VIOLENCE AND AGGRESSION IN PSYCHIATRIC UNITS

Objective: To help predict aggressive and violent behaviors, the frequ ency and types of these behaviors in acute psychiatric inpatient setti ngs were examined, and potential interactions between staffing and pat ient mix and rates of the behaviors were explored. Methods: Data on vi olent incidents were gathered prospectively in three adult acute psych iatric units in a general hospital and two units in a primary psychiat ric hospital in Sydney; Australia. Staff recorded violent and aggressi ve incidents, which were ranked on an 8-level scale. They also complet ed weekly reports of staffing levels and patient mix. Poisson regressi on analysis was used to calculate relative rates, 95 percent confidenc e intervals, and p values. Results: A total of 1,289 violent incidents were recorded over a. seven-month period. Rased on the scale, 58 perc ent of the incidents were serious. Seventy-eight percent were directed toward nursing staff. Complex relationships between staffing, patient mix, and violence were found. Relative risk increased with more nursi ng staff (of either sex), more nonnursing staff on planned leave, more patients known to instigate violence, a greater number of disoriented patients, more patients detained compulsorily, and mole use of seclus ion. The relative risk decreased with more young staff (under 30 years old), more nursing staff with unplanned absenteeism, more admissions, and more patients with substance abuse or physical illness. In total these factors accounted for 62 percent of the variance in violence. Co nclusions: Violent incidents in psychiatric settings are a frequent an d serious problem. Incidents appear to be underreported, and the serio usness of an incident does not guarantee it will be reported.