Implementing the Rating Scale for Aggressive Behaviours in the Elderly: Can it Make a Difference to Nursing Management of Aggressive Behaviours in Elderly Patients with Dementia?

Abstract

Aggressive behaviour is the most common clinical and nursing management problem for patients with dementia. Many elderly patients with dementia show sexual, physical, and verbal aggressive behaviours that complicate their management and make day-to-day nursing care difficult. These behaviours include yelling, hitting, swearing and verbal abuse. Despite this there is no consistent use of rating scales for assessing aggressive behaviour in this population. Nurses in the inpatient setting are often the main target for this aggression and without a rating scale the assessment of the behaviour is open to interpretation of the individual. While aggressive behaviours can be the most difficult behaviours for nursing staff to manage, these behaviours can also disrupt the milieu on inpatient psychogeriatric settings and frequently distress other patients, visiting families/whanau and friends. The Rating Scale for Aggressive Behaviours in the Elderly (RAGE) is a twenty-one item rating scale, designed specifically to measure aggressive behaviours in the elderly in the psychogeriatric inpatient setting. The purpose of the scale is to qualify the aggressive behaviour, note any changes in the behaviour, and record intervention and/or treatments. This study combines both qualitative and quantitative methods with exploratory and descriptive designs to explore nurses’ experiences of using a consistent tool for monitoring, measuring and managing aggressive behaviours. Data gathered over a three month period of implementing RAGE will provide a ‘snapshot’ of the prevalence, extent and type of aggressive behaviours within the inpatient setting, providing evidence to nurses in developing strategies for the management of aggression. Focus group interviews were used to enable nurses to discuss their experiences of utilising a clinically validated tool in their practice and how this made a difference to their practice. Findings from this research indicate that nurses within the setting found that RAGE is a consistent tool with which nurses can record, measure and monitor aggressive behaviours. Responses from nurses’ experiences of utilising RAGE in their practice were varied, with some being unable to articulate how RAGE had made a difference to their practice. Despite this there was an overwhelming positive response for the continued use of RAGE within the setting as a clinically validated tool by which to measure, record and manage aggressive behaviours.