New Study Looks At Workplace Violence In Forensic Psychiatry

A new study published in the Journal of Psychiatric and Mental Health Nursing looked at the contributing factors to severe workplace violence in forensic psychiatry.

“Our study examined workplace violence directed at nursing staff in forensic psychiatric inpatient care,” study author Matias Karvonen told us. “We wanted to determine whether severe incidents were associated with particular times of day, everyday ward activities, physical locations or individual wards.”

Previous research has focused extensively on patient-related risk factors for violence. The researchers were particularly interested in the situational perspective: what is happening on the ward immediately before an incident, where the incident occurs and under what circumstances it becomes severe.

“From a nursing perspective, it is not enough simply to know that violence occurs,” Karvonen told us. “We need to understand the circumstances in which the risk of severe violence is elevated so that preventive measures can be targeted more effectively. I was also interested in this topic because incident reports contain a great deal of experience-based information from frontline staff that is not always used to its full potential in research.”

The starting point for the study was that severe workplace violence cannot be explained solely by a patient’s characteristics or psychiatric condition. The research team expected the risk to increase when several factors occurred simultaneously, such as patient distress, close contact with staff, environmental constraints and limited access to immediate assistance.

For example, the researchers anticipated that severe incidents would be more common during active periods on the ward, in situations associated with outdoor activities and in locations where visibility or access to rapid assistance might be limited. They also expected differences between wards because of variations in patient populations, security levels and everyday care practices.

“Workplace violence is a recurring occupational safety concern in forensic psychiatric nursing,” Karvonen told us. “It can have long-term effects on staff members’ well-being, ability to work and sense of safety. It may also affect patient care and the therapeutic climate of the entire ward.”

The research team analyzed 956 workplace violence incident reports submitted by nursing staff at a Finnish forensic psychiatric hospital over a five-year period from 2020 to 2024. The reports included information about the time and location of the incident, the ward, the form of violence and how the situation developed.

The researchers used statistical analyses to examine whether the proportion of incidents classified as severe varied according to factors such as time of day, outdoor activities, mealtimes, medication administration, incident location and ward. 

“Because incidents associated with outdoor activities emerged as particularly noteworthy, we also conducted a qualitative analysis of the written narratives from 72 such reports,” Karvonen told us. “This allowed us to examine not only how often these incidents occurred, but also the circumstances and interactions that preceded them.”

Just over half of the analyzed incidents were classified as severe. The proportion of severe incidents was highest during daytime and afternoon hours, when wards tend to be particularly active and there are frequent interactions between patients and staff.

Approximately 65% of incidents associated with outdoor activities were severe, compared with around 51% of incidents not associated with outdoor activities. Physical violence was also particularly prominent in these situations. The incidents were often preceded by staff having to deny or limit a patient’s requests or activities, as well as by interactions between patients and staff or between patients.

The severity of incidents also varied according to their location and the ward on which they occurred. Severe incidents were particularly common in patient rooms, seclusion rooms, outdoor areas and communal day rooms. By contrast, the researchers found no statistically significant association between incident severity and the day of the week, mealtimes or medication administration.

“It was not particularly surprising that incidents were more common during active ward hours than at night,” Karvonen told us. “What was more unexpected was how clearly the proportion of severe incidents varied between wards and physical locations.”

Another striking finding was that 52% of all workplace violence incidents in the dataset were classified as severe.

“This is a substantial proportion and higher than the proportions reported in previous studies conducted in forensic psychiatric settings, although comparisons should be made cautiously because definitions and reporting practices may differ between studies,” Karvonen told us. “The prominence of incidents associated with outdoor activities was also noteworthy. Outdoor activity itself does not cause violence, but it may involve several simultaneous sources of strain, including transitions, waiting, setting limits, interactions between patients and situations in which additional assistance may not be as readily available as it is inside the ward. However, the statistical association was small, so this finding should be interpreted with appropriate caution.”

Karvonen believes the findings suggest that violence prevention should consider not only an individual patient’s risk but also the situation, physical environment and everyday organization of ward activities. 

“For example, risk assessments could be updated before outdoor activities, transitions or other potentially demanding situations,” Karvonen told us. “Staff could also assess whether sufficient personnel are available and whether assistance can be obtained quickly if a situation escalates.”

Karvonen also believes the physical environment and working practices of individual wards should also be reviewed. In patient rooms, risks may be related to limited visibility and close physical contact, whereas in communal areas, noise, crowding and interactions between several people may increase tension.

“The aim should not be to restrict patients’ activities or access to outdoor areas as a precaution,” Karvonen told us. “Rather, these activities should be organized safely and adapted to the patient’s current condition. Our findings may help services target preventive measures more precisely towards the times, places and situations in which the proportion of severe incidents is highest.”

Categories: Anxiety , Trauma , Violence | Tags: violence, workplace, psychiatry