PERoPA the nurse managers’ perspective

An international research collaboration examining patient and visitor aggression in healthcare organizations from the nurse managers' perspective.


  • Department Health Professions
  • Research focus Wirkungsorientierung und Nachhaltigkeit im Gesundheitswesen
  • Research field Psychosoziale Gesundheit, Gesundheitsförderung, Prävention
  • Funding body Netzwerk Aggressionsmanagement im Gesundheits- und Sozialwesen Austria – NAGS
    Verein Netzwerk Aggressionsmanagement im Gesundheits- und Sozialwesen Schweiz
    Sigma Theta Tau International
    Stiftung Lindenhof, Bern
    Schweizer Berufsverband der Pflegefachfrauen und Pflegefachmänner (SBK)
  • Duration (planned) 01.01.2017 - 31.12.2019
  • Project management Prof. Dr. Sabine Hahn
  • Head of project Dr. Birgit Heckemann
  • Project partners - organisations Pflegenetz

Patient and Visitor Aggression (PVA) occurs in all clinical healthcare areas. Furthermore, PVA is an international phenomenon that affects healthcare professionals across the globe, causing considerable human suffering and incurring substantial financial costs.

International studies show that workplace aggression affects staff intention to change jobs or to abandon an occupation in healthcare altogether. Moreover, aggression reduces patient safety and quality of care.

To date, little is known about how nurse managers experience and manage PVA, although the link between leadership, workplace safety, job satisfaction and quality of care has been recognised.

PERoPA aims to obtain an international overview of PVA in general and mental health hospitals, from a nurse managers' perspective. Specifically, we will collect information on how nurse leaders experience PVA, what they do about PVA and the obstacles and opportunities they encounter in their efforts to tackle PVA.

PERoPA is a sequential mixed methods project comprising two sub studies.
Sub study 1 is an interview study with nurse managers. Between October 2015 and January 2016, we conducted 15 individual interviews and five focus groups in the German-speaking part of Switzerland. The interviews were analysed during spring 2016. The results contributed to the design of a questionnaire, our data collection tool for sub study 2

Sub study 2 is an international electronic survey aimed at obtaining an overview of PVA from a nurse manager perspective. The questionnaire is purpose designed. In addition to content generated through sub study 1, it contains questions from scientifically evaluated instruments to record and measure PVA.
Between November 2016 and February 2017 we conducted the survey in the German-speaking countries Switzerland, Austria and Germany. The data collection in English-speaking countries (Canada, Great Britain and the United States of America) is currently underway.
The results of the PERoPA project will be published internationally. Moreover, they will contribute further develop a model aimed at helping nurse managers to reduce PVA in healthcare more effectively.

Switzerland, Austria and Germany

  • This research project is lead by Principal Investigator Prof Sabine Hahn, RN PhD. Sabine Hahn is the Director of the Division of Nursing and Division Head of Applied Research & Development in Nursing at Bern University of Applied Sciences, Bern, Switzerland.
  • Birgit Heckemann, RN, PhD is the study coordinator and contact person for the data collection in Switzerland, Austria and Germany. 


  • Bridget Hamilton, PhD, Senior Lecturer, Associate professor Department of Nursing, The University of Melbourne, Clinical Nurse Consultant, St. Vincent’s Mental Health, Australia
  • Marie Gerdtz, PhD, Associate Professor of Emergency Nursing, The University of Melbourne, Australia


  • Sanaz Riahi, Director, Professional Practice & Clinical Information, Ontario Shores Centre for Mental Health Sciences, Canada

Great Britain

  • Joy Duxbury, PhD, Professor of Mental Health Nursing, University of Central Lancashire, United Kingdom

The United States of America

  • Joanne DeSanto Iennaco, PhD, Associate Professor of Nursing and Psychiatric-Mental Health Nurse Practitioner Specialty Coordinator, Division of Primary Care, Yale School of Nursing, USA


First study results were presented 2017 in an oral presentation at the 10th European Congress on Violence in Clinical Psychiatry in Dublin, Ireland.

Peer reviewed publications

Heckemann, B., et al. (2017). «Nurse managers: determinants and behaviours in relation to patient and visitor aggression in general hospitals. A qualitative study.» Journal Of Advanced Nursing 73(12): 3050-3060.

Project team at BFH