Characteristics of aggressive incidents in emergency primary health care described by the Staff Observation Aggression Scale - Revised Emergency (SOAS-RE)

Violence at work experienced by nursing professionals working in hospital units: an exploratory and correlational study

to identify the occurrence of violence at work affecting nursing professionals working in hospitals and to relate professional profile variables to this phenomenon.

this is an exploratory, cross-sectional, descriptive, correlational, field and quantitative study carried out with 218 nursing professionals working in hospital units in the 8th Health Region of Paraná, using a sociodemographic questionnaire and the Questionnaire for the Evaluation of Violence at Work Suffered or Witnessed by Nursing Workers. Data was analyzed using absolute and relative frequencies, and the Chi-squared test with Yates' continuity correction was used to verify the associated factors.

the sample included 218 nursing professionals, 44.0% of whom reported having suffered violence at work, 11.9% physical violence, 47.7% verbal abuse and 2.8% sexual harassment. When the association was made, it was observed that professionals over 30 and who work overtime suffer more violence than other professionals.

in view of the above, it was possible to see a significant occurrence of episodes of violence at work in the last 12 months, with verbal violence being the most frequently reported.

BACKGROUND

(1) Significant prevalence of violence in the workplace.

BACKGROUND

(2) Emphasis on workers' health for nursing professionals.

BACKGROUND

(3) Verbal violence affects 47.7% of the sample studied.

BACKGROUND

(4) The need for public policies to improve safety at work.

BACKGROUND

(5) Encouragement for further research on the subject.

Assessment of aggressive behaviours on an adolescent inpatient psychiatric ward in Poland using the SOAS-R tool - preliminary report

Purpose

The aim of the study was to analyse the incidence of aggressive behaviour in patients of an adolescent psychiatric ward towards medical and nursing personnel and to assess the usefulness of the tools used by the authors to describe the incident itself. Currently, Polish literature and practice lack such scales. The tool used in the study was the Polish version of the Staff Observation Aggression Scale-Revised (SOAS-R).

Methods

The study used the results of 71 questionnaires completed by the staff of the adolescent inpatient psychiatric ward after episodes of aggression in patients in the period from August 2015 to August 2019.

Results

The most frequent object of aggression was medical and nursing personnel (57.8%), self-harm was less frequent (4.6%). Other patients (7.1%) or objects (16.2%) were relatively rarely the victims. The most common form of aggression was aggression using hands. It occurred in 80% of cases. It turned out that half of the aggressive behaviour using hands (punches, blows) took place between 2:00 p.m. and 8:30 p.m.

Conclusions

SOAS-R seems to be an effective tool in incident assessment both at the level of causes and, what seems most important, the consequences of aggressive behaviour. It can also be used to analyse staffing at particular times of the day, week, or even month. The phenomenon of aggression requires more precise, constant, and time-based observation which allows the implementation of appropriate procedures and the overcoming of many stereotypes related to aggressive behaviour and its impact on the relationship between the medical and nursing staff and the patient.

A scoping review of nursing interventions for reducing the negative impacts of domestic violence among women

BACKGROUND

Incidences of domestic violence against women are increasingly every years. Domestic violence has the negative impacts on physical problems, psychological problems, and can even cause death. Nurses have a role for providing interventions to reduce the impact of domestic violence on women.

AIM

The purpose of this study is to explore methods of nursing interventions in reducing the traumatic effect of domestic violence among women.

METHOD

This study used a scoping review method. The literature used in this study from CINAHL, PubMed, and Scopus databases. Search articles used the keywords domestic violence, impact, women, and victims. PRISMA Extension for Scoping Reviews are used for selecting articles. The inclusion criteria for the articles in this study were that the sample was female victims of sexual violence, randomized control trial or quasi-experimental research design, and last 10 years for publications period (2013-2022).

RESULT

From three databases, we found 579 articles. After elimination-based inclusion and exclusion criteria, we found 10 articles discussing the effect of nursing interventions in reducing the impact of domestic violence on female victims. Most of the studies from USA and the range of respondents in the articles is 112-1250 respondents. The methods used in providing nursing interventions are classified into three, namely self-management programs, counseling programs, social support programs. The activities carried out in nursing interventions in the form of psychoeducation, relaxation, meditation, and also discussions about solving problems encountered. All articles show that nursing interventions are effective in reducing the impact of domestic violence on women.

CONCLUSION

Nurses have an important role to provide comprehensive nursing care to victims of domestic violence by paying attention to various aspects, namely physical, psychological, and spiritual aspects to improve safety and comfort of patients.

IMPLICATION FOR NURSING

This study is the basis for nurses to provide comprehensive nursing care to reduce the impact of domestic violence among women victims of domestic violence.

Association between behavioral parameters of men in psychiatric emergency department video recording and subsequent violence in the psychiatric ward

Violence risk is a major challenge among acute psychiatric inpatients. The study aimed to predict violent behavior risk in an acute psychiatric ward using video recordings from the emergency department. 69 videos of the emergency department recording the first ten minutes following patients' arrivals were included. Psychiatrists watched the videos, completed relevant Brief Psychiatric Rating Scale items and answered intuitive questions about each patient's risk of violence. Demographic and clinical data were also collected. Motoric mannerisms as rated in the BPRS significantly differed between violent and non-violent patients (p < 0.05). Additionally, we found a significant correlation between intuitive prediction of violence and actual violence (p = 0.008). Violent behavior was predicted in 42.1% of the cases by the intuitive evaluation compared to 11.5% mistakenly evaluated patients. Logistic regression revealed that the intuitive question and the BPRS items regarding tension and motoric mannerism created a successful model for predicting violence with 88.2% sensitivity and 72.5% specificity. We sought to define the factors that most accurately predict violence in the acute psychiatric ward, based solely on behavior in the emergency department. Intuitive impressions of clinicians and motoric mannerisms should be considered when evaluating patients for potential violent behavior.

Characteristics and Influencing Factors of Post-Traumatic Growth: A Cross-Sectional Study of Psychiatric Nurses Suffering from Workplace Violence in Guangdong China

BACKGROUND

Workplace violence (WPV) had become an important issue that endangered the occupational safety of psychiatric nurses. A growing number of studies showed positive post-traumatic growth (PTG) resulting from coping with trauma.

OBJECTIVE

To investigate the characteristics of PTG in psychiatric nurses who experienced violence in the workplace and analyze its influencing factors.

METHODS

A total of 1202 psychiatric nurses participated in the study. From October 2022 to December 2022, this cross-sectional study collected data on psychiatric nurses from five tertiary hospitals in Guangdong Province, China. Twenty-item Chinese version post-traumatic growth inventory (PTGI), Jefferson Scale of Empathy Health Professional (JSE-HP), Confidence in Coping with Patient Aggression Instrument (CCPAI), Post-traumatic Stress Disorder Checklist-Civilian Version (PCL-C), and Connor-Davidson Resilience Scale (CD-RISC) measured PTG level, empathy, the confidence in coping with WPV, post-traumatic stress disorder, and resilience, respectively. Bivariate analysis and multiple linear regression explored potential influencing factors of PTG. This study complies with the EQUATOR (STROBE) checklist.

RESULTS

The sample was composed of a total of 1202 psychiatric nurses suffering from WPV. The average score of PTGI in psychiatric nurses was above average (65.75 points; SD = 20.20). Linear regression analyses showed from single-child family (β=0.052,95% CI=0.342,5.409, P<0.05), education background (β=0.108,95% CI=1.833,5.097, P<0.001), the confidence in coping with patient aggression (β=0.106,95% CI=1.385,4.317, P<0.001), empathy (β=0.057,95% CI=0.312,4.374, P<0.05), and resilience (β=0.484,95% CI=7.737,9.575, P<0.001) were associated with PTG level.

CONCLUSION

Psychiatric nurses who were non-single child, had received higher education, had confidence in coping with patient aggression, had good resilience and strong empathy were prone to PTG after experiencing WPV. The study findings could help hospitals and nursing managers identify vulnerable individuals and take early intervention measures against such populations.

Registered nurses' exposure to workplace aggression in Norway: 12-month prevalence rates, perpetrators, and current turnover intention

BACKGROUND

Identifying occupational health hazards among Registered Nurses (RNs) and other health personnel and implementing effective preventive measures are crucial to the long-term sustainability of health services. The objectives of this study were (1) to assess the 12-month prevalence rates of exposure to workplace aggression, including physical violence, threats of violence, sexual harassment, and bullying; (2) to identify whether the perpetrators were colleagues, managers, subordinates, or patients and their relatives; (3) to determine whether previous exposure to these hazards was associated with RNs' current turnover intention; and (4) to frame workplace aggression from an occupational health and safety perspective.

METHODS

The third version of the Copenhagen Psychosocial Questionnaire (COPSOQ III) was used to assess RNs' exposure to workplace aggression and turnover intention. A national sample of 8,800 RNs in Norway, representative of the entire population of registered nurses in terms of gender and geography, was analysed. Binary and ordinal logistic regression analyses were conducted, and odds for exposure and intention to leave are presented, with and without controls for RNs' gender, age, and the type of health service they work in.

RESULTS

The 12-month prevalence rates for exposure were 17.0% for physical violence, 32.5% for threats of violence, 12.6% for sexual harassment, and 10.5% for bullying. In total, 42.6% of the RNs had experienced at least one of these types of exposure during the past 12 months, and exposure to more than one of these hazards was common. Most perpetrators who committed physical acts and sexual harassment were patients, while bullying was usually committed by colleagues. There was a strong statistical association between exposure to all types of workplace aggression and RNs' intention to leave. The strongest association was for bullying, which greatly increased the odds of looking for work elsewhere.

CONCLUSIONS

Efforts to prevent exposure to workplace aggression should be emphasised to retain health personnel and to secure the supply of skilled healthcare workers. The results indicate a need for improvements. To ensure the sustainability of health services, labour and health authorities should join forces to develop effective workplace measures to strengthen prevention, mitigation, and preparedness regarding incidents of workplace aggression in health services and the response and recovery regarding incidents that could not be prevented.

Measuring the Severity of Objective and Subjective Patient-to-Staff Violence in Psychogeriatric and Adult Psychiatric Wards: A Retrospective Study of Four Swiss Hospitals

Measurement of patient-to-staff violence (PSV) is essential for the institution to prevent negative outcomes and provide effective interventions. Although there are several approaches to doing this in psychiatry, little is known about how well they adapt to different types of wards. The role of gender and age also needs further investigation. The present study aimed to examine and compare characteristics that contribute to the objective and subjective measurement of the severity of PSV in adult (AP) and geriatric (PG) psychiatric wards. Results show that 70% of the reported violence over 30 months (N = 589) was PSV, mostly perpetrated by male patients against nurses. Objective severity ratings were higher in PG than in AP wards, and conversely, subjective ratings were higher in AP than in PG wards. The findings support the systematic measurement of PSV in psychiatric wards and highlight the need for targeted interventions to address the risks associated with minimizing violence.

Lived Experience of Violence Perpetrated by Treated Patients and Their Visitors in Intensive Care Units: A Qualitative Study of Nurses

BACKGROUND

Patient and visitor violence (PVV) is a widespread problem for health professionals. Nurses working in intensive care units (ICUs) face a relatively high risk of experiencing PVV, which significantly impacts both the health of nurses and the institution as a whole. The subjective perceptions of ICU nurses regarding PVV are inadequately explored in the literature.

PURPOSE

The purpose of this study was to explore the perspectives, experiences, and perceptions of PVV in ICU nurses and to better understand the precipitating factors of violence.

METHODS

A phenomenological qualitative design and purposive sampling were used. A semistructured interview guide was used to conduct in-depth interviews with 12 ICU nurses with PVV experiences. Giorgi's method of analysis was used to discover and identify the essential categories of experience.

RESULTS

Five main experience categories were identified: family and patient factors as flashpoints, managing suppressed emotions by weathering the emotional storm, spiritual awakening after violence, and strategies for surviving further violence. The participants' experiences with PVV included a range of caring and mental health difficulties. In ICU settings, patient progress is often unpredictable, resulting in discrepancies between patient/family expectations and reality. Because feelings of frustration and powerlessness can eventually cause exhaustion in ICU nurses, implementing effective emotional management, stress adjustment, psychological counseling, team support, and violence intervention programs are crucial.

CONCLUSIONS/IMPLICATIONS FOR PRACTICE

This study provides new information on the process by which nurses can progress from inner trauma to self-recovery, moving from a negative affectivity disposition to a better understanding of threat appraisals and coping response options. Nurses should increase their awareness of the complexity of the phenomenon and of the interplay among the factors underlying PVV. The results of this study suggest that routine confusion and delirium assessments to rule out patients with ICU delirium in ICUs are important to preventing PVV. This study considers some of the implications of the research findings for nursing managers. Interventions, training programs, and/or management action should be used to ensure psychological and mental support is extended to all witnesses of PVV events and not only to those targeted by violence.

Interventions for Reducing Negative Impacts of Workplace Violence Among Health Workers: A Scoping Review

Workplace violence on health workers in the workplace causes physical and psychological problems. Negative impacts on victims of workplace violence such as physical problems, anxiety, depression, stress, and risk of death or risk of suicide. This problem needs to be addressed immediately so as not to impact post-traumatic stress disorder and reduce the work performance of health workers. The purpose of this study is to explore interventions to reduce the negative impact of workplace violence on health workers. This study used scoping review design with a descriptive approach to data analysis. The CINAHL, PubMed, and Scopus databases were used in this investigation. This study used PCC's framework (Population, Content, Context). The keywords are workplace violence, healthcare personnel, interventions, and programs were used by the authors. Search strategy used PRISMA Extension for Scoping Reviews. The sample are health workers, original research used a randomized control trial or quasi-experiment design, and the publication time had to be within the previous ten years (2014-2023). The JBI assessment was used to assess the quality of the article. We found 11 articles who discuss about interventions to reduce negative effects of workplace violence among health workers. This study shows that there is a decrease in psychological problems in victims of workplace violence such as anxiety, depression, and incidents of workplace violence. The range of sample in this study are 30-440 respondents. The authors discovered three different types of interventions: training programs, cognitive behavior therapy, and workplace violence programs. Interventions must focus on both the physical and psychological needs of the victims of workplace violence, psychiatric nurses and psychologists carried out interventions in a thorough manner. Interventions carried out by psychiatric nurses and psychologists can reduce the negative impact of workplace violence on health workers such as anxiety, depression and other psychological problems.

Identifying Predictors of Workplace Violence Against Healthcare Professionals: A Systematic Review

Understanding the predictors of workplace violence amongst healthcare professionals is important to develop and implement prevention and mitigation strategies. We conducted a systematic review to synthesize the recent evidence on predictors of workplace violence across healthcare settings. The review has been done as per the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Two electronic databases (PubMed and Google Scholar) were used to search peer-reviewed studies published for the year 2009-2020 to identify studies reporting predictors of workplace violence. The significant predictors were analyzed using descriptive statistics such as proportions in most of the studies and some studies used inferential statistics such as logistic regression analysis, Chi-square test, ANOVA and Student's t-test. A total of 46 studies were identified and overall evidence was graded using an adapted GRADE approach. Some of the moderate quality predictors associated with workplace violence were the patient with a history of mental health disease, psychiatric setting, professional's gender and work experience and evening shift workers. Being a nurse was the only high-quality predictor. Healthcare professionals and administration can identify the predictors relevant to their setting to mitigate episodes of violence against healthcare personnel.

Violence against nurses by patients and visitors in the emergency department: A concept analysis

AIM

This analysis investigates the concept of violence against nurses by patients and visitors in the emergency department. It aims to differentiate, clarify, and clearly identify this specific concept, which will facilitate more apt measurement and reporting, ultimately to contribute violence reduction measures.

BACKGROUND

Due to contextual factors, occupational risk and patient characteristics, violence against nurses by patients and visitors in the emergency department varies from other types of violence against other health care staff.

METHODS

This study employed Walker and Avant's concept analysis technique.

RESULTS

The analysis found that violence against nurses by patients and visitors in the emergency department is primarily an occurrence of interpersonal violence based on the working relationship, whereby the patient and/or visitor becomes an assailant, and a nurse becomes a target in the absence of capable guardianship. There is also an intentional use of physical force or power, which results in or has a high chance of causing harm.

CONCLUSION

A clearer understanding of the antecedents, attributes, and consequences of violence against nurses by patients and visitors arising from this concept analysis provides a framework that will assist in the understanding, measurement, reporting, and prevention of violence and inform future research.

IMPLICATIONS FOR NURSING MANAGEMENT

Nursing managers are encouraged to adopt strategies that act on the factors related to attributes and antecedents that will serve to reduce the occurrence of intentional violent acts.

Prevalence and Risk Factors of Workplace Violence Against Emergency Department Nurses in China

Objectives: We aim to find out the prevalence, characteristics, and predictors of workplace violence (WPV) against current Chinese emergency department (ED) nurses.

Methods: A cross-sectional survey of 20,136 ED nurses was conducted in 31 provinces in China between July and September 2019. Descriptive analyses were used to examine the prevalence and characteristics of WPV. Chi-square analysis and Binary logistic regression analysis were used to identify the predictors of WPV.

Results: During the past 12 months, there are 79.39% of ED nurses exposed to any type of WPV, including 78.38% and 39.65% exposed to nonphysical and physical violence, respectively. Binary logistic regression analysis shows that ED nurses who were male, had bachelor’s degrees, had average monthly salary between 5,001 and 12,000, worked in central China, had higher professional titles, were more experienced, arranging shift work, and had higher work stress were more likely to experience WPV.

Conclusion: A relatively high prevalence of WPV against Chinese ED nurses has been revealed in this study. The characteristics and predictors of WPV remind us to take positive measures to reduce WPV.

Multisite study of Aggressive Behavior Risk Assessment Tool in emergency departments

Objective

Violence is a major preventable problem in emergency departments (EDs), and validated screening tools are needed to identify potentially violent patients. We aimed to test the utility of the Aggressive Behavior Risk Assessment Tool (ABRAT) for screening patients in the ED.

Methods

A prospective cohort study was conducted among adult and pediatric patients aged ≥10 years visiting 3 emergency departments in Michigan between May 1, 2021, and June 30, 2021. Triage nurses completed the 16-item checklist using electronic health records (EHRs), and the occurrence of violent incidents were collected before ED disposition. A multivariate logistic regression model was applied to select a parsimonious set of items.

Results

Among 10,554 patients, 127 had ≥1 violent incidents (1.2%). The regression model resulted in a 7-item ABRAT for EDs, including history of aggression and mental illness and reason for visit, as well as 4 violent behavior indicators. Receiver operating characteristics analysis showed that the area under the curve was 0.91 (95% confidence interval [CI], 0.87-0.95), with a sensitivity of 84.3% (95% CI, 76.5%-89.9%) and specificity of 95.3% (95% CI, 94.8%-95.7%) at the optimal cutoff score of 1. An alternative cutoff score of 4 for identifying patients at high risk for violence had a sensitivity and specificity of 70.1% and 98.9%, respectively.

Conclusion

The ABRAT for EDs appears to be a simple yet comprehensive checklist with a high sensitivity and specificity for identifying potentially violent patients in EDs. The availability of such a screening checklist in the EHR may allow rapid identification of high-risk patients and implementation of focused mitigation measures to protect emergency staff and patients.

Dilemmas and Repercussions of Workplace Violence against Emergency Nurses: A Qualitative Study

Nurses received the highest rate of workplace violence due to their close interaction with clients and the nature of their work. There have been relatively few qualitative studies focus on nurses' perceptions of and experiences with the antecedents, dilemma and repercussions of the patient and visitor violence (PVV), leaving a considerable evidence gap. The aim of this study was to explore nurses' experience of PVV in emergency department, the impact of PVV on quality of care, and supports needed after exposure to such incidents. We conducted semi-structured interviews with a purposive and snowball sample of nurses, and analyzed the content of the interview transcripts. A total of 10 nurses were approached and agreed to participate. Those participants ranged in age from 24 to 41 years old, eight female and two male nurses, and the majority of them (80%) held a university Bachelor degree in nursing. The average time in nursing practice was 7.2 years. We conceptualized five analytical themes, which comprised: (1) multifaceted triggers and causes of PVV; (2) experiences following PVV; (3) tangled up in thoughts and struggle with the professional role; (4) self-reflexivity and adjustment; and, (5) needs of organizational efforts and support following PVV. This paper provides compelling reasons to look beyond solely evaluating the existence of workplace, and considering the perceived professional inefficacy, impacts of being threatened or assaulted in nurses. There are also urgent needs in provision of prevention and management of workplace training programs to ensure the high-quality nursing care.

Interventions for Workplace Violence Prevention in Emergency Departments: A Systematic Review

Emergency departments (EDs) are high-risk settings for workplace violence, but interventions to prevent violent incidents and to prepare staff are not yet consistently implemented, and their effectiveness is often unclear. This study aims to summarise evidence on workplace violence prevention interventions that were implemented in EDs to reduce violent incidents caused by patients/relatives or to increase the knowledge, skills or feelings of safety of ED staff. A systematic review was conducted. The databases MEDLINE, Web of Science, Cochrane Library, CINAHL and PsycINFO were searched for studies dated between January 2010 and May 2021. Interventional and observational studies reporting on behavioural, organisational or environmental interventions among healthcare workers in hospital EDs were included. Studies were assessed for methodological quality using the Johanna Briggs Institute Tools. Key findings of studies were summarised narratively. Fifteen studies were included, of which eleven examined behavioural interventions (classroom, online or hybrid training programmes) on de-escalation skills, violent person management or self-defence techniques. Four studies included in addition, organisational and environmental interventions. Most studies showed that interventions had a positive effect in the form of a reduction of violent incidents or an improvement in how prepared staff were to deal with violent situations; however, evidence is still sparse. Further studies should consider in particular, environmental and organisational interventions and ensure a high methodological quality.

An integrative review of waiting time, queuing, and design as contributory factors to emergency department violence

OBJECTIVE

Reports of violence in health care are continuously increasing. Globally there are attempts to manage this phenomenon. However, while risk factors have been identified, there is a tendency to over accentuate the extent of their contribution. Alcohol and drug misuse, for example, are frequently reported, with limited consideration of the ED environment. By far the biggest cause of violence appears to be the presentation of conditions related to or accompanied by mental illness and the impact of queuing and crowded departments on patients and their families. This study aims to examine the extent to which ED waiting times, design and queuing are linked to ED violence.

METHODS

An integrative literature review was performed using CINAHL Complete and MEDLINE databases. 110 papers were initially selected, and the final analysis included 25 papers.

RESULTS

The literature revealed three emerging themes: the nature of emergency department violence, environmental contributory factors and its management and control.

CONCLUSION

The findings of this review reveal several causes of violence. Surprisingly most approaches take a victim blaming approach aimed at identifying potential perpetrators rather than taking a holistic approach to prevention that would also address environmental and societal issues. More is needed in terms of implementation of more far-reaching, practical, and effective management solutions to promote health care workers' safety and adequately support vulnerable patients.

Exploring the usefulness of medical clowns in elevating satisfaction and reducing aggressive tendencies in pediatric and adult hospital wards

BACKGROUND

Most existing research on medical clowns in health care services has investigated their usefulness mainly among child health consumers. In this research we examined multiple viewpoints of medical staff, clowns, and health consumers aiming to identify the optimal audience (adult or child health consumers) for which medical clowns are most useful. We focused on exploring their usefulness in enhancing health consumers' satisfaction and, in turn, reducing their aggressive tendencies.

METHODS

We conducted three studies that examined the placement fit of medical clowns from different points of view: medical staff (Study 1, n = 88), medical clowns (Study 2, n = 20), and health consumers (Study 3, n = 397). The main analyses in Studies 1 and 2 included frequencies and t-tests comparing perceived adult and child satisfaction with clowns' performance. Study 3 used moderated-mediation PROCESS bootstrapping regression analysis to test the indirect effect of negative affectivity on aggressive tendencies via satisfaction. Exposure to the medical clown moderated this relationship differently for different ages.

RESULTS

Studies 1 and 2 show that the majority of medical clowns and medical staff report that the current placement of the medical clowns is in pediatric wards; about half (44% of medical staff, 54% of medical clowns) thought that this placement policy should change. In Study 3, data from health consumers in seven different hospital wards showed that clowns are useful in mitigating the effect of negative affectivity on satisfaction, thereby reducing aggressive tendencies among health consumers under the age of 21.6 years. Surprisingly, medical clowns had the opposite effect on most adults: for health consumers who were exposed to the medical clown and were above the age of 21.6 negative affectivity was related to decreased satisfaction, and an increase in aggressive tendencies was observed.

DISCUSSION

Medical clowns are most useful in elevating satisfaction and reducing aggressive tendencies of children. Older adults, on the other hand, exhibit lower satisfaction and higher aggressive tendencies following exposure to the performance of medical clowns.

CONCLUSION

Medical clowns should be placed primarily in children's wards.

Aggressive Behavior and Psychiatric Inpatients: a Narrative Review of the Literature with a Focus on the European Experience

PURPOSE OF REVIEW

We summarized peer-reviewed literature on aggressive episodes perpetrated by adult patients admitted to general hospital units, especially psychiatry or emergency services. We examined the main factors associated with aggressive behaviors in the hospital setting, with a special focus on the European experience.

RECENT FINDINGS

A number of variables, including individual, historical, and contextual variables, are significant risk factors for aggression among hospitalized people. Drug abuse can be considered a trans-dimensional variable which deserves particular attention. Although mental health disorders represent a significant component in the risk of aggression, there are many factors including drug abuse, past history of physically aggressive behavior, childhood abuse, social and cultural patterns, relational factors, and contextual variables that can increase the risk of overt aggressive behavior in the general hospital. This review highlights the need to undertake initiatives aimed to enhance understanding, prevention, and management of violence in general hospital settings across Europe.