Aggressive behaviour on acute psychiatric wards: prevalence, severity and management

Aim. This paper reports a study to investigate the nature and prevalence of inpatient aggressive behaviour directed at staff and other patients and, in the case of patient self-harm, the methods used by nursing staff to manage this. Background. Aggressive behaviour poses a threat to the physical and psychological health of psychiatric nursing staff. The fear that results from working in a climate of potential danger can also have a damaging impact on patient care. Methods. Nursing staff on five acute inpatient wards in one hospital in the United Kingdom collected data on aggressive incidents using the Staff Observation Aggression Scale - Revised during a 10 month period from June 2001 to April 2002. Results. There were 254 incidents of aggression recorded. Staff were most commonly targeted and were involved in 57.1% of incidents. The most frequent provocation of the aggression was the patient being denied something such as leave from the ward (29.5% of incidents). The most frequent means used by patients was verbal aggression (60% of incidents), the most frequent outcome for the victim was feeling threatened (59% of incidents), and verbal interventions were used most frequently to manage the aggressive behaviour (43.7%). Despite many incidents involving verbal aggression in both staff- and patient-targeted aggression, 35.9% of incidents involving staff and 25% of incidents involving other patients resulted in seclusion. Conclusion. It is estimated that in a 12 month period at the hospital in this study a nurse would have a one in 10 chance per year of receiving any kind of injury as a result of patient aggression. Despite the predominance of verbal over physical aggression, the fear generated from working in such an environment and a difficulty in understanding the causes of patient aggression may motivate staff to manage aggressive incidents with physical methods such as seclusion and restraint on a frequent basis.