OBJECTIVE: Violence by patients in psychiatric settings is frequently
associated with the quality of staff-patient interactions. Impulsivity has
been identified as a high risk factor for anger and aggression. This study
was designed to test the influence of nurses' limit-setting styles on anger
among psychiatric inpatients grouped by high or low levels of impulsivity.
METHODS: Ninety-seven patients with various diagnoses and either high or
low levels of impulsivity participated in role-play scenarios in which
nurse actors played out six limit-setting styles, ranging from belittlement
to explanations of rules to empathy linked with a presentation of an
alternative course of action. Patients' level of anger in response to the
acted scenario was assessed using the Spielberger State-Trait Anger Scale.
RESULTS: Patients' level of anger was highest in response to unempathic
limit-setting styles, moderate for explanations, and lowest for empathic
styles. Impulsive subjects were more likely to respond with anger than
nonimpulsive patients, regardless of the limit-setting style. CONCLUSIONS:
Although many current intervention programs focus on reducing patients'
anger after it occurs, the study results suggest that it may be possible to
prevent some of patients' anger by improving nurses' limit-setting