ComportamentulComportamentulagresivagresiv

ComportamentulComportamentulagresivagresiv

Maria Nistor & Lili Sepordi

CeCe intelegemintelegem prinprin

““comportamentcomportament agresivagresiv”?”?

CeCe intelegemintelegem prinprin

““comportamentcomportament agresivagresiv”?”?

CatevaCateva tipuritipuri ……

Auto si hetero Verbala si fizica Emotionala sau psihologica Usoara, moderata si severa Caracteriologica si situationala Activa si pasiva Reactiva si instrumentala

Auto si hetero Verbala si fizica Emotionala sau psihologica Usoara, moderata si severa Caracteriologica si situationala Activa si pasiva Reactiva si instrumentala

PerceptiiPerceptii ……

Ale publicului

In mass media

Ale profesionistilor

Ale beneficiarilor

Ale publicului

In mass media

Ale profesionistilor

Ale beneficiarilor

AgresivitateaAgresivitatea inin tulbtulb mentalementale

Marea majoritatea nu sunt periculosi.

Majoritatea actelor agresive nu sunt comise

de pers cu tulb mentale.

Sunt mai mult victime decat abuzatori.

Contributia altor factori este mai mare.

Exista anumiti factori care cresc riscul.

Marea majoritatea nu sunt periculosi.

Majoritatea actelor agresive nu sunt comise

de pers cu tulb mentale.

Sunt mai mult victime decat abuzatori.

Contributia altor factori este mai mare.

Exista anumiti factori care cresc riscul.

FactoriFactori dede riscrisc generaligenerali

Depedenta sau abuzul de subst

Episodul acut psihotic sau maniacal

Lipsa sau intreruperea medicatiei

Istoricul agresivitatii

Sexul, varsta, nivelul socio-economic redus

Expunerea la violenta in copilarie

A fi victima unui abuz

Depedenta sau abuzul de subst

Episodul acut psihotic sau maniacal

Lipsa sau intreruperea medicatiei

Istoricul agresivitatii

Sexul, varsta, nivelul socio-economic redus

Expunerea la violenta in copilarie

A fi victima unui abuz

AgresivitateaAgresivitatea inin tulbtulb dede dezvoltaredezvoltare

1. Comunicare: frustrare, durere, nevoi, neglijare, abuz

2. Comport invatat si intarit (obt atentie, stimulare,

acces, contact; evitare/scapare din situatii, sarcini, stres)

3. Modulare disconfort fizic si emotional

4. Semn al unei tulb mentale sau medicale

Lowry, M. & Sover R. (1991) Functional existence of probl behav. The Habilit Mental Health Care

Matson, J.L., et al (2010) What is the evidence for environmental causes of challenging behaviors

in persons with intellectual disabilities and autism spectrum disorders?Research in Devel Disabilities

1. Comunicare: frustrare, durere, nevoi, neglijare, abuz

2. Comport invatat si intarit (obt atentie, stimulare,

acces, contact; evitare/scapare din situatii, sarcini, stres)

3. Modulare disconfort fizic si emotional

4. Semn al unei tulb mentale sau medicale

Lowry, M. & Sover R. (1991) Functional existence of probl behav. The Habilit Mental Health Care

Matson, J.L., et al (2010) What is the evidence for environmental causes of challenging behaviors

in persons with intellectual disabilities and autism spectrum disorders?Research in Devel Disabilities

InterventiiInterventii inin tulbtulb dede dezvoltaredezvoltare

1. Modificarea antecedentelor

2. Strategii bazate pe intariri

3. Controlul consecintelor

4. Tehnici de blocaj

5. Tratamament medicamentos

Brosnan, J & Healy, O. (2011). A review of behavioral interventions for the treatment of

aggression in individual with developmental disabilities. Research in Develop Disab.

1. Modificarea antecedentelor

2. Strategii bazate pe intariri

3. Controlul consecintelor

4. Tehnici de blocaj

5. Tratamament medicamentos

Brosnan, J & Healy, O. (2011). A review of behavioral interventions for the treatment of

aggression in individual with developmental disabilities. Research in Develop Disab.

AgresivitateaAgresivitatea inin dementedemente

1. Exprimare, comunicare - disconfort, emotii,

supra/substimulare, pierderi, neintelegeri, suspiciune

2. Rezultat al frustrarii (<= dificult, dependenta,

interpretari sau perceptii gresite)

3. In contextul relatiei cu ingrijitorul - majorit actelor

au loc in timpul ingrijirii, calit relatiei, stresul ingrijitorului

4. Semn al unei tulb mentale sau medicale

Kunikm M. , et al (2010). Causes of Aggressive Behavior in Patients With Dementia. J Clin Psychiatry

Morgan, R. (2013). Modeling causes of aggressive beh in patients with dementia. The Gerontologist.

1. Exprimare, comunicare - disconfort, emotii,

supra/substimulare, pierderi, neintelegeri, suspiciune

2. Rezultat al frustrarii (<= dificult, dependenta,

interpretari sau perceptii gresite)

3. In contextul relatiei cu ingrijitorul - majorit actelor

au loc in timpul ingrijirii, calit relatiei, stresul ingrijitorului

4. Semn al unei tulb mentale sau medicale

Kunikm M. , et al (2010). Causes of Aggressive Behavior in Patients With Dementia. J Clin Psychiatry

Morgan, R. (2013). Modeling causes of aggressive beh in patients with dementia. The Gerontologist.

InterventiiInterventii inin dementedemente

1. Interventii pe modificarea fact activatori (durere,

stimuli, ingrijire, relatie, comp ingrijitori)

2. Activitati pentru reducerea comport agresiv(distragere, comunicare & blocare, izolare)

3. Interventii pentru preventie (interv senzoriale,

sociale, comport, structurare act, training ingrijitori)

4. Abordarea centrata pe persoana

Enmarker, I, et al. (2010). Management of person with dementia with aggressive and violent behaviour: asystematic literature review. International Journal of Older People Nursing,.

Pulsford, D, et al. (2011). A survey of staff attitudes and responses to people with dementia who areaggressive in residential care settings. Journal of Psychiatric and Mental Health Nursing

1. Interventii pe modificarea fact activatori (durere,

stimuli, ingrijire, relatie, comp ingrijitori)

2. Activitati pentru reducerea comport agresiv(distragere, comunicare & blocare, izolare)

3. Interventii pentru preventie (interv senzoriale,

sociale, comport, structurare act, training ingrijitori)

4. Abordarea centrata pe persoana

Enmarker, I, et al. (2010). Management of person with dementia with aggressive and violent behaviour: asystematic literature review. International Journal of Older People Nursing,.

Pulsford, D, et al. (2011). A survey of staff attitudes and responses to people with dementia who areaggressive in residential care settings. Journal of Psychiatric and Mental Health Nursing

AgresivitateaAgresivitatea inin relatiarelatia cucu profesionistiiprofesionistii

1. Factori beneficiar (diag, istoric agresivitate, stil

interpersonal, interpretari, perceptie stres, nivel simpt)

2. Factori profesionist (experienta, stil interper, coping,

comunicare, convingeri, stres ocupat, disponibilitate)

3. Factori institutie (supraincarcare, organiz activit,

supra/substimulare, rata beneficiar - personal)

Nijman (2002) A Model of Aggression in Psychiatric Hospitals. Acta Psychiatr Scand

Whittington R & Richter D (2006) From the Individual to the Interpersonal: Environment and

Interaction in the Escalation of Violence in Mental Health Settings. In Violence in Mental Health

Settings (ed by Richter & Whittington), Springer.

1. Factori beneficiar (diag, istoric agresivitate, stil

interpersonal, interpretari, perceptie stres, nivel simpt)

2. Factori profesionist (experienta, stil interper, coping,

comunicare, convingeri, stres ocupat, disponibilitate)

3. Factori institutie (supraincarcare, organiz activit,

supra/substimulare, rata beneficiar - personal)

Nijman (2002) A Model of Aggression in Psychiatric Hospitals. Acta Psychiatr Scand

Whittington R & Richter D (2006) From the Individual to the Interpersonal: Environment and

Interaction in the Escalation of Violence in Mental Health Settings. In Violence in Mental Health

Settings (ed by Richter & Whittington), Springer.

ProgramePrograme dede interventiiinterventii

1. Non - violent crisis intervention (preventia

escaladarii prin ascultare empatie, de-escaladare, teh

fizice)

2. Professional assault response training (principii

comportam, teh comunic, rezolv conflict, modele ale

agresivit, teh de auto-aparare, blocaj, izolare)

3. Therapeutic options (analiza comportam aplicata, abilit

de conectare, abilit gestionare conflict de putere)

Morrison E & Love C (2003). An Evaluation of Four Programs for the Management of Aggression inPsychiatric Settings. Archives of Psychiatric Nursing

Richter D (2006) Nonphysical Conflict Management and Deescalation. In Violence in Mental Health Settings

(ed by Richter & Whittington), Springer.

1. Non - violent crisis intervention (preventia

escaladarii prin ascultare empatie, de-escaladare, teh

fizice)

2. Professional assault response training (principii

comportam, teh comunic, rezolv conflict, modele ale

agresivit, teh de auto-aparare, blocaj, izolare)

3. Therapeutic options (analiza comportam aplicata, abilit

de conectare, abilit gestionare conflict de putere)

Morrison E & Love C (2003). An Evaluation of Four Programs for the Management of Aggression inPsychiatric Settings. Archives of Psychiatric Nursing

Richter D (2006) Nonphysical Conflict Management and Deescalation. In Violence in Mental Health Settings

(ed by Richter & Whittington), Springer.

PosibilePosibile solutiisolutii

1. Analiza si modificare comportamentala

2. Comunicare asertiva si gestionare a conflictului

3. De-escaladare verbala si comunicarea nonverbala

4. Tehnici fizice (evaziune, auto-aparare, blocaj, izolare)

5. Imbunatatirea relatiei (pre si post)

6. Managementul propriilor emotii

Morrison E & Love C (2003). An Evaluation of Four Programs for the Management of Aggression in

Psychiatric Settings. Archives of Psychiatric Nursing

Richter D (2006) Nonphysical Conflict Management and Deescalation. In Violence in Mental Health Settings

(ed by Richter & Whittington), Springer.

1. Analiza si modificare comportamentala

2. Comunicare asertiva si gestionare a conflictului

3. De-escaladare verbala si comunicarea nonverbala

4. Tehnici fizice (evaziune, auto-aparare, blocaj, izolare)

5. Imbunatatirea relatiei (pre si post)

6. Managementul propriilor emotii

Morrison E & Love C (2003). An Evaluation of Four Programs for the Management of Aggression in

Psychiatric Settings. Archives of Psychiatric Nursing

Richter D (2006) Nonphysical Conflict Management and Deescalation. In Violence in Mental Health Settings

(ed by Richter & Whittington), Springer.

ImpactulImpactul expuneriiexpunerii la compla comp agresivagresiv

Eval subiectiva a comp agresiv si a semnif acestuia

Impactul fiziologic (“inundare”, arousal ridicat)

Impactul emotional (stres, vinov, rusine, furie, anxietate,

vulnerab, neindrept, lipsa putere, ranire, ostilitate)

Impact cognitiv (ruminatii, erori, convingeri, evaluari)

Impact relationare (supra/subreactionare, distantare,

respingere pasiva)

Needham, I. (2006) Psychological Responses Following Exposure to Violence. In Violence in

Mental Health Settings (ed by Richter & Whittington), Springer.

Eval subiectiva a comp agresiv si a semnif acestuia

Impactul fiziologic (“inundare”, arousal ridicat)

Impactul emotional (stres, vinov, rusine, furie, anxietate,

vulnerab, neindrept, lipsa putere, ranire, ostilitate)

Impact cognitiv (ruminatii, erori, convingeri, evaluari)

Impact relationare (supra/subreactionare, distantare,

respingere pasiva)

Needham, I. (2006) Psychological Responses Following Exposure to Violence. In Violence in

Mental Health Settings (ed by Richter & Whittington), Springer.

CeCe putemputem faceface

Constientizare si intelegere

Alocarea unui timp pt recuperare

Auto-linistire

Discursul interior

Cum sa vorbim despre

Cum sa ne reconectam cu beneficiarul

Constientizare si intelegere

Alocarea unui timp pt recuperare

Auto-linistire

Discursul interior

Cum sa vorbim despre

Cum sa ne reconectam cu beneficiarul