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.