The purpose of this article was to explore patient assault in acute inpatient psychiatric units and to examine the interplay between the patients, environmental staff factors related to assaults. A log system for recording assault occurrences was used. Four trained research assistants conducted a chart review and interviewed the nursing staff to complete the overt aggression scale, staff observation aggression scale, and environmental assessment questionnaire separately at the four hospitals. The data showed 855 episodes of assaults from 287 patients. The assault incident density ranged from 1.11 to 1.95 per 1,000 patient days. Patient factors (diagnosis, history of assaultive behavior, the duration of admission, and smoking history), environmental factors (patient/nurse ratio and space density) and staff factors (age, length of work experience, training program received in assault prevention and management) were contributing variables to patients' assaultive behavior. This reinforces the complexity of models in predicting assaults among psychiatric in-patients.
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