Making sense of incidents of violence and aggression: A constructivist grounded theory analysis of inpatient mental health nursing staff’s experiences

Introduction: While previous research explored nursing staff’s perceptions of violence and aggression thematically, there was a gap identified for in-depth analysis of the social processes and narratives which inform such perceptions.

Aims: To explore the social processes underpinning narratives used to conceptualise violence and aggression. To identify which narratives support or threaten staff in constructing a positive professional identity.

Method: Eight semi-structured interviews were completed with nursing and support staff who had worked, or currently worked in adult mental health inpatient contexts in the national health service of the United Kingdom. Analysis was conducted applying principles of constructivist grounded theory.

Results: A model, ‘the impact of narratives of violence and aggression on professional identity construction’ was generated. This integrated four key theoretical codes: 1) constructing a positive nursing identity; 2) constructing the (un)deserving patient; 3) professional identity threats related to violence and aggression; and 4) mediating factors and support following violence and aggression. The theory explored the social processes which mediated the use of different narratives; and which narratives operated as protective or threating to the construction of a positive nursing identity. The theory further identified processes of support which could mitigate detrimental emotional and behavioural responses staff may experience following incidents. Narratives that contextualised violence and aggression in relation to restrictive ward environments, threat-responses, and patients’ previous experiences of trauma seemed to support empathy and understanding.

Conclusion: Contextualising violence and aggression in terms of environment and distress in nursing teaching; staff training; and reflective practice may prove beneficial. Debriefs, supervisor support, and informal support from peers and senior team members seemed important following incidents. Mental health support may benefit staff whose emotional and behavioural responses to violence and aggression are acute, or long-lasting. Further research could support transferability and amplify underrepresented voices such as racialised staff.