1. Section Editor(s): Singh Joy, Subashni D.

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According to this study:


* Aggressive behavior was an almost daily occurrence at the psychiatric hospital studied.


* Aggression was more often verbal than physical and frequently directed toward staff.


* Staff used verbal and physical means to deal with aggression.



Aggressive patients threaten not only the well-being of workers in psychiatric hospitals but also the care given. In this study, researchers investigated the prevalence and management of verbal and physical aggression on five acute care inpatient wards on the psychiatric unit of a London hospital.


All staff (psychiatric nurses and health care assistants) were trained in preventing and managing aggression and given an annual refresher course. For this study, they were instructed in using the Staff Observation Aggression Scale-Revised to record incidents of aggression. Data collected included the incident's severity, what provoked it, what form it took, the target, the consequences for the victim, and the measures used to stop it.


In 311 days, there were about six incidents of aggression per week in the five wards. Using a scale of increasing severity ranging from 0 to 22, the mean score was 11. In 44% of the incidents involving any (or no) target, patients were verbally aggressive. Staff members were targeted in 57%; of these, 84% involved verbal aggression. Patients pushed or hit staff in 17% of cases, causing pain or injury in 8%.


"We expected a higher rate of physical aggression," said coauthor Len Bowers, PhD, RMN.


"There were a very small number of such incidents, but there was a lot of verbal abuse and aggression."


When a staff member was the target, talking to the patient was the means of defusing the situation used most frequently (42%); the patient was secluded in 36% of cases and forcibly held in 33%. According to Bowers, seclusion might prevent escalation to an assault by an angry, verbally aggressive patient making direct threats.


Given staffing levels in UK psychiatric wards, the authors calculated that a nurse would need to work for 10 years to be physically injured. But they note that over time verbal aggression can cause "lasting emotional damage." "People are always going to feel threatened when others are aggressive and hostile," Bowers says. "But there are ways nurses make sure that the natural response of fear and anger does not endure. Some nurses manage their emotional responses better because of, for instance, their beliefs about mental disorder [horizontal ellipsis] or how they work together as a team."


Foster C, et al. J Adv Nurs 2007;58(2): 140-9.