Education/teachers, High Risk Adolescents, Residential Care, Youth Justice

Does verbal aggression by clients predict increased use of restraint/seclusion by staff?

Verbal aggression by clients to staff in residential care, YJ and alternative schools is a continuing problem for Practitioners. This study looks at the specific impact of verbal aggression on mental health nurses. It investigates the following hypothesis:


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Why are nursing staff studies relevant to OoHC/YJ/alternative schools?

nurse ratchit 2
She might get angry but will she use restraint/seclusion?

In general, the quality of research in the mental health sector is superior to that from the OoHC and YJ sectors. Therefore, the findings are relevant to these contexts and may deepen practitioners’ understanding of predictive behavioural factors.

What is verbal aggression?

Verbal aggression is defined here as comments made by clients towards staff that are targeted, demeaning or of a humiliating nature.

The study

The study involved 68 male and female mental health nurses working in low-security and medium-security wards in a UK hospital.

Previous research findings

The study provides a summary of previous findings:

  • Staff anger during the management of aggressive behaviour may sensitise staff to challenging behaviour, thus lowering their tolerance to such behaviour

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  • Staff anger may then maintain staff aggression which, in turn, maintains patient aggression, leading to increased likelihood of the use of restraint or seclusion.
  • Poor psychological wellbeing in nursing staff, measured in the seven days prior to an incident occurring, was a predictor of patient aggression.
  • Positive attitudes among nursing staff towards patients were associated with the approval of less restrictive containment methods
  • Clients feel that restraint/seclusion is more punitive when performed by staff who are angry.

Key findings

The study found that greater exposure to verbal aggression was related to increased staff anger; however, whilst the subsequent increase in anger resulted in more frequent approval to use restraint or seclusion, there was not an actual increase in their implementation.


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Moreover, genuine mild to severe physical aggression towards staff in the mental health sector does not predict increased anger by nurses.

The authors speculate that the reason staff anger does not result in increased use of restraint/seclusion is because the staff themselves recognise that they are ‘dysregulated’ and many choose not to interact with their patients until they feel better.

Implications for OoHC, YJ and alternative schools

As noted in previous posts, mental health nurses are better trained than residential care workers or youth justice workers. Can we assume that such workers would also choose not to interact with clients when they are angry?

Take-outs for Practitioners

  • Provides a good summary of the implications of anger by staff towards clients.
  • Makes an agreement to evaluate ‘propensity for anger’, to be assessed when recruiting new staff.


Jalil, R., et al. (2017). “Mental health nurses’ emotions, exposure to patient aggression, attitudes to and use of coercive measures: Cross sectional questionnaire survey.” International Journal of Nursing Studies 75: 130-138.








About graemembaird

I am a psychologist with a special interest in improving the outcomes of families, children and young people in the Out of Home Care and Juvenile Justice systems.
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