Table 2 Description of the meaning of and reasons for aggression among nurses, patients and informal caregivers
Themes | THE MEANING OF AGGRESSION Quotes from nurses, patients and informal caregivers |
Type of aggression | Physical aggression “A patient slapped the nurse and hit the staff member on the head.” (Nurse, Group 1) “I used to fight with other patients.” (Patient, Group 2) “A patient hits anybody, she would even hit the doctor, she hit the nurse before many times.” (Informal caregiver, Group 2) |
Verbal aggression “80–90% incidents are verbal aggression, like arguing, scolding…which means scolding somebody, provocation to fight.” (Nurse, Group 4) “A patient intended to say something to provoke others.” (Patient, Group 4) “A patient argued with the patient who spoke foul language.” (Informal caregiver, Group 3) | |
Threat “A patient grabbed a chair, held it dangerously and walked around the visiting room.” (Nurse, Group 1) “[another patient] had aggressive posture.” (Patient, Group 4) “A patient provoked another patient to fight with some aggressive motions.” (Informal caregiver, Group 3) | |
Target of aggression | Other people “A patient punched a staff member’s chin.” (Nurse, Group 3) “A patient took a chair and threw…threw it in my face.” (Patient, Group 3) “A patient kicked a nurse.” (Informal caregiver, Group 2) |
Objects “A patient grabbed the chair and wanted to damage the lighting on the ceiling.” (Nurse, Group 3) “A patient kicked towards the table” (Patient, Group 1) “A patient expressed aggressive behaviours and threw things towards a nurse.” (Informal caregiver, Group 4) | |
The patient themselves “A patient took out a cutler knife and intended to harm himself.” (Nurse, Group 1) “I wanted to commit suicide.” (Patient, Group 4) “A patient had suicidal thoughts.” (Informal caregiver, Group 3) | |
Themes | THE REASONS FOR AGGRESSION Quotes text of nurses, patients and informal caregivers |
Unstable mental status | “The patient said he doesn’t know why…he saw…something made him afraid, then he attacked.” (Nurse, Group 4) “When the patient hit my head, I felt she was mentally unstable.” (Patient, Group 3) “I do not know, maybe the co-patient lost her emotional control.” (Informal caregiver, Group 1) |
Unmet needs | “...the patient wanted a new pillowcase…a shortage of manpower at that time, but the patient felt annoyed and held up a chair in nurse station.” (Nurse, Group 1) “Because I felt that they (nurses) did not allow me to leave, I dashed to the main door.” (Patient, Group 4) “I want to leave”, the patient said. Then she dashed to the door and scolded staff with foul language.” (Informal caregiver, Group 3) |
Social conflicts | “A patient banged his head on the wall…the patient felt unhappy because his mother said something to him.” (Nurse, Group 2) “Actually, I am not sure of the reason, but I guess, a patient showed his middle fingers to other patients” (Patient, Group 3) “The patient had some verbal conflict with a visitor, then they started to fight.” (Informal caregiver, Group 1) |
No clear reason | “I was attacked by a patient from behind without any reason…” (Nurse, Group 1) “I do not know, it was all of a sudden, I was so scared. The patient slapped my face when I was applying lotion.” (Patient, Group 3) |
Themes | CONSEQUENCES OF PATIENT AGGRESSION Quotes text of nurses, patients and informal caregivers |
Action | Seeking help “…another nurse asked other patients to seek other nurses’ help...the nurse yelled for help…” (Nurse, Group 1) “Police were called.” (Patient, Group 2) “After seeing the doctor and adjusting the medication, the patient could become calm.” (Informal caregiver, Group 2) |
Controlling “…the patient was under restraint finally” (Nurse, Group 2) “Finally, she was under restraint on the bed and likely to be given sedation.” (Patient, Group 1) “My son was restrained on the bed. And I was told that I could not visit him because he was under restraint and his emotions were unstable. But finally I could visit him, a few nurses monitored when visiting him.” (Informal caregiver, Group 2) | |
Calming down “After …after comfort and negotiation, the patient calmed down, no need to be under restraint.” (Nurse, Group 1) “The nurse rushed to help the victim patient and asked if he was OK, and then explained to him that he should not attack a patient on purpose.” (Patient, Group 1) “A patient kicked the bed badly. A few nurses rushed to handle it. The patient’s father also went in just about visiting time to hug his daughter and the patient could calm down. Finally, the patient was not restrained.” (Informal caregiver, Group 2) | |
Burden | Physical burden “I witnessed the waist of my colleague was hurt and his fingernail was hurt.” (Nurse, Group 2) “One of the patients was bleeding from the nose.” (Patient, Group 3) |
Psychological burden “The nurse was not severely hurt but very scared and cried…” (Nurse, Group 3) “…the patient was restrained for 2–3 hours on the bed due to fighting, felt very bad during restraint, did not feel calmed down.” (Patient, Group 4) “The nurse just held the patient down a bit but did not pull the patient back. This incident had made a psychological impact on a relative or another patient as a witness. He was worried about his wife who stayed in the same ward, he could not sleep that night…very worried.” (Informal caregiver, Group 3) |