Violence in municipal care of older people in Sweden as perceived by registered nurses


  • Karin Josefsson MA, RNT,

  • Lars Sonde PhD, RPT,

  • Tarja-Brita Robins Wahlin PhD, RN

Karin Josefsson
Department of Health Sciences
Örebro University
S-701 82 Örebro
Telephone: +46 19 303000


Aims.  The main aim was to describe registered nurses’ perceptions of violence and threats, as well as their access to prevention measures and routines for handling violent behaviour in municipal care of older people. Another aim was to compare nurses’ perceptions working solely in dementia care with those working in general elder care where older people have diverse diagnoses.

Background.  Violence is often reported in care of older people. The development of dementia units and the implementation of reform have changed care of older people. Dementia disorders have been shown to be a predisposing factor to violence.

Design.  A non-experimental, descriptive design with a survey research approach was used. The setting was 60 special types of housing with subunits in a large town. The response rate was 62% (n = 213). Forty-five per cent (n = 95) of the nurses worked in dementia care and 55% (118) in general elder care.

Method.  A questionnaire.

Results.  Nurses had experienced a high degree indirect threats (dementia care, 45%; general elder care, 51%), direct threats of violent acts (dementia care, 35%; general elder care, 44%) and violent acts (dementia care, 41%; general elder care, 43%). Nurses had witnessed violence and threats towards staff (dementia care, 49%; general elder care, 38%). Even care receivers (dementia care, 20%; general elder care, 19%) were subjected to violence and threats. No statistical differences were found between groups. The nurses in dementia care had more access to education in managing violence and threats, as well as routines for handling violence and a door with a lock to their working unit.

Conclusion.  Violence occurred frequently in municipal care of older people without any difference between dementia care and general elder care. Nurses in dementia care were more often offered education on how to manage violence and had routines for when violence occurs.

Relevance to clinical practice.  Municipal authorities should increase staff education for handling violence and creating safety routines. Violence needs to be taken seriously with a ‘zero tolerance’ attitude.