NLE Psychiatric Disorders — Anger, Aggression, and Psychiatric EmergenciesConcept Map

Concept

Anger and Aggression

Sub Concepts

• Anger as normal emotion
• Aggression as harmful behavior
• Violence as acting out of aggression
• Escalation phases
• Warning signs and cues

Relationship To Central

Foundation for early recognition and de-escalation

Concept

Assessment and De-escalation

Sub Concepts

• Verbal cues recognition
• Motor/physical cues detection
• Affective cues identification
• Physiologic cues observation
• Environmental hazard assessment
• De-escalation techniques
• Least restrictive principle

Relationship To Central

First-line interventions to prevent crisis escalation

Concept

Restraints and Seclusion

Sub Concepts

• Legal framework and provider orders
• Time-limited orders (never PRN)
• Indications for use
• Continuous monitoring requirements
• Circulation and skin checks
• Release and rotation protocols
• Documentation standards
• Patient rights protection

Relationship To Central

Last-resort safety measures with strict legal requirements

Concept

Suicide Risk Assessment

Sub Concepts

• Ideation assessment
• Plan specificity evaluation
• Means and intent assessment
• Risk factors identification
• Warning signs recognition
• Safe environment creation
• One-to-one observation
• Safety contracts as adjunct only

Relationship To Central

Critical safety priority in psychiatric settings

Concept

Homicide and Violence Risk

Sub Concepts

• Violence history evaluation
• Threat credibility assessment
• Identifiable target identification
• Command hallucinations
• Intoxication as risk factor
• Duty to warn/protect
• Staff and patient safety

Relationship To Central

Assessment and duty to protect others from harm

Concept

Abuse Recognition and Reporting

Sub Concepts

• Physical abuse signs
• Sexual abuse indicators
• Emotional/psychological abuse
• Financial exploitation
• Neglect recognition
• Inconsistent injury patterns
• Behavioral clues
• Philippine legal framework

Relationship To Central

Mandatory legal responsibility under Philippine law

Concept

Philippine Legal and Ethical Framework

Sub Concepts

• RA 9173 Nursing Practice Law
• RA 7610 Child Protection
• RA 9262 Anti-VAWC Act
• RA 9994 Senior Citizens Act
• Mandated reporting duties
• Patient confidentiality limits
• Documentation requirements

Relationship To Central

Governs all nursing responses to psychiatric emergencies

To

De-escalation Strategies

From

Anger and Aggression

Strength

strong

Relationship

Early recognition of anger and aggression escalation triggers de-escalation as the first-line intervention

To

Restraints and Seclusion

From

De-escalation Strategies

Strength

strong

Relationship

De-escalation must be attempted and documented as failed before restraint/seclusion can be justified; restraint is only used when de-escalation proves ineffective

To

Restraints and Seclusion

From

Least Restrictive Principle

Strength

strong

Relationship

Least restrictive interventions must be exhausted before physical restraint; de-escalation, medication, environmental modification, and show of strength precede restraint

To

Aggression Escalation States

From

Assessment of Escalation Cues

Strength

strong

Relationship

Verbal, motor, affective, and physiologic cues signal progression through escalation states; early detection enables earlier intervention

To

Safe Environment Creation

From

Suicide Risk Assessment

Strength

strong

Relationship

High suicide risk (ideation + specific lethal plan + means access) directly triggers removal of means and one-to-one observation

To

Suicide Risk Assessment

From

Suicide Risk Factors

Strength

strong

Relationship

Presence of risk factors (previous attempts, hopelessness, substance use, loss, isolation) elevates overall risk stratification and monitoring intensity

To

Duty to Protect/Warn

From

Homicide Risk Assessment

Strength

strong

Relationship

Identification of a specific, credible threat against an identifiable person triggers the legal duty to warn and protect the intended victim

To

Mandated Reporting

From

Abuse Recognition

Strength

strong

Relationship

Detection of abuse indicators (inconsistent injuries, behavioral clues, over-control) obligates the nurse to report under Philippine law

To

Mandated Reporting of Child Abuse

From

RA 7610 Child Protection

Strength

strong

Relationship

RA 7610 establishes the legal mandate for health workers to report suspected child abuse to DSWD and barangay authorities

To

Intimate Partner Violence Reporting

From

RA 9262 Anti-VAWC

Strength

strong

Relationship

RA 9262 mandates reporting of physical, sexual, psychological, and economic abuse of women and children by intimate partners; enables protection orders

To

Elder Abuse Recognition and Reporting

From

RA 9994 Senior Citizens Act

Strength

moderate

Relationship

RA 9994 protects senior citizens' rights and requires reporting of elder neglect and abuse to appropriate authorities

To

Circulation Checks and Skin Integrity

From

Restraint Safety Monitoring

Strength

strong

Relationship

Continuous monitoring must include specific assessment of distal pulses, color, temperature, sensation, and skin condition to prevent circulatory compromise and pressure injury

To

Legal and Professional Protection

From

Restraint Documentation

Strength

strong

Relationship

Thorough documentation of behavior, measures attempted, provider order, patient response, and monitoring protects the nurse legally and ensures continuity of care

To

All De-escalation and Restraint Interventions

From

Safety as Central Priority

Strength

strong

Relationship

Safety of patient, staff, and other patients is the organizing principle underlying every intervention decision in psychiatric emergencies

To

De-escalation Environment Setup

From

Nurse Self-Safety

Strength

strong

Relationship

Nurse must maintain safe distance, keep an unobstructed exit, avoid cornering, and never turn back on an agitated patient before attempting verbal de-escalation

To

One-to-One Observation

From

Safety Contracts

Strength

strong

Relationship

Safety contracts are an adjunct tool only and never replace close observation, safe environment, and removal of means in suicide prevention

To

Therapeutic Relationship Building

From

De-escalation Communication

Strength

moderate

Relationship

Calm, non-threatening communication with acknowledged feelings establishes trust and supports therapeutic alliance, reducing escalation

To

De-escalation Effectiveness

From

Environmental Modification

Strength

moderate

Relationship

Reducing environmental stimulation, maintaining personal space, and removing hazards complement verbal de-escalation and medication

To

Show of Strength and Restraint Readiness

From

PRN Medication Refusal

Strength

moderate

Relationship

When a patient refuses voluntary PRN medication, adequate staff presence (show of strength) may de-escalate; if escalation continues, physical restraint may become necessary

To

Time-Limited and Specific Orders

From

Provider Order for Restraint

Strength

strong

Relationship

Provider orders must be time-limited (not PRN or standing), specify reason and type, and be renewed regularly; emergency nurse initiation requires immediate order within ~1 hour