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Limit-setting and decision-making in the management of aggression

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lowe t., wellman n. & taylor r. (2003) Journal of Advanced Nursing41(2), 154–161

Limit-setting and decision-making in the management of aggression

Background. Several published research studies have suggested that inpatient aggression against nursing staff may be directly precipitated by common nurse–patient interactions. This study sought to examine the structure of nurses' judgements in situations of conflict.

Method. Seventy practising United Kingdom psychiatric nurses were presented with a number of conflict scenarios and were asked to rate a range of intervention options for each scenario according to how appropriate they perceived those interventions to be. Their responses were analysed using multidimensional scaling techniques.

Results. The results suggest that issues associated with limit setting and autonomy were perceived as most important by the nurses and that these issues are most likely to lead to disagreements in judgement between nurses of different status. Nurses of higher grades (levels) showed a significantly greater preference for respectful and autonomy-confirming interventions than their more junior nurses. These results have training and policy implications and further research should examine the effects of such nursing judgements on patient care.

Keywords: aggression; assaults on staff; conflict scenarios; decision-making; intervention options; limit-setting; multidimensional scaling; psychiatric inpatients; psychiatric nurses; violence

Document Type: Research Article


Affiliations: 1: Lecturer Practitioner, Isis Education Centre, Oxford Brookes University and Oxfordshire Mental Healthcare NHS Trust, Oxford, UK 2: Consultant Nurse, Berkshire Healthcare NHS Trust, Fair Mile Hospital, Chosley, Oxfordshire, UK 3: Deputy Director of Nursing, Oxfordshire Mental Healthcare NHS Trust, Warneford Hospital, Oxford, UK

Publication date: January 1, 2003

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