s with his spouse or girlfriend or even family members. Co-dependents, according to Martin, Schaffer and Campbell (1999) will often challenge nursing staff in their attempts to meet patient needs. This is because they have a stake in the patient maintaining his dysfunctional relationship.
In summary then, there are several factors that give rise to aggressive behavior in surgical patients with both a psychiatric diagnosis and a substance abuse problem. These factors include the aggressive, demanding nature of the patient, his bizarre often weird, behavior, and his sense of entitlement. Additional contributors are the failure of many hospitals to focus on anything but the patient's immediate physical problem requiring surgery, the tendency of the hospital to under-treat these patients' pain, the deep sense of threat nurses often feel in interaction with these patients, and often the resistance to proper care that arises on the part of family members, girlfriends, and or spouses involved in co-
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