Patient Aggression and the Wellbeing of Nurses: A Cross-Sectional Survey Study in Psychiatric and Non-Psychiatric Settings

Abstract

Wellbeing of nurses is associated with patient aggression. Little is known about the differences in these associations between nurses working in different specialties. We aimed to estimate and compare the prevalence of patient aggression and the associations between patient aggression and the wellbeing of nurses in psychiatric and non-psychiatric specialties (medical and surgical, and emergency medicine). A sample of 5288 nurses (923 psychiatric nurses, 4070 medical and surgical nurses, 295 emergency nurses) participated in the study. Subjective measures were used to assess both the occurrence of patient aggression and the wellbeing of nurses (self-rated health, sleep disturbances, psychological distress and perceived work ability). Binary logistic regression with interaction terms was used to compare the associations between patient aggression and the wellbeing of nurses. Psychiatric nurses reported all types of patient aggression more frequently than medical and surgical nurses, whereas nurses working in emergency settings reported physical violence and verbal aggression more frequently than psychiatric nurses. Psychiatric nurses reported poor self-rated health and reduced work ability more frequently than both of the non-psychiatric nursing groups, whereas medical and surgical nurses reported psychological distress and sleep disturbances more often. Psychiatric nurses who had experienced at least one type of patient aggression or mental abuse in the previous year, were less likely to suffer from psychological distress and sleep disturbances compared to medical and surgical nurses. Psychiatric nurses who had experienced physical assaults and armed threats were less likely to suffer from sleep disturbances compared to nurses working in emergency settings. Compared to medical and surgical nurses, psychiatric nurses face patient aggression more often, but certain types of aggression are more common in emergency settings. Psychiatric nurses have worse subjective health and work ability than both of the non-psychiatric nursing groups, while their psychiatric wellbeing is better and they have less sleep problems compared to medical and surgical nurses. Psychiatric nurses maintain better psychiatric wellbeing and experience fewer sleep problems than non-psychiatric nurses after events of exposure to patient aggression. This suggest that more attention should be given to non-psychiatric settings for maintaining the wellbeing of nurses after exposure to patient aggression.

Emotional intelligence and personality characteristics of psychiatric nurses and their situations of exposure to violence

“…It is important that all violent incidents are correctly reported for good management or prevention of violence. In our study, it was found that 32% of the nurses were exposed to physical violence and 65% had psychological violence at a similar rate with other studies . In contrast, the rate of reporting physical violence was 69%.…”

“…The rate of exposure to workplace violence (WPV) is higher for nurses working in psychiatry clinics than for nurses working in other clinics . WPV ranges from verbal aggression and sexual harassment to physical attack .…”

Prevalence of medical workplace violence and the shortage of secondary and tertiary interventions among healthcare workers in China

“…It not only predicts HCW’s quality of life but also severely impacts psychological health and may lead to suicide. Recent studies report HCW who experienced MWV suffered from anxiety (25.67%), depression (28.13%), post-traumatic stress disorder symptoms (28%),22 23 poor sleep hygiene and fatigue symptoms 24…”

Risks of illness in the work of the nursing team in a psychiatric hospital

“…These aggressions favor the development of anxiety, fear, guilt, sleep disturbances, burnout, low self-perceived health status, work dissatisfaction and stress, with consequent reduction in life satisfaction 41 - 42 .…”

“…A study conducted in Finland pointed out that the prevalence of nurses who experience patient aggressions is higher among professionals working in mental health settings than among those in medical or surgical settings. Working in psychiatry also includes greater odds for diagnosed depression, antidepressant medication use and sick leave due to depression and mental disorders 41 .…”