Transgressive Behaviour in Care Relationships: Perspectives of Nurses Working in a General Hospital

Patient aggression toward healthcare providers occurs frequently. Nurses in particular are at risk of encountering aggressive or transgressive behaviour due to the nature, duration, and intensity of relationships with patients. The frequency and form of aggression and transgressive behaviour are particularly explored in geriatric, emergency and psychiatric settings. Few considered general hospital wards. This study analysed nurse perspectives with regard to the onset and meaning of transgressive patient behaviour in a general hospital setting. The multicenter study encompassed small-scale exploratory incidence registration and qualitative research using constant comparison as proposed by grounded theory. Data were gathered through individual interviews with 18 nurses who were selected using purposive and theoretical sampling. Findings revealed that various nurse-patient interactions can result in perceptions of transgressive behaviour, depending on the interplay of determining and regulating factors which have been identified at the patient, nurse, and ward level. Experiences of transgressive behaviour are influenced by the degree of control nurses experience over the provision of care; the degree of patient acceptance of organisational and ward rules, the degree of gratitude and recognition expressed by the patient, and the extent of patient regard for the nurse as a person. Factors affecting transgressive experiences were a trusting relationship between patient and nurse; the extent to which patient perspectives are understood; methods of managing transgressive behaviour; and the influence of the team, head nurse, and ward culture and habits. The results of this study can support the development of nurses’ coping ability and self-confidence to mitigate or prevent experiences of transgressive behaviour.status: publishe