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Nursing home caregivers’ explanations for and coping strategies with residents’ aggression: a qualitative study

Authors

  • Adelheid Zeller,

    1. Authors:Adelheid Zeller, MNS, NT, RN, Head of Bachelor of Science in Nursing, Department of Health, University of Applied Sciences, St. Gallen, Switzerland; Theo Dassen, PhD, RN, Head of Department of Nursing Science, Centre for the Humanities and Health Sciences and Department of Nursing Science, Charité-Universitätsmedizin, Berlin, Germany; Gerjo Kok, PhD, Professor of Applied Psychology, Department of Work and Social Psychology, Faculty of Psychology, Universiteit Maastricht, Maastricht, The Netherlands; Ian Needham, PhD, NT, RN, Nursing Scientist, Centre of Psychiatry Rheinau, Rheinau, Switzerland; Ruud JG Halfens, PhD, FEANS, Professor, Faculty of Health, Medicine and Lifesciences, Department of Health Care and Nursing Science, Universiteit Maastricht, Maastricht, The Netherlands
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  • Theo Dassen,

    1. Authors:Adelheid Zeller, MNS, NT, RN, Head of Bachelor of Science in Nursing, Department of Health, University of Applied Sciences, St. Gallen, Switzerland; Theo Dassen, PhD, RN, Head of Department of Nursing Science, Centre for the Humanities and Health Sciences and Department of Nursing Science, Charité-Universitätsmedizin, Berlin, Germany; Gerjo Kok, PhD, Professor of Applied Psychology, Department of Work and Social Psychology, Faculty of Psychology, Universiteit Maastricht, Maastricht, The Netherlands; Ian Needham, PhD, NT, RN, Nursing Scientist, Centre of Psychiatry Rheinau, Rheinau, Switzerland; Ruud JG Halfens, PhD, FEANS, Professor, Faculty of Health, Medicine and Lifesciences, Department of Health Care and Nursing Science, Universiteit Maastricht, Maastricht, The Netherlands
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  • Gerjo Kok,

    1. Authors:Adelheid Zeller, MNS, NT, RN, Head of Bachelor of Science in Nursing, Department of Health, University of Applied Sciences, St. Gallen, Switzerland; Theo Dassen, PhD, RN, Head of Department of Nursing Science, Centre for the Humanities and Health Sciences and Department of Nursing Science, Charité-Universitätsmedizin, Berlin, Germany; Gerjo Kok, PhD, Professor of Applied Psychology, Department of Work and Social Psychology, Faculty of Psychology, Universiteit Maastricht, Maastricht, The Netherlands; Ian Needham, PhD, NT, RN, Nursing Scientist, Centre of Psychiatry Rheinau, Rheinau, Switzerland; Ruud JG Halfens, PhD, FEANS, Professor, Faculty of Health, Medicine and Lifesciences, Department of Health Care and Nursing Science, Universiteit Maastricht, Maastricht, The Netherlands
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  • Ian Needham,

    1. Authors:Adelheid Zeller, MNS, NT, RN, Head of Bachelor of Science in Nursing, Department of Health, University of Applied Sciences, St. Gallen, Switzerland; Theo Dassen, PhD, RN, Head of Department of Nursing Science, Centre for the Humanities and Health Sciences and Department of Nursing Science, Charité-Universitätsmedizin, Berlin, Germany; Gerjo Kok, PhD, Professor of Applied Psychology, Department of Work and Social Psychology, Faculty of Psychology, Universiteit Maastricht, Maastricht, The Netherlands; Ian Needham, PhD, NT, RN, Nursing Scientist, Centre of Psychiatry Rheinau, Rheinau, Switzerland; Ruud JG Halfens, PhD, FEANS, Professor, Faculty of Health, Medicine and Lifesciences, Department of Health Care and Nursing Science, Universiteit Maastricht, Maastricht, The Netherlands
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  • Ruud JG Halfens

    1. Authors:Adelheid Zeller, MNS, NT, RN, Head of Bachelor of Science in Nursing, Department of Health, University of Applied Sciences, St. Gallen, Switzerland; Theo Dassen, PhD, RN, Head of Department of Nursing Science, Centre for the Humanities and Health Sciences and Department of Nursing Science, Charité-Universitätsmedizin, Berlin, Germany; Gerjo Kok, PhD, Professor of Applied Psychology, Department of Work and Social Psychology, Faculty of Psychology, Universiteit Maastricht, Maastricht, The Netherlands; Ian Needham, PhD, NT, RN, Nursing Scientist, Centre of Psychiatry Rheinau, Rheinau, Switzerland; Ruud JG Halfens, PhD, FEANS, Professor, Faculty of Health, Medicine and Lifesciences, Department of Health Care and Nursing Science, Universiteit Maastricht, Maastricht, The Netherlands
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Adelheid Zeller, Head of Bachelor of Science in Nursing, Department of Health, University of Applied Sciences St. Gallen, Tellstrasse 2, Postfach 664, 9001 St. Gallen, Switzerland. Telephone: +41 71 226 15 03.
E-mail:heidi.zeller@fhsg.ch

Abstract

Aims and objectives.  This study explored caregivers’ perspectives regarding the conditions and situations of resident aggression and practical strategies caregivers use to deal with aggression.

Background.  Working in a nursing home is associated with a high risk to experience aggression from residents or patients. Despite existing recommendations for dealing with aggression there is a lack of information about caregivers’ ways of dealing with it in practice.

Design.  A qualitative study with focus group method was conducted.

Method.  Five focus group interviews, with a total of 30 participants, from nursing homes in Switzerland were undertaken employing a semi-structured interview guideline. For analysing the data, qualitative content analysis was employed.

Results.  Analysis of the data produced three themes with additional sub-themes. One main theme concerns the explanations of the caregivers in regard to the occurrence of aggressive behaviour. This theme is subdivided into two areas, the contributory resident related factors and the caregiver related factors. The measures for handling aggressive behaviour are illustrated in the second theme ‘dealing with residents’. The third theme refers to the strategies of the caregivers when confronted with aggressive behaviour –‘self-protection’ and ‘coping with the situation’.

Conclusion.  Caregivers use a broad spectrum of interventions for reducing aggression, some of which are recommended by guidelines but often ignore the link between aggressive behaviour and physiological issues like pain or elimination. The caregivers only very rarely linked their practical knowledge about aggressive behaviour with theoretical knowledge.

Relevance to clinical practice.  The results give insight into the caregivers’ perspectives on factors leading to aggression and their coping strategies. Caregivers are informed about relevant reasons for aggressive behaviour and its management, but do not apply a systematic approach. Furthermore, the anxiety of caregivers involved in aggression incidents is an under examined area.

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