Aggression and assault in inpatient psychiatric wards: a review of the literature

Abstract

This literature review identifies many factors which contribute to aggression and assault in inpatients units. The writer uses her own experience of being assaulted as a mechanism to understand the literature and the experience of assault. Patient aggression does not occur as an isolated act, it involves complex interactions all of which involve nurses. The patient is part of the system in which the nurse interacts one to one and within the therapeutic ward milieu. It is important that nurses no longer just concentrate on defining features but reach into their therapeutic relationship and professional knowledge to find the strategies to assist them. The nursing assessment is fundamental to this as it is not based on a mere checklist of predispositions but based on the commitment to knowing the patient first as a person then as a person struggling with illness. The writer suggests that through the creation of a caring environment underpinned by nursing knowledge we can discover the real meaning, understanding and strategies for aggression and assault. Until this occurs the absence of the voice of the assaultive patient and assaulted nurse will continue. Key recommendations have been identified as a result of this literature review for policy makers, nurses, and providers of psychiatric care.