Violence and Aggression in Psychiatric Units

Cathy A Owen · Concetta Tarantello · Michael Jones · Christopher Tennant

254 citations0/0 files storedPsychiatric Services

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Workplace Violence and Bullying Psychiatric care and mental health services Healthcare Decision-Making and Restraints

Abstract

OBJECTIVE: To help predict aggressive and violent behaviors, the frequency and types of these behaviors in acute psychiatric inpatient settings were examined, and potential interactions between staffing and patient mix and rates of the behaviors were explored. METHODS: Data on violent incidents were gathered prospectively in three adult acute psychiatric units in a general hospital and two units in a primary psychiatric hospital in Sydney, Australia. Staff recorded violent and aggressive incidents, which were ranked on an 8-level scale. They also completed weekly reports of staffing levels and patient mix. Poisson regression analysis was used to calculate relative rates, 95 percent confidence intervals, and p values. RESULTS: A total of 1,289 violent incidents were recorded over a seven-month period. Based on the scale, 58 percent of the incidents were serious. Seventy-eight percent were directed toward nursing staff. Complex relationships between staffing, patient mix, and violence were found. Relative risk increased with more nursing staff (of either sex), more nonnursing staff on planned leave, more patients known to instigate violence, a greater number of disoriented patients, more patients detained compulsorily, and more use of seclusion. The relative risk decreased with more young staff (under 30 years old), more nursing staff with unplanned absenteeism, more admissions, and more patients with substance abuse or physical illness. In total these factors accounted for 62 percent of the variance in violence. CONCLUSIONS: Violent incidents in psychiatric settings are a frequent and serious problem. Incidents appear to be underreported, and the seriousness of an incident does not guarantee it will be reported.

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1989Violence by Psychiatric In-patients 1991Violence by Psychiatric Inpatients: A Review

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2000Prevalence and Precipitants of Aggression in Psychiatric Inpatient Units 2012The antecedents of violence and aggression within psychiatric in‐patient settings 2009Identifying Key Factors Associated with Aggression on Acute Inpatient Psychiatric Wards 2015Registered nurses’ experiences of patient violence on acute care psychiatric inpatient units: an interpretive descriptive study 2001Characteristics of violent behaviour in acute psychiatric in-patients: a 5-year Italian study 2011Aggression and seclusion on acute psychiatric wards: effect of short-term risk assessment 2002Prediction of inpatient violence 2001Risk Factors and Correlates of Violence Among Acutely Ill Adult Psychiatric Inpatients

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