Article Patient Aggression and the Wellbeing of Nurses A Cross Sectional Survey Study in Psychiatric and Non Psychiatric Settings Virve Pekurinen 1 ID Laura Willman 1 Marianna Virtanen 2 Mika Kivim ki 2 3 4 Jussi Vahtera 5 6 and Maritta V lim ki 1 6 7 1 Department of Nursing Science University of Turku 20520 Turku Finland vimapek utu V P laura k willman utu L W Finnish Institute of Occupational Health 00250 Helsinki Finland marianna virtanen ttl M V mika kivimaki helsinki M K 3 Department of Epidemiology and Public Health University College London London WC1E 7HB UK 4 Clinicum Faculty of Medicine University of Helsinki 00290 Helsinki Finland 5 Department of Public Health University of Turku 20520 Turku Finland jussi vahtera utu 6 Turku University Hospital 20521 Turku Finland School of Nursing Hong Kong Polytechnic University Hong Kong China 2 7 Correspondence mava utu Tel 358 406890546 Received 4 September 2017 Accepted 14 October 2017 Published 18 October 2017 Abstract Wellbeing of nurses is associated with patient aggression Little is known about the differences in these associations between nurses working in different specialties We aimed to estimate and compare the prevalence of patient aggression and the associations between patient aggression and the wellbeing of nurses in psychiatric and non psychiatric specialties medical and surgical and emergency medicine A sample of 5288 nurses 923 psychiatric nurses 4070 medical and surgical nurses 295 emergency nurses participated in the study Subjective measures were used to assess both the occurrence of patient aggression and the wellbeing of nurses self rated health sleep disturbances psychological distress and perceived work ability Binary logistic regression with interaction terms was used to compare the associations between patient aggression and the wellbeing of nurses Psychiatric nurses reported all types of patient aggression more frequently than medical and surgical nurses whereas nurses working in emergency settings reported physical violence and verbal aggression more frequently than psychiatric nurses Psychiatric nurses reported poor self rated health and reduced work ability more frequently than both of the non psychiatric nursing groups whereas medical and surgical nurses reported psychological distress and sleep disturbances more often Psychiatric nurses who had experienced at least one type of patient aggression or mental abuse in the previous year were less likely to suffer from psychological distress and sleep disturbances compared to medical and surgical nurses Psychiatric nurses who had experienced physical assaults and armed threats were less likely to suffer from sleep disturbances compared to nurses working in emergency settings Compared to medical and surgical nurses psychiatric nurses face patient aggression more often but certain types of aggression are more common in emergency settings Psychiatric nurses have worse subjective health and work ability than both of the non psychiatric nursing groups while their psychiatric wellbeing is better and they have less sleep problems compared to medical and surgical nurses Psychiatric nurses maintain better psychiatric wellbeing and experience fewer sleep problems than non psychiatric nurses after events of exposure to patient aggression This suggest that more attention should be given to non psychiatric settings for maintaining the wellbeing of nurses after exposure to patient aggression Keywords psychiatric nurses non psychiatric nurses occupational health psychological distress self rated health sleep disturbance work ability patient aggression Int J Environ Res Public Health 2017 14 1245 doi 10 3390 ijerph14101245 www mdpi com journal ijerph International Journal ofEnvironmental Researchand Public Health Int J Environ Res Public Health 2017 14 1245 2 of 14 1 Introduction Patient aggression toward health professionals is a serious global concern 1 2 Health professionals taking care of persons with mental disturbances are often exposed to patient aggression 2 Aggression can be de ned as a range of behaviors or actions that has the potential to harm hurt or injure another person either physically or verbally regardless of whether or not harm is actually sustained or the intention is clear 3 Patient aggression in these settings is associated with healthcare workers wellbeing 4 6 Being the target of patient aggression has been found to be associated with anxiety fear guilt sleep disturbances 7 burnout 8 9 poor self rated health 10 or dissatisfaction toward work 4 Furthermore longitudinal studies have shown that the relationship between workplace aggression and the wellbeing of employees seems bidirectional those who experience aggression are more likely to report occupational stress and those who report occupational stress are at a higher risk of workplace aggression 11 12 Patient aggression toward nurses has been documented in several empirical studies e g 13 16 Staff members working in mental health settings are at a higher risk of being assaulted by patients 2 17 For example a systematic review 2 showed that the rate of physical violence varied considerably across settings the highest being in psychiatry 55 The risk for aggression may be greater among inpatients persons with substance abuse disorder 18 and those who have severe mental disorders 19 20 A study conducted on a self selected sample of psychiatric wards in the Veneto Region of Italy 21 found that nearly two thirds 66 4 N 2017 of the staff who worked in psychiatry had a high level of job distress and nearly one fth 19 6 N 281 suffered from severe burnout Working in psychiatry also includes greater odds for diagnosed depression antidepressant medication use and sick leave due to depression and mental disorders 22 On the other hand staff working in emergency care units are at an elevated risk of experiencing physical aggression although the risk is lower than for staff working in psychiatric settings 2 17 The risk of experiencing physical aggression is signi cantly lower in medical and surgical specialties 17 To prevent a serious shortage of nurses in the coming years 23 and nurses leaving the eld because of increased stress as a result of patient aggression 4 8 more knowledge about the association between patient aggression and nurses wellbeing is needed As the data presented in this article is part of a larger data set see e g 24 25 we report the results of the survey of a representative sample for