Aggression in psychiatric hospitalizations: a qualitative study of patient and provider perspectives.
BACKGROUND
When the people hospitalized in psychiatric units demonstrate aggression, it harms individuals and creates legal and financial issues for hospitals. Aggression has been linked to inpatient, clinician and environmental characteristics. However, previous work primarily accessed clinicians' perspectives or administrative data and rarely incorporated inpatients' insights. This limits validity of findings and impedes comparisons of inpatient and clinician perspectives.


OBJECTIVE
This study explored and compared inpatient and clinician perspectives on the factors affecting verbal and physical aggression by psychiatric inpatients.


METHODS
This study used an interpretive theoretical framework. Fourteen inpatients and 10 clinicians were purposefully sampled and completed semi-structured interviews. Data were analyzed using inductive thematic analysis.


RESULTS
Six themes were identified at personal and organizational levels. The three person-level themes were major life stressors, experience of illness and interpersonal connections with clinicians. The three organization-level themes were physical confinement, behavioural restrictions and disengagement from treatment decisions.


CONCLUSIONS
Aggression is perceived to have a wide range of origins spanning personal experiences and organizational policies, suggesting that a wide range of prevention strategies are needed.
a Mental Health Service, St. Michael's Hospital , Toronto, Ontario , Canada.
Denise
D
Lamanna
a Mental Health Service, St. Michael's Hospital , Toronto, Ontario , Canada.
Danijela
D
Ninkovic
b Family and Community Medicine, St. Michael's Hospital , Toronto, Ontario , Canada , and.
Vinothini
V
Vijayaratnam
a Mental Health Service, St. Michael's Hospital , Toronto, Ontario , Canada.|c Department of Psychiatry, Faculty of Medicine , University of Toronto , Toronto, Ontario , Canada.
Ken
K
Balderson
a Mental Health Service, St. Michael's Hospital , Toronto, Ontario , Canada.|c Department of Psychiatry, Faculty of Medicine , University of Toronto , Toronto, Ontario , Canada.
Harold
H
Spivak
a Mental Health Service, St. Michael's Hospital , Toronto, Ontario , Canada.|c Department of Psychiatry, Faculty of Medicine , University of Toronto , Toronto, Ontario , Canada.
Shelley
S
Brook
a Mental Health Service, St. Michael's Hospital , Toronto, Ontario , Canada.|c Department of Psychiatry, Faculty of Medicine , University of Toronto , Toronto, Ontario , Canada.
David
D
Robertson
D000293:Adolescent; D000328:Adult; D000368:Aged; D000374:Aggression; D001291:Attitude of Health Personnel; D005260:Female; D006760:Hospitalization; D006778:Hospitals, Psychiatric / Q000458:organization & administration*; D006801:Humans; D007297:Inpatients / Q000523:psychology*; D008297:Male; D028642:Persons with Psychiatric Disorders / Q000523:psychology*; D008875:Middle Aged; D011369:Professional-Patient Relations; D036301:Qualitative Research; D013315:Stress, Psychological; D055815:Young Adult
Aggression; certification; conflict; inpatients; involuntary hospital admission; qualitative; restraint