Beyond the patient: unravelling staff and ward dynamics in aggression in psychiatry

Aggression on closed psychiatric wards is a widespread problem: between 65 and 99% of nurses experience it at some point in their career. The dissertation Beyond the Patient by Irene Weltens shows that aggression is not simply a patient problem — it arises in the interaction between patient, nursing staff, and ward environment. Using a diary method (Experience Sampling Method), nurses reported their mood, patient contact, and ward atmosphere multiple times daily. The results show that a nurse's positive mood reduces the risk of incidents, while overcrowding and authoritative communication styles increase it. When aggression does occur on the ward, a meta-analysis of 54 studies found that haloperidol combined with promethazine is the most effective medication for acute agitation. The key conclusion: improving safety on psychiatric wards requires investment in team culture, staffing levels, and the quality of human contact.