amounts of time to machines, objects or intellectual pursuits, talking of frustrations but showing no feeling.

Obsessive behavior, such as needing to be clean and tidy, making a habit of constantly checking things, over-dieting or overeating, demanding that all jobs be done perfectly.

Evasiveness, such as turning your back in a crisis, avoiding conflict, not arguing back, becoming phobic.

2. Aggressive anger

The symptoms of aggressive anger are:

Threats, such as frightening people by saying how you could harm them, their property or their prospects, finger pointing, fist shaking, wearing clothes or symbols associated with violent behaviour, tailgating, excessively blowing a car horn, slamming doors.

Hurtfulness, such as physical violence, verbal abuse, biased or vulgar jokes, breaking a confidence, using foul language, ignoring people's feelings, willfully discriminating, blaming, punishing people for unwarranted deeds, labeling others.

Destructiveness, such as destroying objects, harming animals, destroying a relationship between two people, reckless driving, substance abuse.

Bullying, such as threatening people directly, persecuting, pushing or shoving, using power to oppress, shouting, using a car to force someone off the road, playing on people's weaknesses.

Unjust blaming, such as accusing other people for your own mistakes, blaming people for your own feelings, making general accusations.

Manic behavior, such as speaking too fast, walking too fast, working too much and expecting others to fit in, driving too fast, reckless spending.

Grandiosity, such as showing off, expressing mistrust, not delegating, being a sore loser, wanting center stage all the time, not listening, talking over people's heads, expecting kiss and make-up sessions to solve problems.

Selfishness, such as ignoring other's needs, not responding to requests for help, queue jumping.

Vengeance, such as being over-punitive, refusing to forgive and forget, bringing up hurtful memories from the past.

Unpredictability, such as explosive rages over minor frustrations, attacking indiscriminately, dispensing unjust punishment, inflicting harm on others for the sake of it, using alcohol and drugs, illogical arguments.

It should be stated that anyone displaying any of these behaviours does not always have an anger management problem.

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