Risk for self or other- directed violence r/t impulsivity and impaired judgment
and persuasive disregard for the rights of others AEB risk-taking behaviors, irritability,
anger and aggressiveness, conflict with authority, history of previous violence,
and impulsive, explosive behavior
Client will identify
impulse behaviors and demonstrate appropriate self-control behaviors to refrain
from harming self and others by [date].
Client will displace
anger to meaningful activities, refrain from verbal outbursts, and display no aggressive
1.) Assist clients
to identify precipitants of dysfunctional mood, differentiating what can and cannot
be changed. Help them identify available resources and personal strengths. Teach
new problem-solving and coping skills. (Foley, 2010).
of precipitants helps clients develop strategies to prevent mood changes. Using
personal strengths and abilities enhances feels of control.
2.) Develop a behavioral
management plan that is implemented consistently among all healthcare providers.
Communication of rules, expectations, and consequences should be addressed as well
as limitations on intrusive, interruptive behaviors. Provide consistent consequences
for both desired and undesired behaviors and praise the desired behaviors (Foley,
about rules and expectations reduce power struggles and promote feelings of security
for clients. Positive feedback for desired behaviors helps reinforce them.
3.) Have client keep
an anger diary and discuss alternative responses together. Teach cognitive behavioral
techniques for self- evaluation from the client (Ackley, & Ladwig, 2008).
with anger management difficulties may not be aware of changes and cues that they
are becoming angry or of a time delay in the stimulus to their angry response. By
using cognitive behavior techniques and reviewing the diary with staff, the client
can identify though processes leading u to anger and the space between the stimulus
1.) Identify stimuli
that initiate violence and the means of dealing with the stimuli, such as walking
away. (Ackley, & Ladwig, 2008).
the client to identify situations and people that upset him provides information
needed for problem solving. The client can then identify alternative responses:
leaving the stimulus, initiating a distracting activity, or responding assertively
rather than aggressively.
2.) Emphasize that
the client is responsible for his choices and behavior. Introduce descriptions of
possible effects of a client’s aggressive/violent behavior on others (Ackley, &
Rationale: In many
cases clients operate from a worldview that perceives others as instruments of the
clients’ gratification. Clients must gain that they are dealing with other human
beings who experience pain. Clients’ behaviors influence how others respond to them.
3.) Redirect possible
violent behaviors into physical activities such as doing pushups and sit-ups (Ackley,
& Ladwig, 2008).
that distract while draining excess energy help to build a repertoire of alternative
behaviors for stress reduction.
Evaluation of this
goal is set for [date]. The client has demonstrated progress toward this goal by
identifying that he now knows when he is becoming angry and what usually results
when he does not control his impulses. He has also demonstrated less aggressive
behaviors towards his peers during conflicts.
Evaluation of this
goal was set for [date]. The client has accomplished this goal by using meaningful
physical activities whenever he gets angry, refraining from verbal outbursts by
explaining his feelings first, and not getting into aggressive activity.
1.) The client stated
that by knowing the way his body feels when he gets in aggressive moods, he can
to stop and think about what his next move is going to be instead of acting out
on impulse. He also said that he knows that instead of punching or pushing a peer,
he can go to the staff to talk about the situation.
2.) The client discussed
a time when he did not follow the rules during gym time and consequentially he lost
gym privileges for the rest of the week and did not receive his points for the day.
He stated that he knows he deserves the punishment, and from now on he will be patient
and follow the rules.
3.) The client had
just found out about a death in his family, and shortly following had an altercation
with a peer where he was shoved. He demonstrated self-control behaviors by putting
his hands up, taking a few steps backward, and explaining to the peer why he was
upset and that he did not want to fight. They both apologized and moved on.
1.) The client verbally
expressed stimuli that triggered his violence: not being able to get his way, being
wrong, having everyone tell him what to do.
2.) The client expressed
that he wants to be able to control his temper and that he knows all of the clients
in the facility are under stress. He stated that some people clash so it is best
to avoid them or try to decrease their triggers as well as his own to promote a
3.) The client has
gone to his room to do pushups and sit-ups whenever his temperament has escalated.