University of Hertfordshire

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Aggression on haemodialysis units: a mixed method study

Research output: Contribution to journalArticlepeer-review


  • Julia Jones
  • Henk Nijman
  • Jamie Ross
  • Neil Ashman
  • Patrick Callaghan
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Original languageEnglish
Pages (from-to)180-93
Number of pages14
JournalJournal of Renal Care
Early online date16 Jul 2014
Publication statusPublished - 15 Aug 2014


BACKGROUND: Aggression on haemodialysis units is a growing problem internationally that has received little research attention to date. Aggressive behaviour by patients or their relatives can compromise the safety and well-being of staff and other patients sharing a haemodialysis session.

OBJECTIVES: The objectives of the study were twofold: First, to identify the prevalance and nature of aggression on haemodialysis units; and second, to investigate factors that contribute to aggressive behaviour on haemodialysis units.

DESIGN AND METHODS: A cross-sectional, sequential mixed method research design was adopted, with two research methods utilised. Incidents of aggressive behaviour were recorded over a 12-month period, using a renal version of the Staff Observation Aggression Scale. Six months after the incident data collection had commenced, semi-structured qualitative interviews were conducted with 29 multidisciplinary members of staff.

RESULTS: Over 12 months, 74 aggressive incidents were recorded. The majority of incidents involved verbal aggression, and the perpetrators were a minority of patients, relatives and staff. Two patients were responsible for 38% of all incidents; both patients had mental health problems. Distinct temporal patterns to the aggressive behaviour were observed according to the day of the week and time of day.

CONCLUSION: This study demonstrates that aggression is a significant problem on haemodialysis units, with verbal aggression most prevalent. The temporal patterns to aggression observed are related to the uniqueness of the haemodialysis setting, with a distinctly different treatment environment compared with other healthcare settings.


This is the peer reviewed version of the following article: Julia Jones, Henk Nijman, Jamie Ross, Neil Ashman, and Patrick Callaghan, ‘AGGRESSION ON HAEMODIALYSIS UNITS: A MIXED METHOD STUDY’, Journal of Renal Care, Vol. 40 (3): 180-193, September 2014, which has been published in final form at . This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Self-Archiving.

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