Academic journal article Contemporary Nurse : a Journal for the Australian Nursing Profession

Relationships between Aggression Management Training, Perceived Self-Efficacy and Rural General Hospital Nurses' Experiences of Patient Aggression

Academic journal article Contemporary Nurse : a Journal for the Australian Nursing Profession

Relationships between Aggression Management Training, Perceived Self-Efficacy and Rural General Hospital Nurses' Experiences of Patient Aggression

Article excerpt

INTRODUCTION

Patient aggression is a significant clinical and occupational safety issue in contemporary health care.The extent of this phenomenon, its characteristics and its effects are widely reported in the international nursing literature. A consistent finding has been that nurses experience a risk of aggression significantly higher than that of other occupational groups, with studies differing only by how much more they are at risk (Winstanley & Whittington 2002a; Turnbull 1999). Historically, psychiatric inpatient and emergency department settings have been widely considered as high-risk areas, with the incidence of nurses experiencing patient aggression ranging from approximately 60 per cent to over 95 per cent (Erickson & Williams-Evans 2000; Lyneham 2000; Nolan et al. 1999; Rose 1997; Poster 1996; Schneiden & Marren-Bell 1995; Mahoney 1991; Poster & Ryan 1989). However, research undertaken in other, generalist health care settings has identified similarly high levels of patient aggression (Hegney et al. 2006; Åström et al. 2002; Lee 2001;Yassi et al. 1998; Arnetz, Arnetz & Petterson 1996; Graydon, Kasta & Khan 1994; Rosenthal et al. 1992).

The direct impact of patient aggression on nurses may include observable physical harm from bruises, scratches and cuts, through to death. Other effects may include chronic pain, nightmares, powerlessness, unhappiness, anger, emotional exhaustion, depersonalisation, isolation, job dissatisfaction and professional loss (Åström et al. 2002;Winstanley & Whittington 2002b; Levin, Hewitt & Misner 1998; Mahoney 1991). Associations between patient aggression and higher levels of smoking, coffee and alcohol consumption, and poor health have also been reported (Arnetz, Arnetz & Petterson 1996). More fundamentally, there is an inherent conflict between the basic tenets of caring and the negative experiences of patient aggression. Even though nurses may be trained and socialised to undertake the caring role, this may not help them cope with their own experiences of psychological stress and distress.

Despite the considerable number of international studies, there has been little substantive research on patient aggression in the Australian health care sector. Nonetheless, studies undertaken across a range of settings reflect the findings in the international literature. Between 50 per cent and 95 per cent of predominantly generalist nurses experienced workplace aggression, and the main effects included anger, anxiety, helplessness, fear and resentment (Lam 2002; O'Connell et al. 2000; Holden 1985). For nurses, poorer perceptions of workplace safety are associated with a higher incidence of workplace violence toward nurses (Hegney et al. 2006). Nurses have reported taking alcohol or drugs and feeling 'burnt out', but mostly remained on duty (O'Connell 2000). Even after adjusting for personal factors and recent stressful situations, nurses with high aggression exposure had significantly increased risks of psychological distress and depression (Lam 2002).

Health care organisations have a legal and moral responsibility to effectively manage workplace aggression, and 'best practice' models of aggression prevention need to include aggression management training as a key element (Mayhew & Chappell 2001: 2-22). However, studies on nurses' experiences of patient aggression in general hospital settings have found low exposure rates to aggression management training (Lyneham 2000; Rose 1997;Whittington, Shuttleworth & Hill 1996; Schneiden & Marren-Bell 1995; Rosenthal et al. 1992; Holden 1985).While a small number of studies have demonstrated the role of aggression management training in dramatically decreasing incidents of violence toward nursing staff (Hagen 1995;Whittington & Wykes 1994; Rosenthal et al. 1992), there is limited empirical evidence for the effectiveness of training programs in reducing the incidence or impact of aggression. …

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