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The nature and extent of aggression in nurses' clinical settings


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Farrell, Gerald Anthony 1996 , 'The nature and extent of aggression in nurses' clinical settings', PhD thesis, University of Tasmania.

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The concern raised in recent journal articles, reports and books
about the level of aggression within nursing was the impetus for this
study. Up until the last couple of decades the literature on
aggression among health service institutions was sparse. The few
nursing studies that are available on aggression deal with the extent
and effect of patient aggression on nurses. But not all aggression is
patient initiated. A few recent reports speak of horizontal violence, ie,
the idea that staff can be aggressive towards each other.
Understanding the extent of occupational aggression for nurses
whether patient or colleague initiated is thus an imperative research
A total of 299 nurses were asked for their views on the extent and
nature of aggression at their work. Three main issues were
addressed. First nurses' understanding of the term aggression was
explored. Second, the nature and extent of aggression from patients
and others to nurses and vice versa was determined. Third, causal
relationships among variables were sought. Two contrasting methodologies were employed in the study. First,
individual nurses (n = 29) from a variety of work settings were asked
about their experiences of aggression in the clinical setting. This was
essentially a qualitative study and it raised a number of important
insights regarding nurses' understanding of the term aggression and the extent of the overall problem of aggression vis-a-vis patients, nurses and
others. Because of the small sample size, it was felt unwise to
extrapolate the findings to other similar contexts. Therefore,sa second
study was conducted - Phase 2 - in which the views of 270 nurses were
canvassed. As well as completing a questionnaire respondents were
asked to view a short video of an encounter between two nurses. This
enabled cause and effect relationships between hierarchy and blame
placement to be determined through a survey-embedded experiment.
Additionally, structural equation modelling was used to try an account for
why aggression persists. The main findings can be summarised thus: First, nurses' understanding
of the term "aggression" encompasses a range of behaviours and
attitudes that can be conceptualized along three dimensions: physicalverbal;
active-passive; and direct-indirect. In practical terms, this
aggression was played out in such behaviours as rudeness, abusive
remarks, undermining each other's ideas, refusing to help when needed
and, more rarely, actual physical threat and assault. Much of the
aggression can be seen as colleagues' failure to play by the relationship,
rules of work. Second, the majority of respondents at Phase 1 indicated
that aggression from colleagues is a major concern for them. Third, this
view was largely confirmed in the lager sample at Phase 2. Taken
together, colleagues, doctors, and non-nurse managers come under fire
in many different work settings. Fourth, female and male nurses had
similar views about the level of colleague aggression towards them.
However, following colleague aggression, women were more concerned
about aggression from patients' relatives and doctors, men had most trouble dealing with the aggression from their nurse managers. Fifth,
nurses' reactions to aggression can be seen in terms of three main
response patterns: a stress response, an anger response, and a
reflective response. Sixth, there was support for thinking that aggression
among nurses is situated within a culture that subscribes to the notion of
a "task/time" imperative. Seventh, there was little support for the view
that hierarchy influences blame placement preferences for deciding who
should be blamed for an incident. However, the Level-2 nurse attracted
more blame than either the Level-1 or the Level-3 grade for reacting
aggressively towards a colleague who was late. It would appear that the
Level-2 grade of nurse has a credibility gap vis-a-vis fellow colleagues.
Eight, there was tentative support for the notion that aggression, once
begun, may be self perpetuating. Ninth, overall, the results point to a
worrying level of nurse-on-nurse aggression in the clinical setting.

Item Type: Thesis - PhD
Authors/Creators:Farrell, Gerald Anthony
Keywords: Nursing, Aggressiveness (Psychology)
Copyright Holders: The Author
Copyright Information:

Copyright 1996 the Author - The University is continuing to endeavour to trace the copyright
owner(s) and in the meantime this item has been reproduced here in good faith. We
would be pleased to hear from the copyright owner(s).

Additional Information:

Thesis (Ph.D.)--University of Tasmania, 1997. Includes bibliographical references

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