Research Article: Prevalence of workplace violent episodes experienced by nurses in acute psychiatric settings

Date Published: January 24, 2019

Publisher: Public Library of Science

Author(s): Shu-Fen Niu, Shu-Fen Kuo, Hsiu-Ting Tsai, Ching-Chiu Kao, Victoria Traynor, Kuei-Ru Chou, Michelle Tye.


Nurses who experience workplace violence exhibit compromised care quality and decreased work morale, which may increase their turnover rate. This study explored prevalence of workplace violence, the reaction of victims, and workplace strategies adopted to prevent violence among acute psychiatric settings in northern Taiwan. A cross-sectional study was conducted, which consisted of 429 nurses who completed the Chinese version of the Workplace Violence Survey Questionnaire developed by the International Labor Office, International Council of Nurses, World Health Organization, and Public Services International. The rates of physical and psychological violence were 55.7% and 82.1%, respectively. Most perpetrator of the workplace violence were patients. Most victims responded by instructing the perpetrator to stop, followed by narrating the incident to friends, family, and colleagues. Only 4.9%–12% of the victims completed an incident or accident form, and the main reason for not reporting these violent incidents was the belief that reporting such incidents was useless or unimportant. The major strategies adopted by workplaces to prevent violence were security measures, patient protocols, and training. Institutions should train staff to handle violence, provide a therapeutic environment, simplify the reporting process, and encourage reporting of all types of violence.

Partial Text

Nurses who working in psychiatry environments have a 20 times higher rate of physical violence than working in public health unit [1]. Psychiatric nurses experience all types of patient aggression at higher rates than do medical-surgical nurses [2], with an average of 0.55 violent incidents per bed per month in acute psychiatric settings [3]. In mental health facilities, 83% of nurses reported experiencing at least one form of workplace violence in the preceding 12 months, and approximately 33% and 54% of the victims reported resulting moderate psychological distress and severe psychological distress, respectively [4]. Nursing staff experiencing violence in the workplace has become a workplace safety concern to which health institutions worldwide attach considerable importance. Violence is a critical factor that affects the workplace safety of nursing staff. Therefore, recognizing workplace violence is a pressing occupational concern, particularly for psychiatric nurses.

In total, 480 questionnaires were distributed, and 429 valid samples were collected (a response rate of 89.4%).

This study determined that the 12-month prevalence of violence experiences was 88.3%, which is similar to that determined by a study on mental health service employees in Australia (83% of whom were exposed to workplace violence) by Tonso et al. [4]. In the present study, 55.7% of the nurses had experienced physical violence, and 82.1% had experienced psychological violence. These rates are similar to those determined in an integrative study of 38 countries by Spector, Zhou, & Che [28] in which the rates of physical violence and psychological violence in psychiatric settings averaged 55% and 72.8%, respectively.

During the previous 12 months, over half of acute psychiatric nurses had experienced physical violence and four-fifths had experienced psychological violence. The majority of attackers were patients, followed by family members of patients. The main method of handling attackers was verbal warnings. For actions taken or responses of the victims, the majority “told the person to stop”, followed by “told friends/family” and “told a colleague”. Only 12% reported physically violent incidents, and only 4.9%–10.8% reported psychological violence, the primary reasons for not reporting or telling about violent incidents were “useless”, “not important”. Most institutions encourage victims to report violent incidents, but the number of reported violent incidents was considerably lower than the actual number of occurrences, institutions should be no punishing or labeling staff who report incidents, establishing a streamlined incident reporting process to increase reporting rate. The occurrence of workplace violence can affect the physical and psychological health of victims. We recommend that institutions provide multilevel actions to reduce workplace violence and create safe working environments.




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