Internet-Based Training: An Effective Way to Prepare Staff in Responding to Aggressive Residents

An individualized Internet training program was recently evaluated to determine its effectiveness in teaching nurse aides in long-term care communities ways to prevent and safely respond to aggressive residents. Results indicate that such training is a viable approach toward positively influencing the reactions of nurse aides to aggressive resident behavior.

Health care workers in long-term care communities are at high risk of becoming victims of physical and verbal aggression by residents. As many as 35 to 50 percent of nurse aides reported experiencing physical injuries from resident aggression (scratches, cuts, bruises, and human bites) in the previous year. In one study, 138 nurse aides reported an average of 4.69 violent acts over a span of 80 work hours, ranging from 0–67 accounts of violent acts.

Resident aggression negatively affects both the health and well-being of residents and staff. Staff victims of resident aggression experience increased stress, anger, job dissatisfaction, decreased feelings of safety, and fear of future assault. Some studies suggest that staff may avoid residents with a history or propensity for violence, resulting in diminished quality of care for residents. Negative stereotyping of residents with mental illness exacerbates the likelihood that staff may avoid some residents, further diminishing the quality of resident care.

Due to a lack of staff training on how to appropriately react to resident aggression, psychotropic medications or restraints are commonly used to treat problematic behavior among residents. While the use of behavioral treatment methods is atypical, recent studies examining the effectiveness of Internet training programs geared toward helping nurse aides learn how to appropriately handle aggressive resident behavior has proven effective in the short term.

In the current study, researchers attempted to test the maintenance gains of an Internet training program on nurse aides’ knowledge, attitudes, self-efficacy, and behavioral intentions regarding aggressive resident behaviors. Participants were recruited and randomly assigned to treatment (n=80) and control (n=79) groups. Both groups participated in pre-test assessments. The treatment group participated in a two-phase video training series administered via Internet. Participants could access and complete each online phase of the training from their homes at any time during the time allotted. The interval of time allowed between Phase 1 and Phase 2 of the video training series was one week.

Both groups participated in post-test assessments two and six weeks after the completion of the two-phase training program. Results indicated that nurse aides receiving Internet training experienced significantly higher gains in knowledge acquisition, self-efficacy, positive attitudes toward resident actions, and empathy toward residents. This significant difference between groups at the immediate conclusion of the study were maintained overall at the two-month follow-up. However, the positive gains in empathy for residents experienced among the treatment group were slightly diminished at the two-month follow-up. While barriers exist for effectively executing Internet training for long-term care staff, this study largely demonstrates the potential of internet-based training as an effective alternative to in-service instruction for aggressive resident behaviors.


Irvine AB, Billow MB, et al. Internet training to respond to aggressive resident behaviors. The Gerontologist; (2011). 52:13-23.

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