Nurse-perpetrated abuse in Japanese psychiatric hospitals: a cross-sectional study of prevalence and correlates.

Introduction: The abuse of psychiatric inpatients in psychiatric hospitals is a global concern. Although the prevalence may be underestimated due to underreporting rates of physical abuse and restraint have been reported at 6% and 40%, respectively. However, data on this issue are scarce, where the picture is further complicated by the difficulty in defining "abuse" within a context where certain coercive measures are legally permitted. This study aimed to investigate the prevalence of such abuse and its psychological and workplace-related correlates. Methods: We conducted a cross-sectional survey of 203 nursing staff working in eight psychiatric hospitals located in both rural and urban areas of Japan. A self-administered, web-based questionnaire battery assessed demographic characteristics, workplace violence, inappropriate and abusive behaviors, moral sensitivity, ethical climate, attitudes toward recovery, job stressors, and moral distress. Results: The prevalence of respondents who reported experiencing at least one of the 32 abusive behaviors of interest was 87.1%, with ignoring or rejecting patients being the most common form. Logistic regression analysis revealed that experience of workplace violence and more recovery-oriented attitudes were significantly associated with higher odds of engaging in abusive behaviors (adjusted odds ratios: 3.37 and 1.17, respectively), whereas greater moral sensitivity and longer clinical experience were inversely associated (adjusted odds ratios: 0.92 and 0.95, respectively). Discussion: These findings indicate a relatively high prevalence of nurse-to-patient abuse in Japanese psychiatric hospitals and highlight the complex interplay of individual and workplace factors in such behaviors. This evidence may serve as a foundation for the development of targeted interventions aimed at preventing abuse in psychiatric care settings.