Patient and staff views of factors influencing assaults on psychiatric hospital employees.

This study compares the viewpoints of psychiatric hospital employees and patients as to situational and interactional factors that are related to patient assaults on staff. Sixty-nine patients from eight high-assault wards in two state psychiatric hospitals were interviewed to identify hospital practices and aspects of the physical environment that they believed to be related to assaultive behavior. One hundred thirty-seven nursing staff members on the same wards were surveyed. Patients and staff had many concerns in common, including restrictions on patient smoking and access to the outdoors, staff clinical skills and patients' being treated with respect, and the use of seclusion and restraint on the wards. Additionally, patients were concerned about rules not being explained. Staff believed that the single most important issue was an adequate number of personnel. A considerable portion of assaults may relate to circumstances that are amenable to intervention, and assaults may be reduced in severity or number by changes in hospital practices.