Introduction Materials and Methods Design and Data Collection Measures Statistical Analysis Results Description of the Demographic Information Patient Aggression in Psychiatric and Non-Psychiatric Settings The Wellbeing of Nurses Comparison of Associations between Patient Aggression and the Wellbeing of Nurses Working in Psychiatric and Non-Psychiatric Settings Discussion ConclusionsInternational Journal ofEnvironmental Researchand Public HealthArticlePatient Aggression and the Wellbeing of Nurses:A Cross-Sectional Survey Study in Psychiatricand Non-Psychiatric SettingsVirve Pekurinen1ID, Laura Willman1, Marianna Virtanen2, Mika Kivimäki2,3,4,Jussi Vahtera5,6and Maritta Välimäki1,6,7,*1Department of Nursing Science, University of Turku, 20520 Turku, Finland; [email protected] (V.P.);[email protected] (L.W.)2Finnish Institute of Occupational Health, 00250 Helsinki, Finland; [email protected] (M.V.);[email protected] (M.K.)3Department of Epidemiology and Public Health, University College London, London WC1E 7HB, UK4Clinicum, Faculty of Medicine, University of Helsinki, 00290 Helsinki, Finland5Department of Public Health, University of Turku, 20520 Turku, Finland; [email protected] University Hospital, 20521 Turku, Finland7School of Nursing, Hong Kong Polytechnic University, Hong Kong, China* Correspondence: [email protected]; Tel.: +358-406890546Received: 4 September 2017; Accepted: 14 October 2017; Published: 18 October 2017Abstract:Wellbeing of nurses is associated with patient aggression. Little is known about the differencesin these associations between nurses working in different specialties. We aimed to estimate and comparethe prevalence of patient aggression and the associations between patient aggression and the wellbeingof 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 emergencynurses) participated in the study. Subjective measures were used to assess both the occurrence ofpatient aggression and the wellbeing of nurses (self-rated health, sleep disturbances, psychologicaldistress and perceived work ability). Binary logistic regression with interaction terms was used tocompare the associations between patient aggression and the wellbeing of nurses. Psychiatric nursesreported all types of patient aggression more frequently than medical and surgical nurses, whereasnurses working in emergency settings reported physical violence and verbal aggression more frequentlythan psychiatric nurses. Psychiatric nurses reported poor self-rated health and reduced work abilitymore frequently than both of the non-psychiatric nursing groups, whereas medical and surgicalnurses reported psychological distress and sleep disturbances more often. Psychiatric nurses whohad experienced at least one type of patient aggression or mental abuse in the previous year, were lesslikely to suffer from psychological distress and sleep disturbances compared to medical and surgicalnurses. Psychiatric nurses who had experienced physical assaults and armed threats were less likelyto suffer from sleep disturbances compared to nurses working in emergency settings. Compared tomedical and surgical nurses, psychiatric nurses face patient aggression more often, but certain types ofaggression are more common in emergency settings. Psychiatric nurses have worse subjective healthand work ability than both of the non-psychiatric nursing groups, while their psychiatric wellbeing isbetter and they have less sleep problems compared to medical and surgical nurses. Psychiatric nursesmaintain better psychiatric wellbeing and experience fewer sleep problems than non-psychiatric nursesafter events of exposure to patient aggression. This suggest that more attention should be given tonon-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 aggressionInt. J. Environ. Res. Public Health 2017, 14, 1245; doi:10.3390/ijerph14101245 www.mdpi.com/journal/ijerphInt. J. Environ. Res. Public Health 2017, 14, 1245 2 of 141. IntroductionPatient aggression toward health professionals is a serious global concern [1,2]. Health professionalstaking care of persons with mental disturbances are often exposed to patient aggression [2]. Aggressioncan be defined as a range of behaviors or actions that has the potential to harm, hurt or injureanother person, either physically or verbally, regardless of whether or not harm is actually sustainedor the intention is clear [3]. Patient aggression in these settings is associated with healthcareworkers’ wellbeing [4–6]. Being the target of patient aggression has been found to be associated withanxiety, fear, guilt, sleep disturbances [7], burnout [8,9], poor self-rated health [10] or dissatisfactiontoward work [4]. Furthermore, longitudinal studies have shown that the relationship betweenworkplace aggression and the wellbeing of employees seems bidirectional; those who experienceaggression are more likely to report occupational stress, and those who report occupational stress areat 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 considerablyacross settings, the highest being in psychiatry (55%). The risk for aggression may be greateramong inpatients, persons with substance abuse disorder [18] and those who have severe mentaldisorders[19,20]. A study conducted on a self-selected sample of psychiatric wards in the VenetoRegion of Italy [21] found that nearly two-thirds (66.4%, N = 2017) of the staff who worked in psychiatryhad a high level of job distress, and nearly one-fifth (19.6%, N = 281) suffered from severe burnout.Working in psychiatry also includes greater odds for diagnosed depression, antidepressant medicationuse and sick leave due to depression and mental disorders [22]. On the other hand, staff working inemergency care units are at an elevated risk of experiencing physical aggression, although the risk islower than for staff working in psychiatric