Aggression in psychiatry: a qualitative study focusing on the characterization and perception of patient aggression by nurses working on psychiatric wards

The present study focuses on the characterization and perception of patient aggression by nurses working in a psychiatric hospital in The Netherlands. Data have been collected by interviewing nurses working on open and closed wards. The results have been compared and related to the existing literature on aggression. An expert panel has collaborated in the assessment of part of the research findings. Nurses perceive and describe aggression in different ways. Since the descriptions of aggression varied considerably, it was not possible to formulate a general definition of aggression on the basis of the results of the study. Despite the fact that on the whole the general public have a negative view of aggression, the descriptions nurses gave were not always negative. Most of the nurses acknowledged positive as well as negative aspects of aggressive behaviour by patients. Interventions in cases of aggressive behaviour depend on different factors, e.g. the individual nurse's perception of the situation, the (mostly unwritten) rules, and the type of ward (open or closed). The same interventions are often used both to prevent aggression and to stop it. The difference lies in the moment of execution. Most interventions are aimed at stopping aggressive behaviour by acting in a non-restrictive way, e.g. by talking to the patient, touching the patient and giving unexpected responses. Nurses express the belief that aggression is mainly caused by a combination of patient-related, situational and interactional factors. This is not in accordance with the opinion of the North American Nursing Diagnosis Association, who relate aggressive behaviour mainly to patient characteristics.