Reducing and Managing Aggressive Patient Behavior: The Effects of Training

General BVC SOAS-R 7 march 2022

As healthcare providers know, misunderstandings and problems with upset patients can sometimes escalate into aggression or even violence. This article reveals how training in the management of aggressive behavior can help staff deal with this surprisingly widespread problem. We also provide an overview of employers' responsibilities under the US Healthcare Violence Prevention Act.

Understanding the problem

A recent Jordanian survey of approximately one hundred nurses showed that they benefited from courses in how best to handle verbal and physical aggression from in-patients and visitors. Of these incidents in hospitals and mental healthcare environments, just under two-thirds (64 percent) comprised verbal abuse. The remainder involved physical threats, mostly during day shifts (40 percent) and when delivering nursing treatment or care (32 percent). Nurses subjected to such abuse turned mainly to their workplace team (89 percent) to deal with the aftermath. When legal support became necessary, it came from their management around half the time (49 percent). In particular, investigators found clear advantages in nurses receiving specialist training courses in the de-escalation of crises (more on this below).

Evaluating and predicting incidents

Within hospitals, two complementary and easy-to-use assessment instruments lend themselves to predicting episodes of aggression and analyzing why they occur. Specifically, the Broset Violence Checklist (BVC) and the Staff Observation Aggression Scale - Revised (SOAS-R) workplace questionnaires pinpoint risk and analyze incidents. Proven as the best methods available to predict violence around the clock, the BVC highlights indices of irritability and agitation. In contrast, the SOAS-R checklist facilitates the documentation of aggressive behaviors and escalated problems. When used together on a unit, the feedback loop means that ward management can help teams to understand in-patient aggression and keep it under control.

Dealing with difficulties

Management of aggressive behavior training courses teach nurses how to respond safely and effectively in difficult situations. During the latest CPD courses, participants typically learn how to:

  • Recognize the causes of incidents.
  • Deal with typical factors that aggravate minor issues.
  • Respond respectfully to patients' needs, when possible.
  • Set clear behavioral limits.
  • Decide which intervention(s) to employ and when. 

When patients are distressed or confused, various corresponding interventions help to de-escalate matters or – preferably – prevent the position from worsening in the first place. Course sessions include relevant theory and practical demonstrations, de-escalation exercises and role-plays. In feedback, attendees have reported gaining new knowledge, extra confidence and the skills needed to manage even the most challenging clients – with fewer injuries to staff and individuals involved. One flagship program focuses on non-violent responses and developing the verbal intervention skills required to prevent minor crises from spinning out of control. In addition, the syllabus includes disengagement techniques. Where necessary, nurses in high-risk jobs also learn

safe, less restrictive holding skills using the minimum force to keep themselves, patients and others safe.

Protecting staff

In the USA, the Health Care Violence Prevention Act protects employees in these environments. Section 35 of this legislation details training responsibilities within custodial agencies, including secure healthcare facilities.



Frenzs is aware of developments and continues to monitor trends. Its global expertise in monitoring and reducing aggression makes it a leading authority in protecting staff and patients in hospitals and psychiatric wards.


General BVC SOAS-R 7 march 2022
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