Skip to main content

Folie du système? Preventing Violence Against Nurses in In-patient Psychiatry


Violence against psychiatric nurses is a difficult reality of work on in-patient psychiatry units. Health care providers and managers, nursing unions, and workplace protection agencies are looking for solutions to improve safety and quality of care. We are suggesting that simultaneous to this solution-seeking, there is also a need to critically reflect on the nature of violence itself within in-patient psychiatric settings. In this article we consider the gendered dynamics of power and violence within the in-patient psychiatric setting. The nursing profession is over 90% female. Given that violence in society often has a ‘gendered’ nature, and in light of a report from the Ontario Council of Hospital Unions which likened violence against nurses to domestic violence, we have put forth a view of the acute in-patient psychiatric milieu that considers gender and power in its analysis of violence against nurses. Intended to encourage enquiry into our pre-suppositions as health care providers, we use Foucauldian and feminist theories to up-end our notions of “anti-violence technologies”, and to consider the unique and risky position that psychiatric nurses occupy as carers, care providers, and “anti-violence officers”. We conclude by posing ethical questions which may be of interest for professional development, care planning, team building, and clinical ethics and education.

This is a preview of subscription content, access via your institution.


  1. Clarke K. Ministry of labour lays charges against CAMH months after nurse allegedly beaten. The Toronto Star. 2014; Retrieved from Accessed 3 March 2017

  2. Hong J. CAMH fined $80,000 after beating that left nurse “beyond recognition”. The Toronto Star. 2016; Retrieved from Accessed 3 March 2017

  3. Mojtehedzadeh S. Health-care workers face an epidemic of violence. The Toronto Star. 2017; Retrieved from Accessed 3 March 2017

  4. International Labour Office, International Council of Nurses, World Health Organization, & Public Services International. Joint programme on workplace violence in the health sector. Framework guidelines for addressing workplace violence in the health sector. Geneva, CH. 2002. Retrieved from Accessed 14 March 2017

  5. Registered Nurses Association of Ontario. Position statement: - violence against nurses - 'zero' tolerance for violence against nurses and nursing students. 2008. Retrieved from Accessed 8 March 2017

  6. ‘Kicked, spat on, bit:’ Hospital staff take stories of violence on the job to queen's park. CBCnews Toronto. 2017. Retrieved from Accessed 3 March 2017

  7. Arnetz J, Hamblin L, Essenmacher L, Upfal M, Ager J, Luborsky M. Understanding patient-to-worker violence in hospitals: a qualitative analysis of documented incident reports. J Adv Nurs. 2015;71(2):338–48.

    Article  PubMed  Google Scholar 

  8. Chapman R, Styles I. An epidemic of abuse and violence: nurse on the front line. Accid Emerg Nurs. 2006;14(4):245–9.

    Article  PubMed  Google Scholar 

  9. McPhaul K, Lipscomb J. Workplace violence in health care: recognized but not regulated. Online J Issues Nurs. 2004;9(3). Retrieved from Accessed 17 March 2017

  10. Nolan P, Dallender J, Soares J, Thomsen S, Arnetz B. Violence in mental health care: the experiences of mental health nurses and psychiatrists. J Adv Nurs. 1999;30(4):934–41. Retrieved from Accessed 17 March 2017

  11. Ridenour M, Lanza M, Hendricks S, Hartley D, Reirdan J, Zeiss R, et al. Incidence and risk factors of workplace violence on psychiatric staff. Work. 2015;51(1):19–28.

    Article  PubMed  PubMed Central  Google Scholar 

  12. Yassi A, Gilbert M, Cvitkovich Y. Trends in injuries, illnesses, and policies in Canadian healthcare workplaces. Can J Public Health. 2005;96(5):333–9.

    PubMed  Google Scholar 

  13. Shields M, Wilkins K. Findings from the 2005 National Survey of the work and health of nurses. Ottawa: Health Canada and Canadian Institutes for Health Information; 2006. Retrieved from Accessed 8 March 2017

  14. Iozzino L, Ferrari C, Large M, Nielssen O, Girolamo G. Prevalence and risk factors of violence by psychiatric acute inpatients: a systematic review and meta-analysis. PLoS One. 2015;10(6):2.

    Article  CAS  Google Scholar 

  15. Stevenson K, Jack S, Mara L, LeGris J. Registered nurses' experiences of patient violence on acute care psychiatric inpatient units: an interpretive descriptive study. BMC Nurs. 2015;14(1):35. p.39.

    Article  PubMed  PubMed Central  Google Scholar 

  16. Hilton NZ, Ham E, Dretzkat A. Psychiatric hospital workers’ exposure to disturbing patient behavior and its relation to post-traumatic stress disorder symptoms. Can J Nurs Res. 2017;49(3):118–26.

    Article  PubMed  Google Scholar 

  17. Goldsack L. A haven in a heartless world? Women and domestic violence. In: Chapman T, Hockey J, editors. Ideal homes? Social change and domestic life. New York: Routledge; 1999. p. 121–32.

    Google Scholar 

  18. Shepard M. Twenty years of progress in addressing domestic violence: an agenda for the next 10. J Interpers Violence. 2005;20(4):436–41.

    Article  PubMed  Google Scholar 

  19. Sokoloff NJ, Dupont I. Domestic violence at the intersections of race, class, and gender: challenges and contributions to understanding violence against marginalized women in diverse communities. Violence Against Women. 2010;11(1):38–64.

    Article  Google Scholar 

  20. Child[s?], R. H., & Mentes, J. C. Violence against women: the phenomenon of workplace violence against nurses. Issues Ment Health Nurs. 2010;31(2):89–95.

    Article  Google Scholar 

  21. Needham I, Abderhalden C, Halfens RJ, Fischer JE, Dassen T. Non-somatic effects of patient aggression on nurses: a systematic review. J Adv Nurs. 2005;49(3):283–96.

    Article  PubMed  Google Scholar 

  22. Vrikki T. Habitual trust in encountering violence at work: attitudes towards client violence among Finnish social workers and nurses. J Soc Work. 2008;8(3):247–67.

    Article  Google Scholar 

  23. Flaherty MP. Constructing a world beyond intimate partner abuse. Affilia. 2010;25(3):224–35.

    Article  Google Scholar 

  24. Tripp AM, Ferree MM, Ewig C, editors. Gender, violence, and human security: critical feminist perspectives. New York: NYU Press; 2013.

    Google Scholar 

  25. Davis K. The body and doing gender: the relations between doctors and nurses in hospital work. Sociol Health Illn. 2003;25(7):720–42 p.722.

    Article  Google Scholar 

  26. Burstow B. Radical feminist therapy: working in the context of violence. Newbury Park: Sage Publications; 1992.

    Book  Google Scholar 

  27. Canadian Nurses Association. Workforce Profile of Registered Nurses in Canada. 2010. Retrieved from Accessed 27 March 2017

  28. Lazenby M. Caring matters most: the ethical significance of nursing. New York: Oxford University Press; 2017.

    Book  Google Scholar 

  29. Gatens M. Power, bodies and difference. In: Price J, Shildrick M, editors. Feminist theory and the body: a reader. New York: Routledge; 1999. p. 227–34. p.228.

    Google Scholar 

  30. Foucault M. Discipline and punish. (A. Sheridan, Trans.). New York: Vintage; 1977. p.136; 186.

  31. Drach-Zahavy A, Goldblatt H, Granot M, Kostinski H. Control: patients’ aggression in psychiatric settings. Qual Health Res. 2011;22(1):43–53.

    Article  PubMed  Google Scholar 

  32. Foucault, M. The history of sexuality: volume I an introduction. (R. Hurley, Trans.). New York: Vintage; 1990.

  33. Findorff MJ, McGovern PM, Wall M, Gerberich SG, Alexander B. Risk factors for work related violence in a health care organization. Inj Prev. 2004;10(5):296–302. Retrieved from Accessed 17 March 2017

  34. Paynton T. The informal power of nurses for promoting patient care. Online J Issues in Nurs;2009. 14(1):np. Available from Accessed 8 March 2017

Download references


This paper was conceived and written in the context of a graduate level Critical Theory course in the Division of Community Health and Humanities, Faculty of Medicine, Memorial University. We thank the other students in the Theory 2017 class for the engaging discussion and debates that led to us developing this paper.

Author information

Authors and Affiliations


Corresponding author

Correspondence to Fern Brunger.

Ethics declarations

Conflict of Interest

The Authors declare that there is no conflict of interest.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and Permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Campbell, V.L.S., Foley, H.L., Vianna, K.W. et al. Folie du système? Preventing Violence Against Nurses in In-patient Psychiatry. Psychiatr Q 90, 413–420 (2019).

Download citation

  • Published:

  • Issue Date:

  • DOI: