Aggressive encounters between patients and general hospital staff: Staff perceptions of the context and assailants' levels of cognitive processing

A considerable body of research has accumulated regarding aggression toward health care staff, yet little is known about the contextual factors involved. The present study examined the context within which aggressive incidents occurred and the dynamics of the interaction between staff and patients. Two aspects in particular were investigated; firstly, whether incidents were preceded by some anxiety provoking stimulus and secondly, the assailants' levels of cognitive processing apparent at the time of the incident. A prospective study collected data concerning incidents of physical assault and threatening behaviour in a general hospital. Staff were interviewed soon after the incident occurred. A content analysis determined that 82.8% of incidents involved experiences delivered by the staff victims likely to have provoked anxiety in the assailant. Most commonly, incidents involved staff intervening in the patient's intended behaviour. In addition, in 64% of cases, assailants were actually displaying some impairment in cognitive processing at the time of the incident Data suggest that many patients may not have been fully aware of their situation and might have experienced some difficulty in comprehending the staff member's actions. Patients who do not appear to understand what is happening may require additional time and effort to ensure they comprehend fully and accept what the staff member is intending to do, particularly if patients are experiencing an event likely to increase anxiety levels. (C) 2004 Wiley-Liss, Inc.