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Workplace aggression experienced by frontline staff in dementia care

Authors

  • Anne-Marie Boström,

    1. Authors: Anne-Marie Boström, PhD, RN, Assistant Professor, Division of Nursing, Department of Neurobiology, Care Science and Society, Karolinska Institutet, Huddinge, Department of Geriatric Medicine, Danderyd Hospital, Danderyd, Sweden and Assistant Adjunct Professor, Faculty of Nursing, University of Alberta, Edmonton; Janet E Squires, PhD, RN, Postdoctoral Fellow, Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa; Agnes Mitchell, MN, RN, GNC (C), Faculty Member, Health and Community Studies, Grant McEwan University; Anne E Sales, PhD, RN, Professor, Faculty of Nursing, University of Alberta; Carole A Estabrooks, PhD, RN, Professor, Faculty of Nursing, University of Alberta, Edmonton, Canada
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  • Janet E Squires,

    1. Authors: Anne-Marie Boström, PhD, RN, Assistant Professor, Division of Nursing, Department of Neurobiology, Care Science and Society, Karolinska Institutet, Huddinge, Department of Geriatric Medicine, Danderyd Hospital, Danderyd, Sweden and Assistant Adjunct Professor, Faculty of Nursing, University of Alberta, Edmonton; Janet E Squires, PhD, RN, Postdoctoral Fellow, Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa; Agnes Mitchell, MN, RN, GNC (C), Faculty Member, Health and Community Studies, Grant McEwan University; Anne E Sales, PhD, RN, Professor, Faculty of Nursing, University of Alberta; Carole A Estabrooks, PhD, RN, Professor, Faculty of Nursing, University of Alberta, Edmonton, Canada
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  • Agnes Mitchell,

    1. Authors: Anne-Marie Boström, PhD, RN, Assistant Professor, Division of Nursing, Department of Neurobiology, Care Science and Society, Karolinska Institutet, Huddinge, Department of Geriatric Medicine, Danderyd Hospital, Danderyd, Sweden and Assistant Adjunct Professor, Faculty of Nursing, University of Alberta, Edmonton; Janet E Squires, PhD, RN, Postdoctoral Fellow, Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa; Agnes Mitchell, MN, RN, GNC (C), Faculty Member, Health and Community Studies, Grant McEwan University; Anne E Sales, PhD, RN, Professor, Faculty of Nursing, University of Alberta; Carole A Estabrooks, PhD, RN, Professor, Faculty of Nursing, University of Alberta, Edmonton, Canada
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  • Anne E Sales,

    1. Authors: Anne-Marie Boström, PhD, RN, Assistant Professor, Division of Nursing, Department of Neurobiology, Care Science and Society, Karolinska Institutet, Huddinge, Department of Geriatric Medicine, Danderyd Hospital, Danderyd, Sweden and Assistant Adjunct Professor, Faculty of Nursing, University of Alberta, Edmonton; Janet E Squires, PhD, RN, Postdoctoral Fellow, Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa; Agnes Mitchell, MN, RN, GNC (C), Faculty Member, Health and Community Studies, Grant McEwan University; Anne E Sales, PhD, RN, Professor, Faculty of Nursing, University of Alberta; Carole A Estabrooks, PhD, RN, Professor, Faculty of Nursing, University of Alberta, Edmonton, Canada
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  • Carole A Estabrooks

    1. Authors: Anne-Marie Boström, PhD, RN, Assistant Professor, Division of Nursing, Department of Neurobiology, Care Science and Society, Karolinska Institutet, Huddinge, Department of Geriatric Medicine, Danderyd Hospital, Danderyd, Sweden and Assistant Adjunct Professor, Faculty of Nursing, University of Alberta, Edmonton; Janet E Squires, PhD, RN, Postdoctoral Fellow, Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa; Agnes Mitchell, MN, RN, GNC (C), Faculty Member, Health and Community Studies, Grant McEwan University; Anne E Sales, PhD, RN, Professor, Faculty of Nursing, University of Alberta; Carole A Estabrooks, PhD, RN, Professor, Faculty of Nursing, University of Alberta, Edmonton, Canada
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Anne-Marie Boström, Assistant Professor, Division of Nursing, Department of NVS, Karolinska Institutet, Alfred Nobels Allé 23, 23300, 141 83 Huddinge, Sweden. Telephone: +46 8 524 839 19. E-mail:anne-marie.bostrom@ki.se

Abstract

Aim.  To describe the frequency of aggressive acts experienced by frontline staff working in two models of dementia care: Residential Alzheimer’s Care Centers and Secured Dementia Units and to explore the associations between aggressive acts experienced by frontline staff and factors related to the work context and care providers.

Background.  Aggression towards healthcare providers in residential long-term care settings is well documented. However, few studies have examined associations between aggressive behaviours towards care providers and organisational factors.

Design.  A cross-sectional survey.

Method.  The survey included demographic items and questions about aggressive acts experienced by staff and contextual factors. Analyses included: (1) descriptive statistics, (2) tests of difference (i.e. Student’s t-test, Mann–Whitney U-test, chi-squared test and anova), (3) bivariate associations (i.e. Pearson and Spearman rank order correlations) and (4) multivariate linear regression.

Results.  Ninety-one health care aides and licensed practical nurses working in four nursing units using two models of dementia care participated (response rate 81%). The most frequently reported types of aggression were physical assault (50% of staff, n = 45) and emotional abuse (48% of staff, n = 44). Aggressive acts were significantly associated with working in Secured Dementia Units rather than Residential Alzheimer’s Care Centers.

Conclusions.  Frontline staff working in Secured Dementia Units were exposed to higher frequencies of various types of aggressive acts mainly initiated by residents. Future research needs to explore modifiable workplace factors associated with aggressive acts in a larger sample across a variety of long-term care settings.

Relevance to clinical practice.  To prevent staff perceived aggressive acts, leaders and managers in dementia care need to acknowledge the complex topic of workplace aggression and encourage an open discussion among frontline staff without assigning blame. Care provider strategies for dealing with aggressive behaviour have to be implemented in policies and clinical practice.

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