Reducing aggression in the haemodialysis unit by improving the dialysis experience for patients

Document Type


Publication details

Burns, T & Smyth, A 2011, 'Reducing aggression in the haemodialysis unit by improving the dialysis experience for patients', Renal Society of Australasia Journal, vol. 7, no. 2, pp. 79-89.

Peer Reviewed



The haemodialysis nurses at St Georges Hospital chose to address the problem of aggression in the dialysis unit as their 'Models of Care' project. Aggression had been a long-standing problem in the dialysis unit and the nurses perceived that the amount of aggression had increased by felt powerless and unsupported to address this.

Method: Baseline data was collected using: Incident Information Management System (IIMS) data, that is, the online system used by the hospital to report any type of incident; the Aggression Grading Record of Observation (AGRO) score data; process mapping; patient satisfaction surveys; and staff satisfaction surveys. Two simple strategies of standardised communication were implemented for three months: an illustrated flyer outlining realistic waiting times and a system of nurse to patient allocation. After three months the number of aggressive incidents was remeasured and compared with the baseline.

Results: The baseline incidence of aggressive episodes recorded using the AGRO score was found to be between 2% and 8% of all treatments. Common reasons for aggression included: waiting times (52%), mental health issues (17%), environmental issues (11%) and treatment conflicts (11%). After implementing the strategies for three months, data was collected again. The incidence of aggression dropped to less than 2% for the first two weeks and to less than 1% for the last two weeks of data collection.

Conclusion: Through the use of effective, standardised communication it is possible to reduce the incidence of aggressive episodes to <1% of dialysis treatments.

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