Resistance to care, workplace injury and effects on the nursing workforce in NSW: study report

Resistance to care behaviour can range from an expression of minor irritation at one extreme, to non-compliance and ultimately to aggression and violence at the other extreme. “This resistance…is caused by the patient’s belief (often delusional) that the care does not have to be provided or just not understanding the motivation and actions of the caregiver. Therefore, the patient defends himself or herself against the caregiver and, if the caregiver persists in efforts to provide unwanted care, the patient may become combative or strike out”. Non-compliance or resistiveness has been reported to precede “aggressive behaviour in 32% of instances, suggesting a continuum of behaviours that needs investigation”. Consequently, there is a risk of injury to health care workers who are dealing with patients who are resistant to care. Most studies about resistance to care have been conducted on patient populations with dementia (including Alzheimers). Segatore and Adams report that there are a range of possible aetiologies of agitation in dementia (including new resistance to care): acute or exacerbated medical or surgical illness (eg dehydration, infection, head injury) and overlying delirium, pain, abstinence syndrome/acute withdrawal (BZD, caffeine, ethanol, nicotine), drug interactions (adverse, idiosyncratic or side effect), environmental precipitants, psychosocial precipitants, neuropsychiatric syndrome and idiopathic. This suggests that resistance to care behaviours may not be confined to patients suffering dementia in aged care facilities and that nurses may be exposed to resistance to care episodes and the associated risks in a variety of clinical settings. This study extended the context and focus to other clinical environments and diagnoses where resistance to care (RTC) episodes may also occur, and is the first study that focuses specifically on the effect of RTC episodes on nurses. This cross sectional study of NSW nurses utilising a postal questionnaire has included participants from five specialty areas of practice: emergency department, mental health (including drug and alcohol), aged care and medical and surgical nursing. Approximately 1,000 nurses from each specialty area of practice were invited to participate in the study and this resulted in a response rate of 23.3%. The response rate to the survey was relatively low and consequently the results may not be representative of the nursing population sampled or generalisable to other populations of nurses. The low response rate had the potential to affect the achievement of the study objectives; however, there was sufficient power to detect significant differences in nurse reported incidence of RTC between clinical areas of interest