Training nurses to deal with aggressive encounters with the public
Chapter one reviews the literatures on psychological studies of aggression, problems of aggression within the Social Services and the National Health Service, and nurse-patient communication. A number of issues are raised which are addressed by the current research. In chapter two nurses' theories about what defuses and what aggravates aggression are explored. It was found that nurses believe that by remaining calm, gentle and firm they will defuse both physical and verbal aggression. In the case of physical aggression they believe it to be aggravated by being authoritarian, demeaning and defensive, while in the case of verbal aggression they believe it to be aggravated by becoming angry or attempting to deflect it. In chapter three nurses' real-life experiences of what defuses and what aggravates physical and verbal aggression are compared with their theories. The nurses' experiences largely support their theories. It was also found that there are very few methods for dealing effectively with physical aggression, while there are a relatively large number of methods for dealing effectively with verbal aggression. Moreover, those nurses who believe themselves to be more capable of dealing with aggression suffer fewer emotional after-effects than those nurses who do not. Chapter four examines individual differences between nurses and relates these differences to their ability to recover from the emotional aftermath of aggression. It was found that nurses who are highly stressed and who bottle-up their feelings of anger suffer emotionally after aggressive incidents. In contrast, nurses who are assertive, extravert and who exercise interpersonal control are not so distressed by aggressive incidents. In chapter five nurses' attributions are related to their ability to select effective methods of dealing with aggression as well as their ability to recover from it emotionally. It was found that those nurses who have a tendency to blame themselves are both emotionally vulnerable and less capable of selecting effective methods of responding to aggression. In addition, a new method of measuring attribution was developed and tested, and was found to be preferable to the usual method of measuring attribution. Chapter six presents the two-day aggression training programme. The training was designed to incorporate the findings of the current research as well as theoretical issues. The training was carefully evaluated with a control group, pre-post measures of both subjective and objective change, and a seven week follow-up. The aggression training group was no different to the control group before training, but was different on all measures after training. It was concluded that the training model has been shown to make a significant difference to objective skills and subjective evaluations, and that the causal influence of some of the findings described in chapters two to five has been demonstrated. Chapter seven summarises the findings of the research, explores their theoretical and practical implications, and suggests directions for future research.