Survival of the Fittest, or Socially Constructed Phenomena?: Theoretical understandings of aggression and violence towards nurses

Lauretta Luck
School of Nursing and Midwifery, Family and Community Health Research Group, University of Western Sydney, Penrith NSW

Debra Jackson
Professor, Faculty of Nursing, Midwifery and Health, University of Technology, Sydney (UTS), Broadway NSW

PP: 251 - 263


Violence is an issue that is attracting increasing attention in the nursing literature. There is general agreement that nurses are exposed to unacceptable levels of violence and aggression in the workplace, and that levels of violence are increasing.

Despite this attention and awareness, however, violence does not have a standard definition, and theoretical explanations of violence are seldom considered when discussing it in relation to nursing. This paper discusses current issues associated with defining violence, and presents an overview of some of the traditional and contemporary theories of aggression and violence in relation to nursing and the health context. Conflicting issues surrounding predictors and precipitators of violence are examined. We explore the notion that violence is 'part of the job' in nursing.

In conclusion, we assert that the current discourses on aggression and violence maintain the status quo, and argue that new explanatory positions on aggression and violence towards nurses are needed.


nursing, violence, theories of violence, aggression

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Alexander C, Fraser J and Hoeth R (2004) Occupational violence in an Australian healthcare setting: Implications for managers. Journal of Healthcare Management 49(6): 377-390.

Alexander M (2001) Violence in the Emergency Department: A first hand account. Journal of Emergency Nursing 27(3): 279-285.

Arnetz JE and Arnetz BB (2000) Implementation and evaluation of a practical intervention programme for dealing with violence towards health care workers. Journal of Advanced Nursing 31(3): 668-680.

Australian Institute of Health and Welfare (2001) Labour force - nurses. Retrieved 13 April 2005

Badger F and Mullan B (2003) Aggressive and violent incidents: perceptions of training and support among staff caring for older people and people with head injury. Journal of Clinical Nursing 13(4): 526-533.

Bandura A (1973) Aggression: A social learning analysis. New Jersey, Prentice-Hall Inc.

Bandura A (1977) Social learning theory. New Jersey, Prentice-Hall Inc.

Beck RC (1978) Motivation. New Jersey, Prentice-Hall Inc.

Benjamin W (1999) Critique of violence. In MB Steger and NsLind (eds) Violence and its alternatives: An interdisciplinary reader, pp.57-69. New York, St Martin's press.

Berkowitz L (1989) Frustration-aggression hypothesis: Examination and reformulation. Psychological Bulletin 106(1): 59-73.

Book AS, Starzyk KB and Quinsey BL (2001) The relationship between testosterone and aggression: a meta-analysis. Aggression and Violent Behavior 6(6): 579-599.

Breakwell GM (1997) Coping with aggressive Behaviour. Leicester, Social Psychology European Research Institute, University of Surrey.

Burnham TC, Chapman FJ, Gray PB, McIntyre MH, Lipson SF and Ellison PT (2003) Men in committed, romantic relationships have lower testosterone. Hormones and Behavior 44(2): 119-122.

Burton JW (1997) Violence explained. Manchester, Manchester University Press.

Buss AH (1971) Aggression pays. In Singer JL (ed) The control of aggression and violence: Cognitive and physiological factors. New York, Academic Press Inc.

Buss AH (1995) Personality: Temperament, social behavior and the self. Massachusetts, Allyn and Bacon.

Calabro K, Mackey TA and Williams S (2002) Evaluation of training designed to prevent and manage patient violence. Issues in Mental Health Nursing 23(1): 3-15.

Chambers N (1998) ‘We have to put up with it - don't we' The experience of being the registered nurse on duty managing a violent incident involving an elderly patient: a phenomenological study. Journal of Advanced Nursing 27(2): 429-436.

Crilly J, Chaboyer W and Creedy D (2004) Violence towards emergency department nurses by patients. Accident and Emergency Nursing 12(2): 67-73.

Danaher G, Schirato T and Webb J (2000) Understanding Foucault. Australia, Allen & Unwin.

Deans C (2004) The effectiveness of a training program for emergency department nurses in managing violent situations. Australian Journal of Advanced Nursing 21(4): 17-22.

DeLaune SC (2004) Intervening in violence in the psychiatric setting. In CR Kneisl, HS Wilson and E Trigoboff (eds) Contemporary Psychiatric-Mental Health Nursing, pp.802-818. New Jersey, Pearson Education Inc.

Deleuze G (1988) Foucault (S Hand, Trans). London, The Athlone Press.

Diamond I and Quinby L (1988) Feminism and Foucault. Boston, Northeastern University Press.

Erickson L and Williams-Evans A (2000) Attitudes of emergency nurses regarding patient assaults. Journal of Emergency Nursing 26(3): 210-215.

Eysenck HJ (1985) Decline and fall of the Freudian empire. England, Penguin Books.

Fernandes CMB, Bouthillette F, Raboud JM, Bullock L, Moore CF, and Christenson JM et al (1999) Violence in the emergency department: A survey of health care workers. Canadian Medical Association Journal 161(10): 1245-1248.

Hegney D, Plank A and Parker V (2003) Workplace violence in nursing in Queensland, Australia: A self-reported study. International Journal of Nursing Practice 9(4): 2614-2268.

Hinsby K and Baker M (2004) Patient and nurse accounts of violent incidents in a medium secure unit. Journal of Psychiatric and Mental Health Nursing 11(3): 341-347.

Hislop E and Melby V (2003) The lived experience of violence in accident and emergency. Accident and Emergency Nursing 11(1): 5-11.

Holmes D and Gastaldo D (2002) Nursing as a means of governmentality. Journal of Advanced Nursing 38(6): 557-565.

International Council of Nurses (2001) Nurses, always there for you: United against violence. Retrieved 13 April 2005

Jackson D, Clare J and Mannix J (2002) Who would want to be a nurse? Violence in the workplace - a factor in recruitment and retention. Journal of Nursing Management 10(1): 13-20.

Jones J and Lyneham J (2001) Violence: Part of the job for Australian nurses? Australian Journal of Advanced Nursing 4(1): 10-14.

Keely BR (2002) Recognition and Prevention of Hospital Violence [Miscellaneous Article]. Dimensions of Critical Care Nursing 21(6): 236-241.

Lau JBC, Magarey J and McCutcheon H (2005) Violence in the emergency department: A literature review. Australian Emergency Nursing Journal 7(2): 27-37.

Levin PF, Hewitt BJ and Misner TS (1998) Insights of Nurses about Assault in Hospital-based Emergency Departments [Miscellaneous Article] Image the Journal of Nursing Scholarship Quarter Third 30(3): 249-254.

Liu J and Wuerker A (2004) Biosocial bases of aggressive and violent behavior - implications for nursing studies. International Journal of Nursing Studies 42(2): 119-224.

Lyneham J (2000) Violence in New South Wales emergency departments. Australian Journal of Advanced Nursing 18(2): 8-17.

Marcus-Newhall A, Pedersen WC, Carlson M and Miller N (2000) Displaced aggression is alive and well: A meta-analytic review. Journal of Personality and Social Psychology 78(4): 670-689.

Mark VH and Ervin FR (1970) Violence and the brain. United States of America, Harper and Row Inc.

Mayhew C and Chappell D (2001) Occupational violence: Types, reporting patterns, and variations between health sectores, No 139. Sydney, The University of New South Wales.

McHoul A and Grace W (1993) A Foucault Primer; Discourse, power and the subject. Melbourne, Melbourne University Press.

McPhaul KM and Lipscomb JA (2004) Workplace violence in health care: Recognized but not regulated. Online Journal of Issues in Nursing 9(3).

Mednick SA, Gabrielle WFJ and Hutchings B (1984) Genetic influences in criminal convictions: evidence from an adoption cohort. Science May 25 224(4651): 891-894.

Miller NE and Dollard J (1967) Social learning and imitation. United States of America, Yale University Press.

Moore TM, Scarpa A and Raine A (2002) A meta-analysis of serotonin metabolite 5-HIAA and antisocial behaviour. Aggressive Behavior 28(4): 299-316.

Murphy N (2004) An investigation into how community mental health nurses assess the risk of violence from their clients. Journal of Psychiatric and Mental Health Nursing 11(4): 407-413.

O'Connell B, Young J, Brooks J, Hutchings J and Lofthouse J (2000) Nurses' perceptions of the. Journal of Clinical Nursing July 9(4): 602-610.

Polit DF and Beck CT (2004) Nursing research: Principles and methods 7th edn. Philadelphia, Lippincott Williams and Wilkins.

Raine A, Park S, Lencz T, Bihrle S, LaCasse L, Widom CS et al (2001) Reduced right hemisphere activation in severely abused violent offenders during a working memory task: An fMRI study. Aggressive Behavior 27(2): 111-129.

Rippon TJ (2000) Aggression and violence in health care professions. Journal of Advanced Nursing 31(2): 452-460.

Rose M (1997) A survey of violence toward nursing staff in one large Irish accident and emergency department. Journal of Emergency Nursing 23(3): 214 -219.

Saines JC (1999) Violence and aggression in A and E: recommendations for action. Accident and Emergency Nursing 7(1): 8-12.

Schnieden V and Marren-Bell U (1995) Violence in the accident and emergency department. Accident and Emergency Nursing 3(2): 74-78.

Singer JL (1977) The psychological study of aggression. In Singer JL (ed) The control of aggression and violence, pp.1-6. New York, Academic Press Inc.

Todorov A and Bargh J (2002) Automatic sources of aggression. Aggression and Violent Behavior 7(1): 53-68.

Tolhurst H, Baker L, Murray G, Bell P, Sutton A and Dean S (2003) Rural general practitioner experience of work-related violence in Australia. Australian Journal of Rural Health 11(5): 231-236.

Wells J and Bowers L (2002) How prevalent is violence towards nurses working in general hospitals in the UK? Journal of Advanced Nursing 39(3): 230-240.

Whittington R, Shuttleworth S and Hill L (1996) Violence to staff in a general hospital setting. Journal of Advanced Nursing 24(2): 326-333.

Winstanley S and Whittington R (2002) Violence in a general hospital: comparison of assailant and other assault-related factors on accident and emergency and inpatient wards. Acta Psychiatrica Scandinavica 106(S412): 144-147.

Winstanley S and Whittington R (2004a) Aggression towards health care staff in a UK general hospital: variation among professions and departments. Journal of Clinical Nursing January 13(1): 3-10.

Winstanley S and Whittington R (2004b) Aggressive encounters between patients and general hospital staff: Staff perceptions of the context and assailants' levels of cognitive processing. Aggressive Behavior 30(6): 534-543.

Yodanis CL (2004) Gender inequality, violence against women, and fear; A cross-national test of the feminist theory of violence against women. Journal of Interpersonal Violence 19(6): 655-675.

Zuckerman M (1991) Psychobiology of personality. New York, Cambridge University Press.

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