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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.

Objective:  This study sought to compare the characteristics of aggressive incidents occurring on inpatient (medical and surgical) wards with those occurring in the accident and emergency department in terms of assailant, employee and other factors. Method:  A prospective interview‐based survey design was adopted. Forty‐eight assaulted staff were interviewed about 69 incidents within 7 days on average of the incident occurring. The presence or absence of various assailant, employee, situation, interaction and outcome factors derived from the UK Health Services Advisory Committee's model was compared between the two settings. Results:  Inpatient ward incidents were significantly more likely to have the following characteristics: female perpetrator, perpetrator aged over 70 years, daytime occurrence in a restricted area, resolved by support from other health care staff. Conclusion:  Aggression frequently occurs on inpatient (medical and surgical) wards of a general hospital. Aggression management training for staff working in both accident and emergency and inpatient settings should be cognisant of the similarities and differences within general health care specialisms.

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