Violence in psychiatric inpatient care spikes in the afternoon

Severe workplace violence in forensic psychiatric inpatient care is concentrated in specific everyday situations, ward areas and at certain times of day, according to a study published in Journal of Psychiatric and Mental Health Nursing. The work is based on data collected by the Department of Nursing Science at the University of Eastern Finland.

The researchers analysed 956 workplace violence incident reports filed by nursing staff in a Finnish forensic psychiatric hospital between 2020 and 2024. The study examined, among other things, the timing and location of workplace violence incidents, the ward in which they occurred, as well as their association with patients’ everyday activities.

According to the study, workplace violence incidents were associated with busy daytime and afternoon periods on the ward, outdoor activities, specific ward areas and differences between wards. Severe incidents were reported proportionally more often in patient rooms, seclusion rooms, outdoor areas and day rooms, for example.

‘The findings suggest that, in addition to patient-related factors, the severity of workplace violence is also associated with everyday ward routines, situations and environmental factors. The risk of workplace violence is linked to the situation at hand and to how quickly nursing staff can receive support if the situation escalates,’ says Matias Karvonen, a doctoral researcher at the Department of Nursing Science at the University of Eastern Finland.

In particular, patients’ outdoor activities emerged as an everyday situation associated with elevated risk. In incidents related to outdoor activities, the violence often involved physical aggression, such as hitting, kicking, biting or spitting.

‘Outdoor activities should not be seen as a problem per se, as they play an important role in patients’ well-being and rehabilitation,’ Karvonen says. Instead, the findings highlight the importance of preparing carefully for outdoor activities: the patient’s current state should be assessed, adequate staffing should be ensured and clear procedures should be agreed in advance.’

According to the study, efforts to prevent workplace violence should focus particularly on recurring high-risk situations. For example, busy afternoon periods on wards, patient rooms, seclusion rooms, day rooms and outdoor activities may require more careful advance planning than usual, targeted allocation of staff resources and consideration of environmental factors that affect safety.

‘Efforts to prevent workplace violence can be improved by making systematic use of information drawn from incident reports, as they help identify the everyday situations in which the risk of workplace violence increases and where preventive measures should be focused,’ Karvonen said.

Since the study was based on voluntary incident reports from a single hospital, the findings should be interpreted as associations rather than direct causal relationships.