Anger and Patient Care

Anger is often linked to violence. Patients may feel angry because of illness or problems outside the hospital. Since you interact with them often, you may become the target of their anger. Expressing anger can sometimes help patients recover, especially when coping with loss.
Patients may direct anger at nurses, but it often hides deeper fears—for example, a cancer patient may complain about care instead of admitting fear of death.
Handling angry patients is stressful. Their anger may feel like rejection of your care and can affect attention to other patients. Allow patients to express anger, but ensure it does not compromise safety or care. Good communication and de-escalation skills—like calm words, non-threatening body language, or safe physical control—help redirect anger toward problem-solving.

Managing Angry or Potentially Violent Patients

1. Observation
•     Watch for signs of anger: pacing, clenched fists, loud voice, throwing objects.
•     Note expressions: repeated questioning, refusal to follow requests, threats, outbursts.
•     Recognize anger as a normal response but one that blocks communication.

2. Planning
Expected Outcomes
•     Patient stops showing angry behaviors.
•     Anger expressed constructively through de-escalation.
Preparing for Interaction
•     Pause and control your own reactions.
•     Clarify patient’s concerns.
•     Use calm, firm, reassuring voice.
Preparing the Environment
•     Reduce stimuli; ensure safety.
•     Ask provoking individuals to leave.
•     Keep safe distance.
•     Stay near the door; never block exits.
•     Close door if anger disturbs others.
•     Reduce irritants (noise, drafts, poor lighting).
•     Address patient’s physical/emotional needs (e.g., pain relief).

3. Implementation
Responding to Anger
•     Use nonthreatening communication: slow gestures, calm tone.
•     Allow venting with therapeutic silence.
•     Redirect confrontational questions; set clear expectations and consequences.
•     Stay calm and professional with verbal threats; continue setting limits.
•     Maintain personal space and safety: relaxed body language, avoid sudden movements or loud tones.
•     If anger subsides, explore alternatives and teach coping skills.

4. Evaluation
Signs of Success
•     Patient shows fewer angry behaviors.
•     Patient can problem-solve and focus on coping skills.
Unexpected Outcomes & Interventions
•     If anger continues:
•     Reassess and remove triggers.
•     Give calm, firm directions.
•     Administer PRN medications if ordered.
•     Move patient to quiet area for “time-out.”
•     Ensure staff support for safety.

5. Recording & Reporting
•     Document cause of anger (if known), behaviors, techniques used, and patient’s         response in notes/ EHR.
•     Report de-escalation methods and patient’s reaction to nurse in charge.

6. Special Considerations
Teaching
•     Focus on safety, warmth, and acceptance.
•     Teach patients to identify triggers (poor coping, frustration, illness, stressors).
•     After anger subsides, teach adaptive coping skills.
Pediatric
•     Set immediate limits (e.g., time-out).
•     Children need clear, consistent boundaries.
Gerontologic
•     Cognitively impaired older adults may show tantrum-like behaviors.
•     Use distraction or redirect to enjoyable activities.
Home Care
•     Nurse safety is critical in patient’s home.
•     Stay aware of surroundings and exits.
•     If safety is threatened, call for help or leave.

Clinical Decision Point:

• ·         If imminent harm to another is present on discharge, notify proper authorities (e.g., nurse manager, security).

• ·         A potentially violent patient can be impulsive and explosive; therefore, you need to keep personal safety skills in mind. In this case, avoid touch.