Health staff such as nurses and doctors are often victims of aggressive behaviour displayed by patients in hospital and health care settings particularly dementia units, emergency departments and mental health units. In Australia, there is currently an increased media attention on the topic however employers are still unsure of the causes or how to manage their ever-increasing scourge. The commonly pointed out scape goat has been the use of alcohol and drugs. Although this is a likely culprit it is not the only cause of such behaviours. This paper therefore seeks to examine the causes of patient aggressive behaviours and provide a more critical view to the problem and therefore enable solution focused thinking that actually will work. Research indicates that staff exposure to patient violence leads to poor outcomes for the patients, staff and employers . Staff are more likely to have a lower job satisfaction, emotional exhaustion, cynicism, physical injury and poor psychological wellbeing and employers incur higher costs due to injury claims. Therefore, preventing aggressive behaviours has benefits for staff, patients and employers.
Understanding what causes aggressive behaviours is important for effectively reducing aggressive behaviour incidents in hospital settings. We know from previous studies that aggressive behaviours range from verbal abuse and physical violence to damage to property , International Council of Nurses (2009). Current literature generally categorizes risk factors into patient factors, environmental factors, treatment factors and societal factors . We agree with this view but emphasize that these factors are not static but rather interactional. Our view is that in line with systems theory, one factor is hardly the only cause of aggressive behaviour. We argue that aggressive behaviour is the result of an interaction between negative patient, staff, environment and contextual factors as shown in Figure 1 below.
These factors are heterarchical in that no one factor is more
important than another and all elements are unranked. Any one of the factors can become the key cause of the aggressive behaviour depending on the circumstances. This conceptualisation assumes that the more there is a negative interaction between the staff, patient and environment factors within a given context the more likely is aggressive behaviour to occur. The implication for management is therefore to take a more holistic systems
approach to reduce this interaction focusing on patients, staff,
environment and context rather than just one thing such as
intoxication. Such a model allows policy makers to come up
with robust and effective organisational policies to assess and
manage the risk of aggression towards staff or property. The
specific factors of the patient, staff, environment and context are
outlined in Figure 2 below.
We argue that trying to manage each factor individually
is unhelpful and the use of systems theory thinking is much
more likely to yield positive results. We suggest a more holistic
view to aggressive behaviour causes in healthcare settings as a
way of enabling services to make sound policies on aggressive
behaviours in health care going forward and avoid knee jerk
reactions that might even make the situation worse for staff,
patients and employers.