Workplace Violence and Psychiatric Nurses

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The recent alleged murder of a psychiatric nurse practitioner by a patient in a nonprofit halfway house/detoxification center has prompted psychiatric nurses to discuss the risk of workplace violence, and community and hospital settings. June Onkundi had lengthy experience as a psychiatric nurse and had worked in the detox center for 3 months. A doctoral student in nursing, she was allegedly stabbed by her own patient, who has been charged with first-degree murder and is being held without bond (Gaines, October 21, 2022). This editorial will discuss existing literature concerning violence against psychiatric nurses in clinical settings.

Dr. Chizimuzo (Zim) Okoli’s (2023), American Psychiatric Nurses Association’s (APNA) President, Board of Directors Column included in this issue of JAPNA addresses the issue of “inclusive mental health care that is appropriate from the patient’s perspective.” He points out that the American Association of Colleges of Nursing (2021) notes that inclusion involves the intentional development of organizational and environmental cultures that encourage thriving by inviting, welcoming, acknowledging, and embracing diverse perspectives and experiences. Dr. Okoli speaks of the nurse being responsive to the patient’s wishes. This prompted some thought about the precise circumstances or situations where a psychiatric nurse is seriously harmed or murdered, especially in a more unstructured community setting such as a patient’s residence. What were the common issues that led up to an event like the one involving June Onkundi, and could the violence have been prevented? While the event might have been random and out of the nurse’s control, nurses need to be aware of situations when a patient’s psychiatric presentation makes them at risk of becoming violent. Nurses recognize that the patient’s mental status and experience of hallucinations or delusions can contribute to making the patient feel threatened, fearful, and, therefore, more likely to become assaultive (Dean et al., 2021; Goetz & Taylor-Trujillo, 2012)—importantly, what administrative protocols exist to protect nurses from threatened aggression.

The psychological effects of workplace violence and psychiatric nurses have been reported in the literature by many researchers (Edward et al., 2016; Hamrin et al., 2009; Jacobowitz, 2013; Jalil & Dickens, 2018; Spaducci et al., 2018). The causes of violent patient reactions are multifaceted and varied, but there are few studies that specifically identify the psychiatric nurse’s experience with workplace violence (Konttila et al., 2020).

Goetz and Taylor-Trujillo (2012) conducted a patient- and system-focused intervention aimed at decreasing violence in the behavioral health inpatient unit. They highlighted a multifaceted approach that included “leadership involvement, staff education, assessment, debriefing, and milieu management” as key to the success of this program. The training was comprehensive and resulted in institutional and organizational support that markedly decreased violence. After several years of focused interventions, they reported achieving a violence-free clinical environment (Goetz & Taylor-Trujillo, 2012, p. 96). According to the authors, their model continued to evolve.

A systematic review conducted in China looked at 13 studies that addressed the nurse’s response to workplace violence. The researchers found that physical, sexual, and psychological levels of workplace violence differed by culture and country. Related factors included patient, nursing, social, and environmental factors (He & Yue, 2021). The authors concluded that more careful research was needed looking at psychiatric nurses’ response to violence in the workplace (He & Yue, 2021). They specifically identified the following actions: “train in communication/professional skills, enhance teamwork, and ensure safety” (He & Yue, 2021, p. 16).

Psychiatric nurses require interpersonal and administrative support in preventing violence and dealing with it when it occurs. Amelioration of the negative effects of experienced violence should be the goal to reduce trauma. This includes organizational protocols that maximize safety and prioritizing interpersonal supports if the nurse experiences trauma (He & Yue, 2021; Itzhaki et al., 2018).

Who is ultimately responsible for a psychiatric nurse’s safety? While the organization must take all measures to reduce the risk of patient aggression, for that nurse meeting alone with a patient, it is a necessity that they trust their judgment and use careful assessment skills while paying particular attention to verbal and nonverbal cues suggesting that violence is possible. It is equally important that the care system avoids blaming or second-guessing a psychiatric nurse’s decision not to take the risk of seeing a violent patient without ensuring that structured supports are in place and utilized by all leaders and staff. An episode of aggression influences all aspects of patient care and particularly the nurses who provide care.

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最近，一名精神科护士被指控在一家非营利性中途之家/戒毒中心被一名患者谋杀，这促使精神科护士讨论工作场所暴力的风险，以及社区和医院环境。琼·昂孔迪拥有长期的精神科护士经验，曾在戒毒中心工作3个月。她是护理学博士生，据称被自己的病人刺伤，他被指控犯有一级谋杀罪并被无保释金地关押（Gaines，10月21日，2022）。这篇社论将讨论现有的文献有关暴力侵害精神科护士在临床设置。

奇齐姆佐（齐姆）奥科利博士（2023），美国精神科护士协会（APNA）主席、董事会专栏收录本期JAPNA 他指出，美国护理学院协会（2021） 注意到包容性涉及有意识地发展组织和环境文化，通过邀请、欢迎、承认和拥抱不同的观点和经验来鼓励繁荣。Okoli博士谈到护士对患者的意愿做出反应。这促使人们思考精神科护士受到严重伤害或谋杀的确切情况或情况，特别是在一个更松散的社区环境中，如病人的住所。导致像June Onkundi这样的事件的共同问题是什么？暴力事件是否可以预防？虽然事件可能是随机的，超出了护士的控制，护士须留意病人的精神病表现使他们有可能变得暴力的情况。护士明白病人的精神状态及幻觉或妄想的经历，会令病人感到威胁及恐惧，因而更容易变得有攻击性（Dean等人，2021年;戈茨和泰勒-特鲁希略，2012年）-重要的是，存在什么行政协议来保护护士免受威胁的侵犯。

工作场所暴力和精神科护士的心理影响已被许多研究人员在文献中报道（爱德华等人，2016年;Hamrin等人，2009年;雅各布维茨，2013年;贾利勒和狄更斯，2018;Spaducci等人，2018年）。导致病人暴力反应的原因是多方面的，但很少有研究明确指出精神科护士在工作场所暴力的经历（Konttila等人，2020年）.

戈茨和泰勒-特鲁希略（2012） 进行了以患者和系统为中心的干预，旨在减少行为健康住院病房的暴力。他们强调了一种多方面的方法，包括"领导参与，员工教育，评估，汇报，和环境管理"作为该方案成功的关键。培训是全面的，并导致机构和组织支持，显著减少了暴力。经过几年的重点干预，他们报告实现了一个无暴力的临床环境（戈茨和泰勒-特鲁希略，2012年，第96页）。根据作者的说法，他们的模型继续演变。

在中国进行的一项系统性综述研究了13项关于护士对工作场所暴力反应的研究。研究人员发现，工作场所暴力的身体、性和心理水平因文化和国家而异。相关因素包括患者、护理、社会和环境因素（和悦，2021）。作者认为，需要更仔细地研究精神科护士对工作场所暴力的反应（和悦，2021他们具体确定了下列行动：“培训沟通/专业技巧，加强团队合作，确保安全”（和悦，2021，第16页）。

精神科护士在预防暴力和处理暴力时需要人际和行政支持。减轻暴力的负面影响应是减少创伤的目标。这包括组织协议，最大限度地提高安全性和优先考虑人际支持，如果护士经历创伤（和悦，2021;伊扎克等人，2018年）.

谁对精神科护士的安全负最终责任？虽然组织必须采取一切措施降低患者攻击的风险，但对于护士单独与患者会面，他们有必要相信自己的判断，并使用仔细的评估技巧，同时特别注意暗示暴力可能发生的语言和非语言线索。同样重要的是，护理系统避免指责或第二-猜测一个精神科护士决定不冒风险去看一个暴力的病人，而不确保结构化的支持到位，并由所有的领导和工作人员利用。攻击性事件影响病人护理的各个方面，特别是提供护理的护士。

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