In completing the case study, students will be addressing the following learning objectives:

Discuss various interventions to manage anger and aggression.

Define broad factors that can increase risk for anger, aggression, and violence.

1. Frances, a 49-year-old African American client, is a newly admitted patient to the psychiatric hospital. Frances has the dual diagnoses of Bipolar I and Borderline Personality Disorder. Frances refuses to abide by the unit rules of being out in the day room after breakfast and is staying in her room. Her treatment level permits her to make two telephone calls daily, and Frances is demanding unlimited access to the telephone Frances is becoming increasingly frustrated and angry at the staff and has used some expletives in telling them what she thinks of the unit rules. The primary nurse attempts to defuse Frances' anger but finally becomes frustrated and angry herself, and she commented to Frances that if she did not cooperate with unit rules, she could expect to be in the hospital longer than usual. Frances then lunged at the nurse, striking her on the head with her fist. Frances was taken to the calming room and given a medication for her aggressive behavior.
(Learning Objectives: 2)

a. What therapeutic communication techniques could the nurse have used with Frances to prevent her from becoming angry and aggressive?

b. What factors could have contributed to an increase in Frances' level of anger?