Systematic review of studies of mental health nurses’ experience of anger and of its relationships with their attitudes and practice

Introduction Emotional regulation is important in mental health nursing practice but individual emotions may require different regulation strategies. There is ample evidence that nurses experience anger specifically during their work, for example when experiencing patient aggression. It is, therefore, important to consolidate what is known about how anger manifests in mental health nursing practice. Aim We aimed to systematically identify, evaluate, and synthesise results from studies about mental health nurses and anger, where anger was measured objectively. Methods Systematic literature review based on PRISMA guidelines. Results We identified 12 studies. A range of validated and non-validated instruments were used. Mental health nurses may have lower levels of anger than normative samples but anger is commonly reported as an issue for them. Anger was studied in relation to its links with i) clinical management of patients, notably violence containment; and ii) employment issues more generally, notably job motivation. Anger is related to nurses' attitudes about the acceptability of coercion but there is no evidence that it results in more coercion. Implications for practice Nurses should be aware of the potential influence of anger on their practice. Anger, specifically, should be considered when supporting mental health nurses, for example in clinical supervision. Emotional regulation training should target anger. Relevance statement There is ample evidence that anger can be an issue for mental health nurses. Further, anger can have deleterious consequences for nurses and potentially for patient care. Nurses report experiencing anger spontaneously in surveys and qualitative studies. In this review we have systematically gathered and evaluated those studies which have investigated anger in mental health nurses and its relationships with all relevant reported outcomes using defined measures. The review has clear relevance to mental health nursing practice, education, and informs future research