Navigating Aggression in Neurological Care The Lived Experiences of Professional Healthcare Staff and Racialised Non-Qualified Carers

Systematic Literature Review: Aggression in healthcare settings contributes to staff burnout, emotional exhaustion, and job dissatisfaction. This review synthesises qualitative literature on professional workers’ experiences with aggression in neurological care. A systematic search of databases identified eleven relevant studies. A thematic synthesis revealed three key themes: 1) ‘The Emotional Impact of Care’ (subthemes: ‘Staff Impacted by Care they are (un)able to Provide’ and ‘Consequences of Burnout’); 2) ‘A Small Cog in a Large Institutional Machine’ (subthemes: ‘Organisational/ Systemic Pressures Impacting Care’, ‘Facing Pressures to Cope in their Roles: Emotional Suppression and the Normalisation of Aggression’, and ‘Power Structures, Feeling Powerless, and Struggles with Reporting’); and 3) ‘What Aggression Means to Staff’ (subthemes: ‘Understanding Aggression’ and ‘Addressing Aggression’). The review reveals that neurological care staff experience significant moral injury and emotional distress, compounded by inadequate support, power imbalances, and unrealistic expectations. Findings suggest a need for revised organisational practices, including better support systems and policies, to enhance staff wellbeing and patient safety. Future research could explore and deconstruct staff burnout and their valid reactions in the context of unsupportive workplaces.

Empirical Study: This study explores the experiences of racialised non-qualified carers facing aggression in inpatient neurological care settings. Seven racialised non-qualified carers from UK minority groups were purposively sampled and their experiences analysed through Interpretative Phenomenological Analysis (IPA). Three key themes emerged: 1) ‘Aggression is all around us in different forms’ (subthemes: ‘understanding and conceptualising aggression’ and ‘coping and managing’); 2) ‘Navigating Racial Dynamics: The Impact of Exclusion and How We Cope’ (subthemes: ‘racism comes from staff too’, ‘racialised staff are misunderstood and mistreated’, and ‘solidarity amongst the racialised’); and 3) ‘I don’t feel I have the power to do anything about it’ (subthemes: ‘risks of coming forward about racism in a culture of unsafety’ and ‘power and hierarchy’). The findings highlight the need for systemic changes to protect racialised staff from psychological harm and improve support structures in clinical settings. Future research should investigate these issues across different researcher and conceptual contexts and could further explore the role of religion and spirituality as protective factors on racialised carers’ coping.