Nurses struggle to cope with violent patients

Nov 29 2004

Nurses who bottle up anger triggered by a violent incident at work are more likely to become nervous, worn out and depressed, a team of psychologists at The University of Nottingham has found.

The research, led by Dr Phil Leather and Dr Angeli Santos at the University’s Institute of Work, Health and Organisations (I-WHO), found the problem was common in NHS units that expected staff to handle difficult situations and aggressive patients with ‘a stiff upper lip’. It recommends that greater access to counselling and support services needs to be made available to medical staff confronted with violence in their jobs.

Violence towards health care workers is a considerable problem that appears to be on the increase, with nurses at the greatest risk. In the present study, 30 per cent of nurses had experienced some form of physical abuse from patients in the previous 12 months. The harmful effects are not only confined to acts of physical assault but also ‘psychological violence’, which includes threats and intimidation.

Dr Phil Leather, Director of the Social Psychology Research Group at I-WHO, said: "We are faced with a serious situation here that has a number of ramifications. It’s not just a problem for the member of staff who is the victim of violence, but patient care is at risk. A nurse who is worn out or who harbours residual anger is hardly going to be capable of excelling in his or her duty.

"Nurses need people to be made available to them who they can talk to about their experiences of abuse. They need a supportive environment, one which does not encourage the ‘denial’ so often seen among the medical profession."

The I-WHO research will be unveiled today (Friday November 26) at the European Academy — Occupational Health Psychology conference in Oporto, Portugal. The study, a survey of 202 nurses and health visitors working in a UK NHS Trust, found that suppressing anger following the threat or act of physical assault, reduced job satisfaction and increased stress. Conversely, the expression of anger following a violent episode alleviated the symptoms of stress.

Previous research has found that individuals who suppress their anger have higher mortality rates. They are more likely to develop a range of chronic medical illnesses, such as rheumatoid arthritis, lung cancer, breast cancer, high blood pressure and coronary heart disease.

With exposure to violence affecting nurses, patients and standards of patient care, the researchers propose that NHS spending on staff counselling and support services or assault management training, for example, may be an astute investment.