Cognitive model of patient aggression towards health care staff: The patient's perspective

Abstract

Aggression towards health care staff has become the focus for research as well as for government intervention. Negative effects upon staff and organizations have been established, yet few detailed explanations are offered for this aggression, and none represents the patient's perspective. This paper presents a model from the patient's perspective that takes account of situational variables, while also focusing upon patient cognitions. It also considers physiological responses related to arousal that might underpin aggression in an anxiety-provoking situation. In a previous study the frequency with which aggression was preceded by some anxiety-provoking event and the extent to which assailants displayed diminished cognitive processing were established; these were incorporated into the model. Increased anxiety commonly experienced by patients can have a negative effect upon cognitive processing. Anxiety generates a hyper-vigilance for threatening stimuli, induces selective attentional bias for threat, and causes a narrowing of attention, thus reducing cues and information upon which to make accurate appraisals and attributions. With such impairments, patients may make negative rather than positive attributions regarding actions of staff, which are frequently anxiety provoking. Thus, patients perceive staff behaviour as threatening rather than benign, and in the absence of positive attributions it will invoke an aggressive response. What health care staff perceive as aggression may be seen by patients as a defence against perceived attack. Changes in policy that take this into account may reduce future aggressive incidents.

Keywords:

• Violence
• aggression
• assault
• patient aggression
• health care staff
• anxiety
• cognitive model