Aggression in a high secure hospital: staff and patient attitudes


D. Pulsford, School of Health, Room 332 Brook Building, University of Central Lancashire, Preston PR1 2HE, UK, E-mail:


Accessible summary

  • • A key role of nursing staff in high secure hospitals is responding to patients' aggressive behaviour.
  • • Attitudes of staff in high secure hospitals may influence how they respond to patient aggression.
  • • Patients will have their own attitudes towards aggression and how it should be managed.
  • • In our study, the views of staff and patients regarding aggression were overall similar, with both groups espousing controlling means of aggression management (medication, restraint, seclusion) in addition to interpersonal strategies.


Responding to aggressive behaviour is a key activity for nurses and other care staff in high secure hospitals. The attitudes and beliefs of staff regarding patient aggression will influence the management strategies they adopt. Patients will also hold attitudes regarding the causes of and best ways to respond to aggressive behaviour. This study measured the attitudes towards aggression of staff (n= 109) and patients (n= 27) in a high secure hospital in the UK using the Management of Aggression and Violence Attitude Scale (MAVAS). There was considerable concordance of views, staff and patients disagreeing on only two items on the MAVAS. Aggression was felt to have a range of causes, embracing factors internal to the person, factors in the external environment and situational or interactional factors. Interpersonal means of managing aggression were supported, but both staff and patients also advocated the use of controlling management strategies such as medication, seclusion and restraint. The implications of these findings for aggression management in high secure settings are discussed in the light of best practice guidelines that promote interpersonal approaches over controlling strategies.