Nursing Times reader Linda Smith talks about dealing with verbal aggression in the workplace.
I do not understand why a nurse feels angry when a patient is verbally aggressive. If I was distressed, felt intimidated, threatened or had just been detained under the Mental Health Act I too might “fight my corner” with a few choice words.
Before finding patients who “appear” verbally aggressive a problem nurses should ask themselves “Would I be happy today if I was the patient”? Patients may have a problem with the ‘nurse in uniform’ rather than Tom, Dick or Sally wearing it.
I would say to the three named nurses here that they should not take to heart any personal comments, unless of course they know they have done something wrong when interacting with their patient. Learn from comments made.
It is not good practise to immediately presume a patient is suffering from a psychiatric illness. One must remember to rule in every possible physical illness first.
Only when all investigations have been done and all physical illness ruled out can a psychiatric illness be considered. I am sure no nurse would take offence at a patient who was verbally aggressive or rude if they had dysphasia or aphasia following a cerebral vascular accident.
“It is not good practise to immediately presume a patient is suffering from a psychiatric illness. One must remember to rule in every possible physical illness first.”
What causes a patient’s behaviour is sometimes outside of their control, epilepsy can cause a dramatic change in a person’s demeanour and I remember witnessing one quiet, unassuming man who during a Petit Mal could have won The World’s Strongest Man competition.
Verbal and physical aggression should not be considered anything but a possible symptom of illness and any nurse who keeps this fact uppermost in their mind will be more able to accept what is said and done.
Once physical illness has been ruled out a nurse should still remember that their patient may well be a victim of circumstance, abuse, or even others who have fabricated symptoms. One of the most important points to remember is give your patient the opportunity to speak and explain.
Sometimes a patient may seem unwell when in fact they have an unusual lifestyle. Listen to what is said and do not rule out the possibility of what sounds implausible.
Another person’s lifestyle may well end up sounding acceptable or even preferable to the one you have. A nurse who is open to unusual circumstances and swearing may well be the one person able to help their patient. Do not judge what life may have taught others is acceptable and that includes their vocabulary!
“A patient with a strange-but-true event to talk about may understandably become demonstrative, loud, and yes even aggressive when disbelieved.”
A patient with a strange-but-true event to talk about may understandably become demonstrative, loud, and yes even aggressive when disbelieved, or a usually quiet, conforming patient will be unable to argue the toss with you.
Aggression can be a “fight response” and any verbally aggressive patient should be allowed to let go of their distress.
I would not want a patient to bottle up their stress and end up riddled with anxiety and anger. My ears are not too delicate to hear a jumbled up mixture of letters considered rude or offensive to some when I’m a nurse with a communicative patient.
I believe the problem for psychiatric nurses is that most have never been a patient of Psychiatry services and I hope have never felt threatened or held against their will in a general setting. As a psychiatric nurse one will hear the words “psychiatry and psychology” but not always will a nurse be introduced to “sociology”.
Many patients have a “history” and this should be considered, here are two examples why:
1. Any failings from the past which are not readily acknowledged will only infuriate your patient. If he is able to prove his point and gives examples describing good practise then a competent nurse should have the confidence to say that others were wrong.
2. Any positive interactions in the past should not be forgotten. Therapies provided then may well be responsible for the forthright patient today!
One of the most important points to remember is that every swearing patient is still communicating with you. When a nurse tells a patient to “please don’t swear” this often stops communication and that is the end of the nurse/patient relationship.
The opportunity to learn about, or from your patient has gone.
“Think nurses find physical aggression less stressful because they are able to release their own feelings of distaste, annoyance, or anger back on to the patient whilst restraining them.”
A recent article in the Nursing Times stated 60% of psychiatric nurses find verbal aggression more stressful than physical aggression and I wonder what the percentage is for general nurses.
Interestingly, a patient may have psychiatric or psychological symptoms and every nurse has a psyche!
My final thought on the subject of aggression leads me to think nurses find physical aggression less stressful because they are able to release their own feelings of distaste, annoyance, or anger back on to the patient whilst restraining them.
I do not like conflict and so my approach is aimed at continuing communication in order to prevent a physically harmful situation occurring. I don’t presume to think my patient would be happy to see me tomorrow if we’d grappled with one another on the floor today.
Linda Smith trained at Shotley Bridge General Hospital in the 1980s and nursed on placement at Winterton Psychiatric Hospital for a short time. In her third year she became paraplegic and was unable to complete her training. Articles in the Nursing Times have spurred her on to educate those who are now working, and she hopes others will learn that communication is the first step to compassionate care.