Attitudes of Emergency Department Nurses Toward Violent Patients With Mental Illness

Background: The attitudes of clinical staff toward aggression have been shown to influence the way they manage this behavior. The purpose of this study was to examine the attitudes of nursing staff toward the causes and management of aggression in an emergency department (ED) setting of a tertiary care multispecialty hospital.

Methods: A convenience sample of 35 staff nurses was recruited from the emergency department of a tertiary care hospital in South India. Participants completed the Management of Aggression and Violence Scale (MAVAS), which assessed attitudes toward the causes and management of aggression in psychiatric settings. The study was conducted between August 2017 and December 2017.

Results: A total of 35 clinical staff were invited to take part in the study, and of these, 33 completed the questionnaire. 51.5% of the respondents were male. 87.9% were BSc educated, and 57.6% had 1-3 years of experience in psychiatry. The MAVAS total score showed that 18 (54.5%) respondents had a positive attitude, and the rest of the respondents had a neutral attitude. The respondents had a tendency to disagree that factors directly related to the patient or external and situational factors, such as the environment and other people, contributed to aggressive behaviors. They also disagreed with the statement that patients from certain cultural groups were prone to these behaviors. Respondents had mixed views regarding the prevention and management of aggressive behavior. There was agreement that negotiation and de-escalation could be used more effectively and that seclusion and physical restraint sometimes may be required and should not be discontinued.

Conclusions: Aggression in ED units of multispecialty hospitals occurs occasionally and is problematic. Attitudes of staff nurses toward the causes and management of aggression can affect the way staff manage this behavior. Hence, educational and training initiatives are needed to change the complex and contradictory attitudes of the nursing staff toward aggression for better management of this challenging clinical situation.

Prim Care Companion CNS Disord 2026;28(2):25m04081.

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