• Virve Maaret Pekurinen, Maritta Välimäki, Marianna Virtanen, Paula Salo, Mika Kivimäki, and Jussi Vahtera.
• Ms. Pekurinen is with the Department of Nursing Science, Faculty of Medicine, Dr. Salo is with the Department of Psychology, and Dr. Vahtera is with the Department of Public Health, Faculty of Medicine, all at the University of Turku, Turku, Finland (e-mail: vimapek@utu.fi ). Dr. Salo is also with the Finnish Institute of Occupational Health, Turku. Dr. Vahtera is also with Turku University Hospital, where Dr. Välimäki is affiliated. Dr. Välimäki is also with the School of Nursing, Hong Kong Polytechnic University, Hong Kong, China (SAR). Dr. Virtanen is in the Helsinki office of the Finnish Institute of Occupational Health. Dr. Kivimäki is with Department of Epidemiology and Public Health, University College London and with Clinicum, Faculty of Medicine, University of Helsinki, Helsinki.
• Psychiatr Serv. 2017 May 1; 68 (5): 490-496.

ObjectivesThis study tested the hypothesis that poor organizational justice and collaboration among nurses are associated with increased stress among nurses, which, in turn, increases the likelihood of violent assaults by patients.MethodsA cross-sectional survey was conducted of nurses in 90 psychiatric inpatient wards in five hospital districts and one regional hospital in Finland. A total of 758 nurses (registered nurses or enrolled/mental health nurses) responded to the survey. Self-administered postal questionnaires were used to assess organizational justice, collaboration, nurses' stress, and violent assaults by patients. Structural equation modeling (SEM) was used in model testing.ResultsSEM did not support a role for stress in mediating between organizational justice, collaboration between nurses, and violent assaults by patients, given that stress levels were not dependent to a significant degree on organizational justice, nor were patients' assaults dependent on stress levels. However, low organizational justice and poor collaboration between nurses were associated with increased reports of violent assaults by patients in psychiatric inpatient settings (p<.05 for both). The model explained 5.7% of violent assaults at nearly significant levels (p=.052).ConclusionsThese findings suggest that organizational justice, collaboration between staff members, and violent assaults by patients are linked in psychiatric inpatient settings. Evaluating a variety of factors, including issues related to organizational justice and collaboration among nurses, may be useful to minimize assaults by patients in psychiatric settings.

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