Nurse managers: Determinants and behaviours in relation to patient and visitor aggression in general hospitals. A qualitative study

Abstract Aim(s) To explore nurse managers’ behaviours, attitudes, perceived social norms, and behavioural control in the prevention and management of patient and visitor aggression in general hospitals. Background Patient and visitor aggression in general hospitals is a global problem that incurs substantial human suffering and organizational cost. Managers are key persons for creating low‐aggression environments, yet their role and behaviours in reducing patient and visitor aggression remains unexplored. Design A qualitative descriptive study underpinned by the Reasoned Action Approach. Method(s) Between October 2015–January 2016, we conducted five focus groups and 13 individual interviews with nurse leaders in Switzerland. The semi‐structured interviews and focus groups were recorded, transcribed, and analysed in a qualitative content analysis. Findings We identified three main themes: (i) Background factors: “Patient and visitor aggression is perceived through different lenses”; (ii) Determinants and intention: “Good intentions competing with harsh organizational reality”; (iii) Behaviours: “Preventing and managing aggressive behaviour and relentlessly striving to create low‐aggression work environments”. Conclusion(s) Addressing patient and visitor aggression is difficult for nurse managers due to a lack of effective communication, organizational feedback loops, protocols, and procedures that connect the situational and organizational management of aggressive incidents. Furthermore, tackling aggression at an organizational level is a major challenge for nurse managers due to scant financial resources and lack of interest. Treating patient and visitor aggression as a business case may increase organizational awareness and interest. Furthermore, clear communication of expectations, needs and resources could optimize support provision for staff.