Resident-to-resident aggression in long-term care facilities: insights from focus groups of nursing home residents and staff.

OBJECTIVES: To more fully characterize the spectrum of resident-to-resident aggression (RRA).
DESIGN: A focus group study of nursing home staff members and residents who could reliably self-report.
SETTING: A large, urban, long-term care facility. PARTICIPANTS: Seven residents and 96 staff members from multiple clinical and nonclinical occupational groups. MEASUREMENTS: Sixteen focus groups were conducted. Content was analyzed using nVivo 7 software for qualitative data.
RESULTS: Thirty-five different types of physical, verbal, and sexual RRA were described, with screaming or yelling being the most common. Calling out and making noise were the most frequent of 29 antecedents identified as instigating episodes of RRA. RRA was most frequent in dining and residents' rooms, and in the afternoon, although it occurred regularly throughout the facility at all times. Although no proven strategies exist to manage RRA, staff described 25 self-initiated techniques to address the problem.
CONCLUSION: RRA is a ubiquitous phenomenon in nursing home settings, with important consequences for affected individuals and facilities. Further epidemiological research is necessary to more fully describe the phenomenon and identify risk factors and preventative strategies.