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

BACKGROUND: Psychiatric 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. METHOD: This 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. RESULTS: Severe 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.