title: Violent events, ward climate and ideas for violence prevention among nurses in psychiatric wards: a focus group study.
abstract: BACKGROUND
  Patient violence against nurses in their work environments is a widespread global concern, particularly in the field of mental health care. A high prevalence of violent events impacts the well-being of nurses and may also impair overall ward climate. However, it has been proposed that nurses' use limited techniques to prevent patient violence, and, therefore, more comprehensive methods for dealing with patient violence are needed. There is still restricted understanding of the ward climate during the occurrence of a violent event as well as how these incidents could be more effectively prevented. This study aimed to explore nurses' experiences of violent events in psychiatric wards, give insight into ward climates and examine suggestions for violence prevention.
  
  
  METHODS
  This study employed a descriptive, exploratory design including focus groups (n = 5) and open-ended questions. The participants were registered and enrolled nurses (n = 22) working on three closed psychiatric in-patient wards in one Finnish hospital district. Focus groups were tape-recorded, transcribed and analyzed with inductive content analysis.
  
  
  RESULTS
  Nurses' experiences of violent events included a variety of warning signs and high-risk situations which helped them to predict forthcoming violence. Patient-instigated violent events were described as complicated situations involving both nurses and patients. When the wards were overloaded with work or emotions, or if nurses had become cynical from dealing with such events, well-being of nurses was impaired and nursing care was complicated. Suggestions for violence prevention were identified, and included, for example, more skilled interaction between nurses and patients and an increase in contact between nurses and patients on the ward.
  
  
  CONCLUSIONS
  This study revealed the complexity of violent events on psychiatric wards as well as the implications of these events on clinical practice development and training, administration and policy. A routine process is needed through which nurses' experiences and ideas concerning prevention of violent events are acknowledged.
authors.affiliation: Department of Nursing Science, University of Turku, Hoitotieteen laitos, TURUN YLIOPISTO, 20014 Turku, Finland.
authors.forename: Tella
authors.initials: T
authors.lastname: Lantta
authors.affiliation: Department of Nursing Science, University of Turku, Hoitotieteen laitos, TURUN YLIOPISTO, 20014 Turku, Finland.
authors.forename: Minna
authors.initials: M
authors.lastname: Anttila
authors.affiliation: Helsinki University and Hospital District of Helsinki and Uusimaa, Helsinki University Central Hospital, Helsinki, Finland.
authors.forename: Raija
authors.initials: R
authors.lastname: Kontio
authors.affiliation: Division of Psychiatry, Institute of Mental Health, University of Nottingham, Nottingham, UK.
authors.forename: Clive E
authors.initials: CE
authors.lastname: Adams
authors.affiliation: Department of Nursing Science, University of Turku, Hoitotieteen laitos, TURUN YLIOPISTO, 20014 Turku, Finland ; School of Nursing, The Hong Kong Polytechnic University, Hong Kong, China ; Turku University Hospital, Turku, Finland.
authors.forename: Maritta
authors.initials: M
authors.lastname: Välimäki
keywords: Focus groups; Patient assault; Psychiatric Hospitals; Psychiatric nursing; Qualitative research; Violence; Violence prevention; Workplace violence