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antecedents include factors associated with high arousal such as pain from illness or
treatinent, anxiety, fear of negative outcomes from illness, dismhibition caused by
alcohol, prescribed and non-prescribed medicines and dmgs, reduced cognition,
brought about by post-operative confusion or dementia, interpersonal issues,
contributed to by invasion of privacy and personal space, and organisational issues
emanating from high sfress levels among patients and staff, varying skill levels of
staff and cultural and communication issues resulting from different value systems.
Secondly, nurses and patients are attempting to establish and maintain a
therapeutic relationship within a stressful environment that is often typified by the
presence of pain, tension, fear of death or disability and anxiety about loss of control.
Thirdly, nurses are perceived to be and actually are more available than other
health professionals. This puts them in a unique but difficult position as negotiators of
health care, as they are frequently attempting to forge multiple channels of
-communications between doctors and other allied health professionals and patients.
Whereas medical staff have most of the power when allocating resources to patients,
it is inevitably nurses who must put into practice medical decisions often in an
environment which has a lack of resources to fully implement prescribed Ueatments.
Other problems which indirectiy impact upon aggressive behaviour toward
nurses have been identified by Kasta (1990, in Lechky, 1994) who stated that nurses
work in a patriarchal medical model that is characterised by poor communication
between doctors and patients. Patients who are angry with the doctor are reluctant to
abuse a dominant authority figure, often male, and consequently take their fhisUation
out on the nurse who is usually female. Ruben, Wolken and Yamamoto (1980)
claimed that aggression is related to arrogance, bmsqueness and aloofness of
professional staff coupled with issues of domination, power and coercion, rather than
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