Background: Physical assault on nurses is a major occupational hazard especially for psychiatric nurses working in inpatient psychiatric settings. Physical assault impacts nursesʼ health and well-being and causespsychological and emotional stress.

Objective: The purpose of this study was to examine and explore the relationships between perceived stress, coping, attitudes toward patient assault and their intent to leave.

Design: A descriptive, cross-sectional study using the convenience sampling method.

Setting: United States of America

Participants: One hundred thirty one (n=131) psychiatric nurses who had experienced patient physical assault in an acute psychiatric setting within the last 10 years completed online surveys. Age range at the time of assault was 20-65 years, with an average age of 40. Eighty four percent were female nurses.

Instruments: Demographic Questionnaire, Attitudes Toward Patient Physical Assault (ATPPA), Perceived Stress Scale (PSS)-10 and the Brief COPE Scale (BCS) were used.

Data Analysis and Findings: Participants experienced patient assault one to five or more times. The PSS mean and standard deviation was 22.94 (11.06), indicated participants experienced moderately high stress. Over half (68.7%) of the psychiatric nurses felt that they can expect to be physically assaulted by a mentally ill patient sometime during their career. Most felt that they were not equipped or staffed to treat those patients admitted to their units safely. A t-test and chi-square analysis revealed no significant differences between the demographic characteristics and the intent to leave in the past six and 12 months, t = 0.47, p >.05. The mean for BCS subscale active coping was not significant at 4.35 (2.02) and mean was significant for denial at 5.36 (3.21). The BCS subscale denial was significantly related to intent to leave at six months, t(129) = 2.02 p = 0.04. Stress was related to intent to leave at six months, t (129) = 2.58, p = 0.011. ATPPA subscale legal score was significant t (129) = -2.28, p = 0.02 at six months. The 12 monthsʼ intent to leave ATPPA subscale staff performance was significant, t (129) = 2.57, p = 0.11. Independent t-test was significant for PSS and intent to leave at six months; and significant for ATPPA subscale staff performance and the intent to leave at 12 months. Logistic regression equation for the past 6 months was significant at .000, chi-square = 19.36, p = .004; and significant for the past 12 months at .000, chi-square = 15.38, p = .017. The ATPPA subscale staff performance was identified as a predictor for the intent to leave at 12 months.

Discussion and Conclusion: The findings of this study support previous studies and provides new empirical knowledge. This studyʼs findings found that psychiatric nurses used denial copings strategies significantly more than active coping strategies. These psychiatric nurses experienced moderately high stress. There was a significant correlation between PSS and their intent to leave related to physical assault. Moreover, PSS was identified as a predictor for the intent to leave the job at six months. Staff performance and legal issues were also identified as predictors for intent to leave. A key implication for nurse intention is the well-being of the psychiatric nurses. Nurse supervisors and nurse managers must collaborate to focus in providing an emotionally healthy environment with stress management interventions designed to help psychiatric nurses modify appraisal of stressful situations to effectively cope with stressful events.

Biography:
Carolyn Hanohano began her nursing career in the United States Navy as a hospital corpsman.She holds a Bachelor of Science in Nursing from California State University Dominguez Hills (CSUDH), Carson, CA, Master of Science in Nursing Administration from CSUDH, and PhD in Nursing from Azusa Pacific University, Azusa, CA. Carolyn is a psychiatric nursing supervisor at Ventura County Medical Center in Ventura, CA.
She has served as part-time nursing clinical instructor at Ventura College and California State University Channel Islands, Camarillo, CA. Research includes physical assault, perceived stress, coping, and attitudes toward assault experienced by psychiatric nurses and their intent to leave.