Violence prevention in inpatient psychiatric settings: Systematic review of studies about the perceptions of care staff and patients

• Staff and patients views violence prevention in psychiatric hospitals are reviewed.
• Thirty-seven studies were identified, most were cross-sectional.
• No valid tools have been developed to measure the violence prevention climate.
• Themes related to patients, care staff factors and to organisation and environment.
• To improve violence prevention we need to understand how people perceive it.

Primary and secondary violence prevention can reduce conflict in inpatient psychiatric settings. We aimed to review the empirical literature about how patients and staff in these settings perceive violence prevention. We conducted a systematic review using comprehensive terms to search multiple electronic databases. Thirty-seven studies were identified; all used either qualitative methods, quantitative cross-sectional surveys, or mixed method combinations. There are currently no adequate psychometric tools that can measure the perception of violence prevention in the inpatient setting. No studies have established a link between perceptions about inpatient violence prevention and violence preventive behaviors. The results from included studies were synthesized into a narrative review guided by thematic analysis. Important themes related to patient factors, care staff factors, and organizational and environmental factors. The narrative review can provide the basis for an empirically-based, descriptive, middle range theory of attitudes to violence prevention. However, further theoretical and empirical development is required to link conceptual developments from the current review to models that explain the role of perception in behavior in general and violence prevention behavior specifically. Future work should develop methods to measure the violence prevention climate in psychiatric settings and interventions to increase preventive behaviors.