Aggression in the Acute Care Setting

Written by Samira M Moughrabi

doi: https://doi.org/10.13178/jnparr.2023.13.02.1308

Abstract

Background: Among healthcare professionals, nurses are at highest risk for workplace aggression (WPA), which ranges in type and severity. If not appropriately addressed, WPA impacts patient care and outcomes, and nurses’ psychological wellbeing, job satisfaction, and retention.

Objective: The objective of this project was to improve the care of patients with verbal and manipulative behaviors through a multicomponent, interprofessional aggression-care program.

Methods: Using one-group, pre/post design, 15 medical-surgical telemetry nurses at a metropolitan hospital volunteered to participate in this change project. The intervention included the development of an aggression nursing care guideline, the provision of training workshops, ongoing leadership support, debriefing sessions, and two-weeks-in-advance primary care assignments of aggressive patients to trained nurses. Outcomes were measured using a Likert-scale type questionnaire with response options ranging from 1 = Strongly Disagree to 4 = Strongly Agree.

Results: Post intervention, nurses reported improvement in their attitude, confidence, and preparation to care for patients with verbally abusive behavior; whereas improvement was mainly observed in their preparation to care for patients exhibiting manipulative behavior. When caring for patients with verbally abusive behavior, and in contrary to patients with manipulative behavior, nurses were less likely to request different patient assignments on subsequent shifts. Post-intervention, more nurses  reported positive feelings, especially calmness and clear mindedness, but more felt unappreciated with patients who exhibited both behaviors.

Conclusions: Findings from this project show that a multicomponent interprofessional intervention is effective in the care of acutely ill patients with aggressive behaviors, especially verbal abuse. This project provides support for nurse leaders to improve workplace conditions through similar care programs that improve nurses’ preparation and emotional wellbeing when caring for patients that demonstrate aggressive behavior. Special attention is needed with manipulative patients, seemingly more challenging to nurses.

Keywords: aggression, acute care, verbal abuse, manipulative behavior