Contributing Factors to Severe Workplace Violence in Forensic Psychiatry: A Longitudinal Retrospective Analysis of Incident Reports.

backgroundPsychiatric nurses in forensic psychiatric units encounter high levels of workplace violence, but less is known about how ward routines and environmental factors relate to incident severity. AIM/QUESTION: To identify temporal, routine-related, work-related and environmental factors associated with severe reported workplace violence incidents in a Finnish forensic psychiatric hospital.

methodThis longitudinal retrospective study analysed 956 workplace violence reports from 2020-2024 using descriptive statistics, chi-square tests with Benjamini-Hochberg FDR correction and inductive content analysis of narratives from incidents involving outdoor activities.

resultsSevere reported incidents were associated with time of day (FDR-adjusted p = 0.030, V = 0.12), incidents involving outdoor activities (FDR-adjusted p = 0.030, V = 0.08), incident location (FDR-adjusted p < 0.001, V = 0.28) and ward (FDR-adjusted p < 0.001, V = 0.46). Incidents involving outdoor activities were more often classified as severe and frequently involved physical violence. DISCUSSION: Daytime and afternoon periods, incidents involving outdoor activities and specific ward locations were associated with a higher proportion of severe reported incidents, suggesting that routine and environmental factors shape incident severity. LIMITATIONS: Limitations include the single-site retrospective design, voluntary reporting, possible repeated incidents involving the same patients and subjective classification of some reports. IMPLICATIONS FOR PRACTICE: Targeted nurse-led prevention should focus on incidents involving outdoor activities, afternoon peaks and location-specific controls to support safety in forensic psychiatric wards.