Iyus Yosep, Helmy Hazmi, Zabidah Putit, Henny Suzana Mediani


This is a study of Exposure of Violence among Mental Health Nurses and Patients, associated with Working Alliance in Indonesian Mental Hospital. This study determined the relationship between Working Alliance and its association with Physical, Verbal, Psychological and Sexual Violence among Mental Health Nurses and patient in Indonesian Mental Hospital. The traumatic experiences of mental health nurses and the violence experiences of patient were explore through focus group discussion. This study adopted a Sequential Explanatory Mixed Method.  A total of 120 nurses and 40 patients were selected in the Mental Hospital West Java Indonesia using purposive sampling. About two third of the respondent were female; 80% had an education background of bachelor and diploma. About 80% of the respondent has work experienced of more than 10 years and 60 % of the nurses are currently working in acute and chronic room. Most of the nurses experiences low level of violence in all four categories (physical, verbal, Psychological and sexual) which range of 54.2% to 69.2%. Psychological violence recorded the highest percentage of violence (45.5) among all four type of violence. The percentage of Working Alliance is high about 51.1% among Mental Health Nurses. Qualitatively; Nurse’s experiences included: physical assault, verbal violence, sexual harassment, and intimidation of family, threat of lawsuit, unpredictable situation and desire to leave the job. On the other hand, patient’s experiences were classified into three major themes. These included patient’s experiences as perpetrator, as victim and as perpetrator to neighbors. In addition, patients also described a theme of experiences as victim by family, and showed the way of coping with violence. There is a significant relationship between violence and Working Alliance, wherein the higher the exposure to violence, the lower the working alliance. This study recommended four aspect in the working alliance; safety consideration, education and training, nursing management, unit after trauma to be emphasized.


Exposure Mental Health Nurses to Violence, Working Alliance

Full Text:



Adriaenssens, J., de Gucht, V. & Maes, S. 2012, 'The impact of traumatic events on emergency room nurses: Findings from a questionnaire survey', International Journal of Nursing Studies, vol. 49, no. 11, pp. 1411-22,.

Abdul-Ghani, M. (2014). Exploring domestic violence experiences from the perspective of abused women in Malaysia(Doctoral dissertation, © Mariny Abdul Ghani).

Angland, S., Dowling, M. & Casey, D. 2014, 'Nurses’ perceptions of the factors which cause violence and aggression in the emergency department: a qualitative study', International emergency nursing, vol. 22, no. 3, pp. 134-9.

Araujo, S. & Sofield, L. 2011, 'Workplace violence in nursing today', Nursing Clinics of North America, vol. 46, no. 4, pp. 457-64.

Arnetz, J. E., & Arnetz, B. B. (2015). Implementation and evaluation of a practical intervention programme for dealing with violence towards health care workers. Journal of Advanced Nursing, 31(3), 668-680.

Chang, H.-Y., Shyu, Y.-I.L., Wong, M.-K., Friesner, D., Chu, T.-L. & Teng, C.-I. 2015, 'Which Aspects of Professional Commitment Can Effectively Retain Nurses in the Nursing Profession?(Report)(Author abstract)', Journal of Nursing Scholarship, vol. 47, no. 5,.

Coomber, B., & Barriball, K. L. (2007). Impact of job satisfaction components on intent to leave and turnover for hospital-based nurses: a review of the research literature. International journal of nursing studies, 44(2), 297-314.

Creswell, J. W., Hanson, W. E., Clark Plano, V. L., & Morales, A. (2007). Qualitative research designs: Selection and implementation. The counseling psychologist, 35(2), 236-264.

Hem, M. H., & Heggen, K. (2003). Being professional and being human: one nurse's relationship with a psychiatric patient. Journal of Advanced Nursing, 43(1), 101-108.

Higgins, A., Barker, P., & Begley, C. M. (2009). Clients with mental health problems who sexualize the nurse client encounter: the nursing discourse. Journal of advanced nursing, 65(3), 616-624.

Horvath, A.O. 2000, 'The Therapeutic Relationship: From Transference to Alliance.(The Therapeutic Alliance)(Review)', Journal of Clinical Psychology, vol. 56, no. 2,.

Kontio, R., Välimäki, M., Putkonen, H., Kuosmanen, L., Scott, A., & Joffe, G. (2010). Patient restrictions: are there ethical alternatives to seclusion and restraint?. Nursing ethics, 17(1), 65-76.

Latha, K. S. (2010). The noncompliant patient in psychiatry: the case for and against covert/surreptitious medication. Mens sana monographs, 8(1), 96.

Lee, S., Pai, H.C. & Yen, W.J. 2010, '[Nurse violence in the workplace: a study of experiences and related factors in Taiwan]', Hu Li Za Zhi, vol. 57, no. 2, pp. 61-9.

Lee, S.Y., Kim, K.R., Park, J.Y., Park, J.S., Kim, B., Kang, J.I., Lee, E., An, S.K. & Kwon, J.S. 2011, 'Coping strategies and their relationship to psychopathologies in people at ultra high-risk for psychosis and with schizophrenia', The Journal of nervous and mental disease, vol. 199, no. 2, pp. 106-10.

Lützén, K., Blom, T., Ewalds-Kvist, B. & Winch, S. 2010, 'Moral stress, moral climate and moral sensitivity among psychiatric professionals', Nursing Ethics, vol. 17, no. 2, pp. 213-24.

Mayring, P. (2001, February). Combination and integration of qualitative and quantitative analysis. In Forum Qualitative Sozialforschung/Forum: Qualitative Social Research (Vol. 2, No. 1).

Mcmenamin, P. 2013, 'Average Staff Nurse Wages Increase but Below the Rate of Inflation', Georgia Nursing, vol. 73, no. 4, p. 7,.

Norvoll, R., & Pedersen, R. (2016). Patients’ moral views on coercion in mental healthcare. Nursing ethics, 0969733016674768.

Papadopoulos, C., Ross, J., Stewart, D., Dack, C., James, K., & Bowers, L. (2012). The antecedents of violence and aggression within psychiatric in patient settings. Acta Psychiatrica Scandinavica, 125(6), 425-439.

Roche, M., Diers, D., Duffield, C. & Catling Paull, C. 2010b, 'Violence toward nurses, the work environment, and patient outcomes', Journal of Nursing Scholarship, vol. 42, no. 1, pp. 13-22.

Roche, M., Diers, D., Duffield, C., & Catling Paull, C. (2010). Violence toward nurses, the work environment, and patient outcomes. Journal of Nursing Scholarship, 42(1), 13-22.

Sharkey, V. 2012, 'Uniform approach: Mental health nurse uniforms create a barrier and are a leap back in time, a The NMC’s Judith Ellis rgues Valerie Sharkey', Nursing Standard, vol. 26, no. 45, pp. 26-7.

Smith, C.D., Fisher, C. & Mercer, A. 2011, 'Rediscovering nursing: a study of overseas nurses working in Western Australia', Nursing & health sciences, vol. 13, no. 3, pp. 289-95.

Spector, P.E., Zhou, Z.E. & Che, X.X. 2014, 'Nurse exposure to physical and nonphysical violence, bullying, and sexual harassment: a quantitative review', Int J Nurs Stud, vol. 51, no. 1, pp. 72-84.

Speroni, K.G., Fitch, T., Dawson, E., Dugan, L. & Atherton, M. 2014, 'Incidence and Cost of Nurse Workplace Violence Perpetrated by Hospital Patients or Patient Visitors', Journal of Emergency Nursing, vol. 40, no. 3, pp. 218-28,.

Spetz, J. 2004, 'Hospital Nurse Wages and Staffing, 1977 to 2002: Cycles of Shortage and Surplus', JONA: The Journal of Nursing Administration, vol. 34, no. 9, pp. 415-22,.

Vessey, J.A., DeMarco, R. & DiFazio, R. 2010, 'Bullying, Harassment, and Horizontal Violence in the Nursing Workforce The State of the Science', Annual review of nursing research, vol. 28, no. 1, pp. 133-57.

Quinn, C., & Happell, B. (2015). Sex on show. Issues of privacy and dignity in a Forensic mental health hospital: Nurse and patient views. Journal of clinical nursing, 24(15-16), 2268-2276.

World Health Organization. (2003). Investing in mental health.

World Health Organization. (2013). Global and regional estimates of violence against women: prevalence and health effects of intimate partner violence and non-partner sexual violence. World Health Organization.

Zabidah, P. (2011). Domestic Violence: Implication for Health Practitioners. International Journal of Public Health Research Special Issue, 2011, 22-22.


  • There are currently no refbacks.