Risk for other-directed violence

Domain 11. Safety-protection
Class 3. Violence
Diagnostic Code: 00138
Nanda label: Risk for other-directed violence
Diagnostic focus: Other-directed violence

Nursing Diagnosis Risk For Other-Directed Violence: Introduction and Definition

Nursing diagnosis, or the assessment of patient's health needs, can play an important role in identifying, preventing and intervening with deadly violence. An essential component of patient care, nursing diagnosis is used to identify and address a patient's risk for other-directed violence. This involves recognizing antecedents that may lead to attempted or actual communication and understanding the psychological and cultural context in which violence occurs.

NANDA Nursing Diagnosis Definition: According to NANDA International (2018), “Risk for Other-Directed Violence” is defined as “A state in which an individual is at risk for localizing aggression on another person or group.”

Risk Factors

Understanding the risk factors associated with other-directed violence allows medical providers to intervene before any harmful acts have been initiated. The following have been identified as risks for other-directed violence:

• Substance abuse: Use of illicit drugs, alcohol and certain prescribed medications can significantly increase the risk for violent behavior.
• Cultural differences: Differences in language, religion, beliefs and values can cause misunderstandings that can lead to violence.
• Mental illness: Individuals who suffer from mental illnesses, such as depression, schizophrenia and borderline personality disorder, are more likely to become aggressive around others.
• Presence of weapons: Having access to lethal weapons, including firearms, increases the risk for other-directed violence.
• Past history of violence: A history of domestic violence, sexual violence, trauma, physical abuse and bullying can put individuals at increased risk for future aggressive behavior.
• Family dysfunction: family dynamics, such as living in poverty, inadequate parenting, broken homes, and emotional neglect and abuse, can be evidenced as contributing to risk of other-directed violence.
• Environmental stressors: Living in an unsafe community, overcrowded conditions, school or work place harassment or feeling disempowered can lead to violence.

At-Risk Populations

Individuals who may be at higher risk for other-directed violence include those with cognitive impairment, developmental delays, elderly patients, children, adolescents and pregnant women. Patients exhibiting aggressive behaviors, particularly those that express verbal and nonverbal cues, should also be monitored closely for potential risk for other-directed violence.

Associated Conditions

When assessing for risk of other-directed violence, medical professionals should consider the associated conditions that may contribute to the risk. These include but not limited to social isolation, self-destructive behaviors, low self-esteem, extreme frustration, anxiety and impulsivity. Other conditions linked to risk of violence include an absence of close relationships, feelings of futility, financial hardship and unemployment.

Suggestions for Use

When caring for an individual at risk for other-directed violence, health care providers should consider the use of a thorough assessment process. This includes gathering information about past behavior and evaluating signs and symptoms related to cognitive functioning and emotional status. Key assessment areas may include:

• Cultural values and beliefs
• Coping strategies
• Current problem list
• Recent life events
• History of violent episodes
• Presence of addiction

Health care providers should attempt to identify any mental health concerns, strengths and resources available. Update safety plans if necessary and follow up with patients on their progress in addressing risk factors.

Suggested Alternative NANDA Nursing Diagnoses

In situations where other-directed violence is imminent, consider applying the following NANDA nursing diagnoses:

• Ineffective Coping: This diagnosis applies in cases where individuals are unable to effectively cope with stress and environmental demands.
• Deficient Knowledge: This applies when individuals lack adequate knowledge to prevent harm to oneself or others.
• Fear: When individuals are afraid of suffering loss of control, damaging relationships or other consequences, fear is considered a possible diagnosis.
• Social Isolation: In cases where an individual experiences persistent lack of or loss of meaningful relationships, this diagnosis may apply.

Usage Tips

When caring for patients at risk for other-directed violence, health care providers should prioritize client safety and employ evidence-based approaches to treatment. Providing a safe environment, engaging in active listening and honest communication, using positive affirmation and facilitating positive relationships are just a few strategies that can be used to reduce risk of other-directed violence.

NOC Outcomes

Ensuring effective nursing care for individuals at risk for other-directed violence requires evaluation against stated outcomes. The following are NOC outcomes applicable to care for individuals at risk for other-directed violence:

• Safety Status: Evaluated by nurse to determine client safety.
• Interpersonal Relations: Evaluates quality of relationships with others, ability to interact and establish meaningful connections.
• Coping: Assesses individual's coping capabilities, e.g., identifying and managing stress, meeting demands and handling environmental complexities.
• Knowledge: Assesses the client's knowledge related to the management of the underlying condition leading to other-directed violence.
• Social Interaction Skills: Evaluates the effectiveness of communication, cooperation and collaboration in interpersonal interactions

Evaluation Objectives and Criteria

When assigning nursing diagnosis for risk for other-directed violence, evaluation objectives and criteria should be established. These guidelines help ensure the goals of treatment are met and can include items such as:

• Identification of behaviors associated with risk for violence
• Treatment strategy aimed at preventing violence
• Appropriate timeframe for implementing interventions
• Sustaining treatment for long term improvement
• Ongoing monitoring and documentation of patient progress

NIC Interventions

Along with evaluation objectives and criteria, nurses should identify appropriate NIC interventions that align with care strategies. Some examples of NIC interventions that can be used to manage other-directed violence risk include:

• Aggression Replacement Training: Effective technique designed to teach individuals healthy expression of anger and other emotions.
• Provision of Social Support & Resources: Strives to improve the quality of community support and provide people access to resources needed.
• Relationship Building: Focuses on teaching effective communication and skills needed to build trust with others.
• Reality Orientation and Cognitive Stimulation: Engages the patient in activities to help improve or maintain cognitive functioning.
• Drug Therapy: Prescribe medication to treat a mental disorder, reduce aggression or modify behavioral responses.
• Environmental Modification: Manipulate the environment to reduce risk and improve safety, such as installing safety devices or alarms.

Nursing Activities

When providing care to individuals at-risk of other-directed violence, nursing activities should align with the described NIC interventions. This may involve providing accurate health education and resources, engaging in various techniques such as cognitive restructuring and assertiveness training, providing psychosocial interventions, monitoring medication and providing supportive care.

Conclusion

Other-directed violence remains a significant problem in the health care sector, in particular, for individuals with escalating behavioral health problems. Developing a better knowledge of risk factors, at-risk populations and associated conditions is essential for providing quality patient care. By employing a thorough assessment process, health care providers can better identify and address risks for violence, ultimately protecting both the patient and the provider from harm.

FAQs

1. What is the definition of “Risk for Other-Directed Violence”?

According to NANDA International (2018), “Risk for Other-Directed Violence” is defined as “A state in which an individual is at risk for localizing aggression on another person or group.”

2. What are some examples of associated conditions that can lead to risk of other-directed violence?

Examples of associated conditions that may lead to risk of other-directed violence include social isolation, self-destructive behaviors, low self-esteem, extreme frustration, anxiety, impulsivity, lack or loss of meaningful relationships, feelings of futility and financial hardship.

3. What methods should be used to assess for risk of other-directed violence?

When assessing for risk of other-directed violence, medical professionals should gather information about past behavior and evaluate signs and symptoms related to cognitive functioning and emotional status. Key assessment areas include cultural values and beliefs, coping strategies, current problem list, recent life events, history of violent episodes and presence of addiction.

4. What are some nursing interventions that can be used to manage other-directed violence risk?

NIC interventions that can be used to manage other-directed violence risk include Aggression Replacement Training, provision of social support and resources, relationship building, reality orientation and cognitive stimulation, drug therapy and environmental modification.

5. What nursing activities should be employed when working with individuals at-risk for other-directed violence?

Nursing activities should align with NIC interventions and involve providing accurate health education and resources, engaging in various techniques such as cognitive restructuring and assertiveness training, providing psychosocial interventions, monitoring medication and providing supportive care.

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