THEORITICAL BACKGROUND

VIOLENT BEHAVIOR
A. VIOLENT BEHAVIOR
1. Definition

Violent behavior is a form of behavior that aims to hurt someone

physically and psychologically. Based on these definitions, violent behavior
can be carried out verbally, directed at oneself, others and the
environment. Violent behavior can occur in two forms, namely ongoing
violence or previous violent behavior (history of violent behavior).

Violent behavior is a condition in which a person performs an action

that can be physically harmful to both himself and others and the environment
that is perceived as a threat (Kartika Sari, 2015: 137).

2. Cause
a. Predisposing factors
According to Yosep (2010), the predisposing factors of clients with violent
behavior are:

1) Biological Theory
a) Neurologic Factors
Various components of the nervous system such as synapses,
neurotransmitters, dendrites, axon terminalis have the role of
facilitating or inhibiting stimuli and messages that affect
aggression. The limbic system is very involved in stimulating the
emergence of hostile behavior and aggressive responses
(Mukri pah Damaiyanti, 2012: p. 100).

The frontal lobe plays an important role as an intermediary between

meaningful behavior and rational thinking, which

is a part of the brain where there is an interaction between rational

and emotional. Damage to the frontal lobes can cause aggressive
action that is excessive (Nuraenah, 2012: 29).

b) Genetic Factor
The gene factor that is passed down through parents is a potential
for aggressive behavior. According to research by Kazu Murakami
(2007) in human genes there is aggressive (potential) dormancy

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 that will wake up if stimulated by external factors. According to
genetic research of the XYY karyotype type, it is generally owned
by occupants of criminal acts as well as people who are involved in
the law due to aggressive behavior (Mukri pah Damaiyanti, 2012:
p. 100).

c) Cycardian Rhytm
Cadardian rhythm holds the role of the individual. According to
research, during peak hours such as crossing work and before the
end of work or at certain hours will stimulate people to be more
aggressive (Mukri pah Damaiyanti, 2012: p. 100).

d) Biochemical factors
Body biochemical factors such as neurotransmitters in the brain,
for example epineprine, norepenieprin, dopamine and serotonin
play a role in conveying information through the nervous system in
the body. If there are stimuli from outside the body that are
considered threatening or dangerous, they will be delivered through
neurotransmitter impulses to the brain and respond to them through
efferent fibers. Increased androgen and norepineprine hormones
and decreased serotonin and GABA (Gamma Aminobutyric Acid)
in the cerebrospinal vertebra can be a predisposing factor for
aggressive behavior (Mukri pah Damaiyanti, 2012: p. 100).

e) Brain Area Disorder

Disorders of the limbic and temporal lobe systems, brain siindrom,
brain tumors, brain trauma, encephalitis, epilepsy are found to be
very influential on aggressive behavior and violence (Mukri pah
Damaiyanti, 2012: p. 100).

2) Psychogical Theory
a) Psychoanalysis Theory
Aggressiveness and violence can be influenced by a person's
growth history. This theory explains that the existence of oral phase
dissatisfaction between the ages of 0-2 years in which children do
not get affection and the fulfillment of sufficient milk needs tend to
develop aggressive and hostile attitudes after adulthood as a
component of distrust in their environment. Unfulfilled satisfaction
and security can result in the development of an ego and a low self-
concept. Aggressive behavior and acts of violence are open

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 disclosures of feelings of helplessness and low self-esteem of
violent behavior (Mukripah Damaiyanti, 2012: pp. 100 - 101)

b) Imitation, modeling and information processing theory According

to this theory violent behavior can develop in environments that
tolerate violence. There are examples, models and behaviors that
are copied from the media or the surrounding environment
allow individuals to imitate that behavior. In one study several
children were collected to shoot beatings on the doll with positive
rewards (the harder the punch will be given chocolate). Another
child was given a spectacle that was the same as the show loving
and kissing the doll with the same reward (the one who got the
prize). After the children come out and are given a doll it turns out
that each child behaves accordingly de ngan tontnan ever
seen (pah Mukri Damaiyanti, 2012: case 101).

c) Learning Theory
Violent behavior is the result of individual learning towards the
closest environment. He observed how father responded when he
received disappointment and observed how the mother responds
when she is angry (Mukri pah Damaiyanti, 2012: p. 101).

b. Precipitation Factor
In general, someone will respond angrily when they feel themselves
threatened. The threat can be a psychological injury, or better known as a threat
to one's self-concept. When someone feels threatened, maybe he doesn't realize
at all what is the source of his anger. Therefore, both the nurse and the client
must identify it together. Threats can be internal or external, for example:
external assessors: psychological attacks, loss of relationships that are
considered meaningful, to the criticism of others. Whereas an example of an
internal stressor: feeling a failure at work, feeling a loss of a loved one and fear
of illness.
When viewed from the angle of the nurse - client, the factors that influence
the occurrence of violent behavior are divided into two, namely:
a. Clients: Physical weakness, decision, helplessness, lack of confidence.
b. Environment: Noise, loss of valuable people / objects, social
interaction conflicts (Yosep, 2013).

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3. Response range

Respon adaptif Respon maladaptif

Asertif frustatoin pasif agresif violence behavior

a. Adaptive Response
Adaprif response is an acceptable response to the prevailing socio-cultural
norms. In other words, the individual is within normal limits if facing a
problem will be able to solve the problem, adaptive response (Mukripah
Damaiyanti, 2012: p. 96):
1) Logical thinking is a view that leads to reality.
2) Accurate perception is the right view of reality
3) Emotions are consistent with experience that is feelings that arise from
experience
4) Social behavior is an attitude and behavior that is still within reasonable
limits
5) Social relations is the process of interaction with other people and the
environment.
b. Maladaptive Response
1) Mind abnormalities are beliefs that are firmly maintained even if they
are not believed by others and are contrary to social reality
2) Violent behavior is the status of emotional ranges and expressions of
anger manifested in physical form.
3) Damage to the emotional process is a change in status arising from
the heart
4) Unorganized behavior is an irregular behavior (Mukripah
Damaiyanti, 2012: p. 97).
4. The Process of Problems
a. Predisposing factors
Factors experienced by individuals who are predisposed factors,
meaning that there may or may not be violent behavior if
the following factors are experienced by individuals:
1) Psychological
According to Townsend (1996, in the research journal)
Psychological factors in violent behavior include:

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 a) Psychoanalytic Theory, this theory explains that non-
fulfillment of satisfaction and security can result in the
development of an ego and a low self-concept. Aggression and
violence can provide strength and improve self-image
(Nuraenah, 2012: 30).
2) Learning theory, violent behavior is learned behavior, individuals
who have a biological influence on violent behavior are more likely
to be influenced by external roles (Nuraenah, 2012: 31). \
3) Behavior, reinforcement received when committing violence, often
observing violence at home or outside the home, all these aspects
stimulate individuals to adopt violent behavior (Eko Prabowo, 2014:
p. 142).
4) Socio-culture, the process of globalization and the rapid progress of
information technology have an impact on social and cultural values
in society. On the other hand, not all people have the same ability to
adjust to various changes, and manage conflict and stress (Nuraenah,
2012: 31).
5) Bioneurologically, much that damage to the limbic system, frontal
lobe, temporal lobe and neurotransmitter imbalances play a role in
the occurrence of violent behavior (Eko Prabowo, 2014: p. 143).
b. Precipitation Factor
In general, someone will be angry if he feels threatened, either in the form
of physical, psychological injury or threat of self discipline. Some trigger
factors for violent behavior are as follows:
1) Concert clients: physical weakness, hopelessness, helplessness, life full
of aggression and an unpleasant past.
2) Interaction: humiliation, violence, loss of people, feeling threatened
both internally from the client's own problems and externally from the
environment.
3) Environment: When it is busy, it is noisy and noisy
5. Signs and symptoms
Nurses can identify and observe signs and symptoms of violent behavior:
(Muk ripah Damaiyanti, 2012: p. 97)
a. Red face and tense
b. Eyes bulging or sharp eyes
c. Hands clenched
e. The jaw closes
f. The face is red and tegan

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 g. Stiff body posture
h. Sharp view
i. Road back and forth
Clients with violent behavior often show their presence (Kartika Sari, 2015:
138):
a. Clients complain of feeling threatened, angry and resentful
b. Clients express feelings of uselessness
c. The client expresses annoyance
d. The client expresses physical complaints such as chest palpitations,
feeling suffocated and confused
e. Clients say they hear voices that tell to hurt themselves, others and
the environment
f. The client says everyone wants to attack him
6. Consequence
According to Townsend, violent behavior where people do actions that can
be dangerous, both themselves and others. A person can experience violent
behavior in themselves and others can show behavior (Kartikasari, 2015: p.
140):
Subjective Data:

a. Express hearing or seeing threatening objects

b. Express feelings of fear, anxiety and worry
Objective Data:
a. Red face tense
b. Back and forth
c. Eyes bulging, jaws closed
d. Hands clenched
e. Get out a lot of sweat
f. Red eye
h. Sharp eyes
i. Red face
7. Koping mechanism
Some coping mechanisms used in angry patients to protect themselves
include:
a) Sublimation
Accept a noble substitute goal. This means that in the eyes of the
community for an impulse that has obstacles to normal distribution. For
example, someone who is angry vent his anger on other objects such as

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 squeezing adona cake, punching the wall and so on, the goal is to reduce
tension due to anger (Mukhri pah Damaiyanti, 2012: p. 103).

b) Projection
Blaming others for their difficulties or bad desires, for example a young
woman who denies that she has sexual feelings and is a coworker, turns
around alleged that his friend tried to seduce. (Mukhripah Damaiyanti,
2012: p. 103).

c) Repression
Prevent painful or dangerous thoughts from entering into
consciousness. For example, a child who really hates his parents who
doesn't like him. But according to the teachings or upbringing he has
received since childhood that hating parents is not good and condemned by
God. So he suppressed feelings of hatred and finally he could forget it
(Mukhri pah Damaiyanti, 2012: p. 103).

d) Formation reaction
Preventing dangerous desires when expressed. By exaggerating the
attitudes and behavior that are opposite and using as obstacles, for example,
someone who is interested in her husband's friend will treat the person
strongly (Mukhripah Damaiyanti, 2012: p. 103).

e) Deplacement
Releasing a depressed feeling is usually hostile to an object that is not so
dangerous as it was at first arousing that emotion, for example: 4-year-old
timmy was angry because he had just received a sentence from his mother
for drawing on his bedroom wall. He began fighting with his theme
(Mukhri pah Damaiyanti, 2012: p. 104).

8. Management
a. Pharmacotherapy

Patients with angry expressions need treatment and treatment to have a

high effective dose, for example: clorpromazine HCL which is useful for
controlling psychomotor. If no one can use the effective low dose. For
example trifluoperasineestelasine, if there is none too, a transilizer can be
used instead of an anti-psychotic drug such as neuroleptics, but even so both
have anti-tension, anti-anxiety, and anti-aggression effects (Eko Prabowo,
2014: p. 145).

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b. Occupational therapy

This therapy is often translated into therapeutic work therapy is open

giving work or activities as a medium to carry out activities and restore the
ability to communicate, therefore in this therapy does not have to be given
a job but all forms of activities such as reading newspapers, playing chess
can also be important media after they have done the activity, they are
invited to have a dialogue or discuss about the experience and meaning of
Uityu's activities for him. This therapy is the first step that must be taken
by the officer towards rehabilitation after the selection and activity program
is determined (Eko Prabowo, 2014: p. 145).

c. Family participation

Family is the main support system that provides direct care for each
patient's (healthy) condition. The nurse helps the family to be able to do
five health tasks, namely recognize health problems, make health action
decisions, provide care for family members, create a healthy family
environment, and use existing resources in the community. Families that
have the ability to deal with problems will be able to prevent maladaptive
behavior (primary prevention), overcome maladaptive behavior (secondary
prevention) and restore maladaptive behavior to behavioral (tertiary
prevention) so that the health status of patients and families can be
increased optimally (Eko Prabowo, 2014: p. 145).

d. Somatic therapy

According to the Indonesian Ministry of Health 2000 p.230, it explains

that somatic therapy therapy is given to patients with mental disorders with
the aim of changing the behavior of adaftive males into adjective behavior
by carrying out actions shown in the patient's physical condition, therapy
is the patient's behavior (Eko Prabowo, 2014: p. 146).

e. Electrical seizure therapy

Electrical convulsive therapy (ECT) is a form of therapy for patients by

causing grand mall seizures by flowing electric current through electrodes
that treat schizophrenia requiring 20-30 times the therapy usually carried
out is every 2-3 days (2 times a week ) (Eko Prabowo, 2014: p. 146).

9. Data that needs to be reviewed:

1) The risk of injuring yourself, others and the environment
1) Subjective Data:

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  The client says hate or resent someone.

 Clients like to yell and attack people who disturb them

if being upset or angry.

 History of violent behavior or other mental disorders.

2) Objective Data:

 Red eyes, slightly red face.

 High and loud tone of voice, master talk: shouting, screaming,

hitting yourself / others.

 An angry expression when talking about people, sharp eyes.

 Damaging and throwing things.

2) Violent behavior
1) Subjective Data:
 The client says hate or resent someone.
 Clients like to yell and attack people who disturb them
if being upset or angry.
 History of violent behavior or other mental disorders.
2) Objective Data:
 Red eyes, slightly red face.
 High-pitched and loud tone, talk master
 An angry expression when talking about people, sharp eyes.
 Damaging and throwing things.
3) Self-esteem disorders: low self-esteem
1) Subjective data:
 The client said: I am incapable, unable, ignorant, stupid, self-
criticizing, expressing feelings of shame towards myself.
2) Objective data:
 Clients seem to prefer themselves, confused if told to choose
alternative actions, want to injure themselves / want to end life.

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 10. Problem Tree

Risk of injury to yourself and others

Violent behavior PPS ; Halusination

Low Self-Esteem

ineffectife Regiment therapeutic Individual coping ineffectiveness Social Isolation

ineffectife family coping dysfunctional griest

Source : Nita Fitria,2014

11. Nursing diagnoses

Nursing diagnoses from tree problems in the picture are as follows
(Mukhri pah Damaiyanti, 2012: p. 106).
1) Violent Behavior

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 12. Nursing Care Plan
Implementation Strategy for Client Implementation Strategy for family
Implementation Strategy 1 Implementation strategy 1
1. Identify cause sign and symptoms violence behavior and consequence 1. Discuss the perceived problems in treating patients
violence behavior 2. Explain how to treat patients with violent behavior
2. explain how control violence behavior 3. Discuss with family about violent behavior (causes, signs and symptoms,
3. training how control violence behavior with ohysical deep breath and behaviors that arise and the consequences of these behaviors)
hit the pillow 4. Practice one way to treat violent behavior by carrying out physical
4. Insert in the schedule activity for training training physical activities: take a deep breath and hit a mattress / pillow
5. Recommend to help according to the activity schedule and give re
enforcement positive
Implementation Strategy 2 Implementation strategy 2
1. evaluation activity training physical, give re-enforcement positif 1. Evaluate family activities in treating / training patients in a physical way,
2. explain about 6 true drug (usage, way, dosage, frequency, route, give praise
continuity of taking medicine, due to drugs are not taken in accordance 2. Explain 6 correct ways to give medicine
with the program, due to the breakup of drugs. 3. Encourage help according to the activity schedule and give re enforcement
3. Insert in the schedule activity for training training physical and take a positif
medicine

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Implementation Strategy 3
1) Evaluation physical activity training and give positive re-enforcement. 1. Evaluate family activities in caring for / training physical patients 1 and 2
2) Explain about 6 true way of take a medicine (usage, dosage, frequency,
route, continuity of taking medicine, due to drugs are not taken in 2. Train families how to guide good ways of speaking
accordance with the program, due to the breakup of drugs).
3) Insert in client’s daily activity for physical training, take a medicine and
verbal.
Implementation Strategy 4
1) Evaluate client daily activity schedules (physical activity, medicine,
and verbal)
2) Teach the client howa control violent behavior with spiritual practice
(2 kinds activity)
3) Insert in client’s daily activity for physical training, take a medicine,
verbal and spiritual.
Implementation Strategy 5
1). Evaluation activity physical training 1 and 2 take a medicine , verbal,
spiritual. Give re-enforcement positif.
2) Assess the ability of independent clients.
3) Assess whether violent behavior is controlled
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Implementation strategy 3
and giving medication, give praise
3. Train families how to guide spiritual activities
Implementation strategy 4
1. Evaluating family activities in caring for / training physical patients 1 and
2, and spiritual activities, give praise
2. Explain follow-up to the mental hospital, relapse and referral
3. Recommend helping patients on schedule and give re enforcement positif
Implementation Strategy 5
1. Evaluating family activities in caring for / training physical patients 1 and
2, giving medication, good speech and spiritual activities and pollowing up.
Give reinforcement positif
3.The value of the family's ability to care for the patient
3. The value of the family's ability to control the mental hospital