The Manager’s Perspective: Perceptions of and Behaviors Toward Patient and Visitor Aggression in Hospitals (PERoPA). An international online survey
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Background: Patient and visitor aggression has a damaging influence on workflows as well as patient and staff safety in all areas of healthcare. Nurse managers are in a key position to address patient and visitor aggression. Despite their important role, little is known about nurse managers' perception of patient aggression and nursing team efficacy in dealing with aggressive behaviours.
Aims: To explore (1) whether managers' perception of patient and visitor aggression differs between countries, management levels and care settings (general hospital/mental health) and (2) perceived team-efficacy in association with social structural variables (e.g. communication), leadership characteristics, and organizational support factors (e.g. administration attitude, care environment).
Methods: A cross-sectional, international open online survey amongst nurse managers in German-speaking countries (Switzerland, Germany, Austria). The survey tool comprised 86 items relating to 13 domains. Data were collected between November 2016 and February 2017 and analysed descriptively (frequencies, cross tabulation) and in logistic regression.
Findings: 646 managers started the survey, 446 completed it. Overall, few differences between countries and management levels in the perception of patient and visitor aggression and team efficacy were observed. However, significantly more managers working in the mental health setting perceived patient and visitor aggression to be a potentially positive force.
Four factors associated with perceived team efficacy were identified. These included a supportive organisational attitude, communication and reporting of incidents, adequate care environment (e.g. sufficient lighting etc.) and working in mental health.
Conclusion: The findings highlight the importance of a positive organizational attitude towards reducing patient aggression. Nurse managers link clinical practice and organizational management and are thus in a key position to promote safer work environments by strengthening communication channels and influencing organisational attitudes. Furthermore, an exchange between nurse managers in mental health and general hospital nursing might contribute to improving team efficacy in general hospitals.