Reducing Violence by Patients against Healthcare Workers at Inpatient Psychiatric Hospitals: An Integrative Review

Violence by patients against healthcare workers is of global concern among both producers and consumers of health care. The US is among the countries with the highest reports of workplace violence, and the majority of the violent incidents occur in healthcare settings. The purpose of this integrative review is to identify, analyze and appraise the best interventions for reducing violence by patients against healthcare workers in adult acute psychiatric hospitals. Additionally, findings from the review inform our recommendations designed to contribute to violence reduction in these settings. We explored the PsycINFO, PubMed, CINAHL and Cochrane Library databases and launched an integrative review using the Johns Hopkins Nursing Evidence-Based Practice Model as a framework and the Preferred Reporting Items for Systematic Reviews and Meta Analysis (PRISMA) guidelines. Fifteen records were included in this review using specific inclusion and exclusion criteria. Four themes were identified from the review as providing evidence-based interventions to reduce and mitigate violence against healthcare providers in acute psychiatric hospitals. These were staff attributes, patient characteristics, environmental factors, and staff-patient relationships. These factors interact in a dynamic and complex manner in optimizing the nurse-patient relationship to decrease violence by patients against healthcare workers in inpatient psychiatric settings. The implications of this review are that a multifactorial approach is needed in devising effective strategies to reduce violence in psychiatric settings. The strategies should involve all stakeholders including providers, administrators, and patients.