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Updated: Aug 13, 2026

The Resident-intruder Paradigm: A Standardized Test for Aggression, Violence and Social Stress
Published on: July 4, 2013
A multiregional study of nurses' beliefs and attitudes about work safety and patient assault
1University of California, Neuropsychiatric Institute and Hospital, Los Angeles 90024.
Objective:
The study attempted to increase understanding of nursing staff members' beliefs and concerns about work safety and patient assault.
Methods:
A study conducted at a university-affiliated psychiatric facility in California in the late 1980s was replicated in five other psychiatric settings. Data were collected using the Attitudes Toward Patient Physical Assault Questionnaire, containing 31 statements designed to elicit nurses' beliefs about safety concerns, staff performance, and legal issues related to assaults.
Results:
A total of 557 nursing staff members at the six sites responded to the questionnaire; 84 percent were female. The majority (76 percent) had been physically assaulted at least once, but 71 percent reported feeling safe in their work environment most of the time. Compared with female staff members, males tended to believe that assaults were to be expected, that assaulted staff have personality traits that make them vulnerable to assault, and that legal action against assaultive patients might jeopardize their jobs. Recently hired staff were more confident that their facilities did not admit unmanageable patients and that the environment was adequate to prevent assaults. Staff who had been assaulted more frequently tended to believe that assaults were to be expected.
Conclusions:
The study highlights a nationwide concern among nursing staff about safety. Ensuring a safe working environment requires better training, more adequate staffing, and a security plan to protect staff, patients, and others.
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