How to Assess ED Nurse Attitudes Toward Patient Aggression
How can a clinical team systematically assess emergency department nurses' attitudes toward the causes and management of aggression in patients with mental illness?
Emergency department staff attitudes can shape whether aggression is approached with person-centered strategies or with containment measures. This guide applies to teams that want to identify local beliefs about what causes aggression and which management approaches staff view as acceptable or effective.
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Administer the MAVAS in the local ED setting
Use the Management of Aggression and Violence Scale to survey nursing staff about the causes and management of aggression. In the study, respondents were instructed to answer all items based on their own perceptions and experiences within their specific emergency department and hospital setting.
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Score responses using the 4-point agreement threshold
The MAVAS used in the study contains 27 items rated from 1 for strongly agree to 4 for strongly disagree. Interpret 2.5 as the cutoff for agreement, with lower scores indicating agreement with the statement.
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Interpret attitudes across the four MAVAS domains
Review results within the scale's 4-factor structure: internal factors, external factors, situational or interactional factors, and approaches to the management of aggression. In this framework, internal factors cover beliefs that aggression arises from the person, external factors cover physical or social environment influences, situational or interactional factors address immediate environmental and staff-patient interaction issues, and the management domain addresses response strategies.
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Identify domains where staff discount common contributors
Look for domain mean scores above 2.5, which indicate disagreement with the statements in that domain. In the study, mean scores for all internal, external, and situational or interactional statements were above 2.5, signaling that respondents tended not to endorse patient, environmental, or immediate interactional contributors to aggression.
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Examine item-level views on management approaches
Review specific management items rather than relying only on a total score, because attitudes may be mixed across strategies. In the study, respondents agreed that negotiation was effective, showed mixed views on de-escalation, disagreed that medications were a valuable approach for violent patients with a mean score of 3.3, and did not endorse seclusion or restraint as straightforwardly effective or overused.
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Use the findings to target staff education
Translate identified attitude gaps into focused education on causes of aggression and on the range of management options. The article concludes that the findings underscore the need for a comprehensive approach to aggression management that includes pharmacologic, restrictive, and nonphysical strategies.
Clinical Considerations
- This guide is based on a survey of 33 nurses from a single tertiary care hospital emergency department in South India, so findings may not generalize broadly.
- The study used a convenience sample and a relatively homogeneous cohort, with all respondents aged 20 to 30 years.
- The article describes attitude assessment, not a validated bedside treatment algorithm for managing an actively violent patient.
- The MAVAS total score in this sample was not correlated with age, sex, education level, clinical experience, or psychiatric experience.
Bottom Line
If an ED wants to improve aggression management, first measure staff attitudes with the MAVAS and use domain- and item-level results to identify which causes and interventions staff are not recognizing or accepting.
