Team efficacy and leadership in managing aggressive situations in the general hospital setting: A qualitative descriptive analysis of focus groups with ward managers

Aims and objectives: To explore the perception and issues regarding the ability of nursing teams to manage patient and visitor aggression in clinical practice, from ward managers' perspectives.

Background: Patient and visitor aggression causes substantial human suffering and financial damage in healthcare organisations. Nurse managers are key persons for developing their teams' efficacy in dealing with patient and visitor aggression. However, their perception of patient and visitor aggression in clinical practice has rarely been explored, and issues relating to team management in this context are underinvestigated.

Design: A secondary, qualitative thematic analysis of focus group interviews.

Methods: Five focus groups consisting of a total of 30 ward and deputy ward managers from five Swiss hospitals were interviewed with audio recording between December 2015-January 2016. Since the recordings were rich in additional content exceeding the primary research question, a secondary analysis was conducted to answer the questions: (1) Which factors influence team efficacy in regard to patient and visitor aggression? (2) What are the implications for nurse leadership? The Consolidated Criteria for Reporting Qualitative Research was followed in the conduct and reporting of this study.

Results: Three themes emerged from our analysis: (a) contextual factors (organisational safety culture and collaboration), (b) influences from within the team (team culture, nursing aggression and general management principles) and (c) implications for nurse leadership.

Conclusions: Managing patient and visitor aggression is a challenge for nurse managers. A team's ability to prevent, de-escalate and debrief after PVA incidents is an important leadership task in which ward managers are neither supported in nor trained for within their organisations.

Relevance to clinical practice: Nurse managers in general hospitals require more support to enable their teams to cope effectively with patient and visitor aggression. Policy and guideline implementation need to be prioritised.