Registered Nurses' Association of Ontario

Nursing Best Practice Guidelines

Checklist of Risk Factors for Aggressive Behaviour (OSACH, 2006)

Client Factors

  • Language or cultural barriers
  • Diagnosis (psychogeriatric illness, mental illness, medical condition)
  • Poverty
  • Fear
  • Loss of control
  • Loneliness
  • Frustration
  • Boredom
  • Effects of medications or lack of medication
  • Anniversary of a significant event
  • Losses (friends, family, no support system)
  • Lack of information
  • Time of day or week (“sundown syndrome”)
  • Task too complicated
  • Physiological needs (fatigue, hunger, need to void)
  • Reaction to race and sex of caregiver


Caregiver Factors

  • Unpredictable work load
  • Lack of training
  • Time of day (mealtime)
  • Day of week
  • Working alone, especially at nigh
  • Geographic isolation (difficulty in getting help quickly)
  • Stress
  • Lack of Staff (clients have to wait for care or attention)
  • Worker unaware of client’s history of abusive behaviour
  • Worker unfamiliar with client (staff rotation or change of staff)
  • Uniform, appearance, religious jewellery
  • Infringement on personal space
  • Need to physically touch to provide care
  • Body language
  • Inconsistent handling
  • Hurried approach
  • Level of authority
  • Regimented client care schedule


Environmental or Ergonomic Factors

  • Colour (cool colours are calming)
  • Too much noise
  • Lighting (too much glare on the floors or a lack of visual contrast may confuse cognitively impaired clients); too little light (for example, dark parking lots in isolated areas, underground, not supervised)
  • Lack of space and privacy
  • Lack of, or improper, communication systems
  • Temperature (too hot, too cold)