Between Boundaries and Care – How to Prevent Aggression in Hospitals? "There are Certain Symptoms Everyone Can Look Out for"

A conversation with Dr. Anna Kieszkowska-Grudny, president of Minds of Hope | Stress-Free Institute, shows that effectively counteracting aggression is not just a matter of procedures, but above all, mindfulness, empathy, and understanding the sources of human emotions. In hospital psychiatric wards, boundaries are clearly defined. "For example, we don't smoke on the ward," says psychologist, neuropsychologist, and psychotherapist Anna Kieszkowska-Grudny. "Patients, of course, sometimes try to smuggle things in, but that's a boundary we don't cross. However, simply setting a boundary isn't enough. How we enforce it—with empathy, calm, and mindfulness—is crucial."

When a patient breaks the rules, the staff's response can't be merely rigid and punitive. "There's a greater chance the patient will react differently when the staff modifies their behavior," explains Dr. Kieszkowska-Grudny. "My request to the patient should be expressed with care and empathy. This is also what we teach healthcare workers in various training courses and classes conducted by Minds of Hope | Stress-Free Institute – so they can recognize the sources of the patient's emotions, their "flash points," and at the same time, be aware of their own automatic reactions to difficult situations."

Understanding a patient's emotional mechanisms is not only a key element of effective therapy—it's also a way to avoid conflict escalation. This, as the specialist emphasizes, directly translates into fewer instances of direct coercion.

The most advanced approaches in this field are currently being implemented in closed psychiatric wards. In these settings, it's easier to achieve consistent communication and exchange experiences within the team. "If I notice during my shift that a patient is reacting in a certain way, for example, to specific words or gestures, I can share this with my colleagues during the morning report," says Dr. Kieszkowska-Grudny. "This allows the entire team to be more aware, prepared, and better able to prevent conflicts."

It's precisely this environment, where the team is cohesive and the exchange of information is fluid and conscious, that becomes a safer space for both patients and staff. That's why coordinated care is so important—especially, though not exclusively, in psychiatry. Dr. Kieszkowska-Grudny has been developing this for years as an expert at the Ministry of Development and Technology within the National Smart Specializations program and in practice at her center, Minds of Hope | Stress-Free Institute. Team meetings, not only with psychiatrists and psychologists but also with other specialists (e.g., mindfulness teachers, somnologists, physiotherapists, dietitians, neuropsychologists, and physicians with other specialties—neurology, endocrinology, pulmonology, etc.), allow for a better understanding of the nature of patients' problems and how they function, which in turn allows for the development of a more tailored, comprehensive, and personalized treatment plan.

But is recognizing signals of aggression a competence reserved only for specialists?

The most noticeable changes are in body posture: stiffness, muscle tension, frozen body.

But warning signals can also be more subtle: intense or, conversely, suddenly broken eye contact, nervous movement, inability to sit still, stomping, rocking.

Both in the hospital and in everyday life, the key is not so much "controlling" aggression, but understanding where it comes from. Attentiveness to others, awareness of one's own reactions, and a willingness to talk are the foundations of psychological safety—and one of the most important pillars of modern psychiatric care.