OBJECTIVES-To more fully characterize the spectrum of RRA.DESIGN-A focus group study of nursing home staff members and residents who could reliably self-report.SETTING-A large urban, not-for-profit long-term care facility in New York City PARTICIPANTS-7 residents and 96 staff members from multiple clinical and non-clinical occupational groups.
MEASUREMENTS-16focus groups were conducted. Content was analyzed with nVivo 7 software for qualitative data.RESULTS-35 different types of physical, verbal and sexual RRA were described, with screaming and/or yelling being the most common. Calling out and making noise were the most frequent of 29 antecedents identified as instigating episodes of RRA. RRA was most frequent in dining and residents' rooms, and in the afternoon, though it occurred regularly throughout the facility at all times. While no proven strategies exist to manage RRA, staff described 25 selfinitiated techniques to address the issue.CONCLUSION-RRA is a ubiquitous phenomenon in nursing home settings with important consequences for affected individuals and facilities. Further epidemiologic research is necessary to more fully describe the phenomenon and identify risk factors and preventative strategies.