Background: Patient aggression and violence against staff members and other patients are common concerns in psychiatric units. Many structured clinical risk assessment tools have recently been developed. Despite their superiority to unaided clinical judgments, staff has shown ambivalent views towards them. A constant worry of staff is that the results of risk assessments would not be used. The aims of the present study were to investigate what were the interventions applied by the staff of a psychiatric admission ward after a high risk patient had been identified, how frequently these interventions were used and how effective they were. Methods: The data were collected in a naturalistic setting during a 6-month period in a Finnish psychiatric admission ward with a total of 331 patients with a mean age of 42.9 years (SD 17.39) suffering mostly from mood, schizophrenia-related and substance use disorders. The total number of treatment days was 2399. The staff assessed the patients daily with the Dynamic Appraisal of Situational Aggression (DASA), which is a structured violence risk assessment considering the upcoming 24 h. The interventions in order to reduce the risk of violence following a high DASA total score (>= 4) were collected from the patients' medical files. Inductive content analysis was used. Results: There were a total of 64 patients with 217 observations of high DASA total score. In 91.2% of cases, at least one intervention aiming to reduce the violence risk was used. Pro re nata (PRN)-medication, seclusion and focused discussions with a nurse were the most frequently used interventions. Non-coercive and non-pharmacological interventions like daily activities associated significantly with the decrease of perceived risk of violence. Conclusion: In most cases, a high score in violence risk assessment led to interventions aiming to reduce the risk. Unfortunately, the most frequently used methods were psychopharmacological or coercive. It is hoped that the findings will encourage the staff to use their imagination when choosing violence risk reducing intervention techniques.

Wellbeing of nurses is associated with patient aggression. Little is known about the differences in these associations between nurses working in different specialties. We aimed to estimate and compare the prevalence of patient aggression and the associations between patient aggression and the wellbeing of nurses in psychiatric and non-psychiatric specialties (medical and surgical, and emergency medicine). A sample of 5288 nurses (923 psychiatric nurses, 4070 medical and surgical nurses, 295 emergency nurses) participated in the study. Subjective measures were used to assess both the occurrence of patient aggression and the wellbeing of nurses (self-rated health, sleep disturbances, psychological distress and perceived work ability). Binary logistic regression with interaction terms was used to compare the associations between patient aggression and the wellbeing of nurses. Psychiatric nurses reported all types of patient aggression more frequently than medical and surgical nurses, whereas nurses working in emergency settings reported physical violence and verbal aggression more frequently than psychiatric nurses. Psychiatric nurses reported poor self-rated health and reduced work ability more frequently than both of the non-psychiatric nursing groups, whereas medical and surgical nurses reported psychological distress and sleep disturbances more often. Psychiatric nurses who had experienced at least one type of patient aggression or mental abuse in the previous year, were less likely to suffer from psychological distress and sleep disturbances compared to medical and surgical nurses. Psychiatric nurses who had experienced physical assaults and armed threats were less likely to suffer from sleep disturbances compared to nurses working in emergency settings. Compared to medical and surgical nurses, psychiatric nurses face patient aggression more often, but certain types of aggression are more common in emergency settings. Psychiatric nurses have worse subjective health and work ability than both of the non-psychiatric nursing groups, while their psychiatric wellbeing is better and they have less sleep problems compared to medical and surgical nurses. Psychiatric nurses maintain better psychiatric wellbeing and experience fewer sleep problems than non-psychiatric nurses after events of exposure to patient aggression. This suggest that more attention should be given to non-psychiatric settings for maintaining the wellbeing of nurses after exposure to patient aggression.

Background: Nurses' collegiality is topical because patient care is complicated, requiring shared knowledge and working methods. Nurses' collaboration has been supported by a number of different working models, but there has been less focus on ethics. Aim: This study aimed to develop nurses' collegiality guidelines using the Delphi method. Method: Two online panels of Finnish experts, with 35 and 40 members, used the four-step Delphi method in December 2013 and January 2014. They reformulated the items of nurses' collegiality identified by the literature and rated based on validity and importance. Content analysis and descriptive statistical methods were used to analyze the data, and the nurses' collegiality guidelines were formulated. Ethical considerations: Organizational approval was received, and an informed consent was obtained from all participants. Information about the voluntary nature of participation was provided. Results: During the first Delphi panel round, a number of items were reformulated and added, resulting in 32 reformulated items. As a result of the second round, 8 of the 32 items scored an agreement rate of more than 75%, with the most rated item being collegiality means that professionals respect each other. The item with second highest rating was collegiality has a common objective: what is best for patients, followed by the third highest which was professional ethics is the basis of collegiality. Conclusion: Nurses' collegiality and its content are well recognized in clinical practice but seldom studied. Collegiality can be supported by guidelines, and nurses working in clinical practice, together with teachers and managers, have shared responsibilities to support and develop it. More research in different nursing environments is needed to improve understanding of the content and practice of nursing collegiality.

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 inpatient 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.