The influence of team members on nurses' perceptions of transgressive behaviour in care relationships: A qualitative study.

Abstract

The aim of this study was to gain insight into the influence of team members in how nurses perceive and address patients' transgressive behaviour. Aggression and transgressive behaviour in health care have been a focus of research over the past few decades. Most studies have focused on individual nurses' experiences with aggression and transgressive behaviour. Literature examining group dynamics in nursing teams and team members' interactions in handling patients' transgressive behaviour is scarce. Qualitative interview study. Seven focus-group interviews and two individual interviews were carried out in 2014-2016. Twenty-four nurses were drawn from eight wards in three general hospitals. Interviews were analysed using the constant comparative method influenced by the grounded theory approach. While elaborating how they perceived and addressed transgressive behaviour, nurses disclosed how interactions with team members occurred. Several patterns arose. Nurses talk to one another, excuse one another, fill in for one another, warn one another and protect and safeguard one another. In these patterns in reaction to patients' transgressive behaviour, implicit group norms transpire, causing nursing teams to acquire their specific identity "as a group". Consequently, these informal group norms in nursing teams impinge how nurses feel threatened by patients' potential transgressive behaviour; gain protection from the group of nurses and conform to informal ward rules. The findings of this study can support intervention strategies aimed at supporting nurses and nursing teams in managing patient aggression and transgressive behaviour by identifying and explicating these group dynamics and team members' interactions.