Culture and Philosophy

To foster a treatment environment conducive to recovery, it is essential to cultivate a culture in which staff and patients alike feel secure and respected. An organization’s mission, vision, and values statements commonly articulate its workplace culture and philosophy. These typically include terms like person-centered, relationship-based, trauma-informed, recovery-oriented and culture of safety. They guide the direction of patient care, are promoted by leaders and conveyed through workplace teams.

Culture can be shaped by the beliefs of both leaders and workers – for example, the perception that patient-related injuries are a common aspect of nursing. Healthcare organizations have been working to change this idea by encouraging reporting of assaults to staff and providing support for victims of violence.

Organizations that have been able to decrease violence toward staff have found that safety for staff and patients requires a balance between caring interventions that promote therapeutic relationships and safety precautions that reduce potential risks for harm. Use of trauma-informed care, motivational interviewing and shared decision-making can help nurses to engage patients in realizing their recovery goals, while decreasing the frustration and anger that may lead patients toward violence.
The following resources and references, organized chronologically from newest to oldest, explore patient care models and treatment strategies that ensure safety and support recovery, while minimizing risks and harm.

Resources:

Safewards Model
Bowers, L. (2025). https://www.safewards.net/images/pdf/Safewards%20model.pdf

Trauma Informed Care
SAMHSA (2025). Mental Health. Trauma and Violence. Trauma Informed Approaches.
https://www.samhsa.gov/mental-health/trauma-violence/trauma-informed-approaches-programs

Recovery-Oriented, Person-Centered Behavioral Treatment 
SAMHSA (2025). https://library.samhsa.gov/sites/default/files/recovery-oriented-fact-sheet-pep24-08-003.pdf

Motivational Interviewing Practical Strategies for Nurses
APNA (2025). https://www.apna.org/courses/motivational-interviewing-practical-strategies-for-nurses/

Shared Decison-Making Tools 
SAMHSA (2025). Bringing Recovery Supports to Scale. https://www.samhsa.gov/technical-assistance/brss-tacs/decision-making

TeamSTEPPS program
United States Department of Health & Human Services, Agency for Health Research and Quality (AHRQ). (2025). TeamSTEPPS program. https://www.ahrq.gov/teamstepps-program/index.html

Psychiatric Mental Health Nursing Scope and Standards of Practice. 3rd Ed.
APNA. American Psychiatric Nurses Association.  (2022). https://www.nxtbook.com/apna/apna/psychiatric_mentalhealthnursing_3/index.php

Transforming Health Care and Strengthening Results
Kolouroutis, M. (2022). Creative Healthcare Management. https://chcm.com/news-events/why-relationship-based-care/

Building a Safe Workplace and Community.- Violence Mitigation in a Culture of Safety
AHA (2021) American Hospital Association. Issue Brief. https://www.aha.org/issue-brief/2024-05-14-issue-brief-building-safe-workplace-and-community-violence-mitigation-culture-safety

The Sanctuary Model of Trauma-Informed Organizational Change
Bloom, S. (2007). https://www.researchgate.net/publication/242222586_The_Sanctuary_Model_of_Trauma-Informed_Organizational_Change

References:

Effectiveness of Trauma-Informed Care Implementation in Health Care Settings:
Goldstein, E., Chokshi, B., Melendez-Torres, G. J., Rios, A., Jelley, M., & Lewis-O’Connor, A. (2024). Effectiveness of Trauma-Informed Care Implementation in Health Care Settings: Systematic Review of Reviews and Realist Synthesis. The Permanente journal, 28(1), 135–150. https://doi.org/10.7812/TPP/23.127.

Workplace violence against healthcare workers: an umbrella review of systematic reviews and meta-analyses:
Rossi, M. F., Beccia, F., Cittadini, F., Amantea, C., Aulino, G., Santoro, P. E., Borrelli, I., Oliva, A., Ricciardi, W., Moscato, U., & Gualano, M. R. (2023). Workplace violence against healthcare workers: an umbrella review of systematic reviews and meta-analyses. Public health, 221, 50–59. https://doi.org/10.1016/j.puhe.2023.05.021

Psychological effects of professional exposure to trauma and human suffering:
Velasco J., Sanmartín F. J., Gálvez-Lara M., Cuadrado F., Moriana J. A. (2023). Psychological effects of professional exposure to trauma and human suffering: Systematic review and meta-analysis. Trauma, Violence, & Abuse, 24(3), 1656–1676. https://doi.org/10.1177/15248380221074314

Patient Safety Culture: The Impact on Workplace Violence and Health Worker Burnout:
Kim, S., Kitzmiller, R., Baernholdt, M., Lynn, M. R., & Jones, C. B. (2023). Patient Safety Culture: The Impact on Workplace Violence and Health Worker Burnout. Workplace health & safety, 71(2), 78–88. https://doi.org/10.1177/21650799221126364.

Patient-centered care: achieving higher quality by designing care through the patient’s eyes:
Edgman-Levitan, S., & Schoenbaum, S. C. (2021). Patient-centered care: achieving higher quality by designing care through the patient’s eyes. Israel journal of health policy research, 10(1), 21. https://doi.org/10.1186/s13584-021-00459-9

Moral distress and psychiatric nursing:
Pearson G. S. (2021). Moral distress and psychiatric nursing. Journal of the American Psychiatric Nurses Association, 27(6), 441–442. https://doi.org/10.1177/10783903211051998

Spiritual knowing in psychiatric nursing:
Pearson G. S. (2019). Spiritual knowing in psychiatric nursing. Journal of the American Psychiatric Nurses Association, 25(3), 168–169. https://doi.org/10.1177/1078390319843124

Safety of Psychiatric Inpatients at the Veterans Health Administration:
Marcus, S. C., Hermann, R. C., Frankel, M. R., & Cullen, S. W. (2018). Safety of Psychiatric Inpatients at the Veterans Health Administration. Psychiatric Services, 69(2), 204-210. https://doi.org/10.1176/appi.ps.201700224

Communication skills training in the management of patient aggression and violence in healthcare:
Baby, M., Gale, C., & Swain, N. (2018). Communication skills training in the management of patient
aggression and violence in healthcare. Aggression and Violent Behavior, 39, 67-82.
https://doi.org/10.1016/j.avb.2018.02.004

What are effective strategies for implementing trauma-informed care in youth inpatient psychiatric and residential treatment settings?
Bryson, S. A., Gauvin, E., Jamieson, A., Rathgeber, M., Faulkner-Gibson, L., Bell, S., . . . Burke, S. (2017). What are effective strategies for implementing trauma-informed care in youth inpatient psychiatric and residential treatment settings? A realist systematic review. International journal of mental health systems, 11(1), 1-16.

Safety in psychiatric inpatient care: The impact of risk management culture on mental health nursing practice:
Slemon, A., Jenkins, E. & Bungay, V.  (2017). Safety in psychiatric inpatient care: The impact of risk management culture on mental health nursing practice. Nursing inquiry, 24(4): e12199. https://doi.org/10.1111/nin.12199

Engagement as an Element of Safe Inpatient Psychiatric Environments:
Polacek, M. J., Allen, D. E., Damin-Moss, R. S., Schwartz, A. J., Sharp, D., Shattell, M., Souther, J., & Delaney, K. R. (2015). Engagement as an Element of Safe Inpatient Psychiatric Environments. Journal of the American Psychiatric Nurses Association, 21(3), 181–190. https://doi.org/10.1177/1078390315593107

Safewards: a new model of conflict and containment on psychiatric wards:
Bowers L. (2014). Safewards: a new model of conflict and containment on psychiatric wards. Journal of psychiatric and mental health nursing, 21(6), 499–508. https://doi.org/10.1111/jpm.12129.

Improving the Culture of Safety on a High-Acuity Inpatient Child/Adolescent Psychiatric Unit by Mindfulness-Based Stress Reduction Training of Staff:
Hallman, I. S., O’Connor, N., Hasenau, S., & Brady, S. (2014). Improving the Culture of Safety on a High-Acuity Inpatient Child/Adolescent Psychiatric Unit by Mindfulness-Based Stress Reduction Training of Staff. Journal of Child and Adolescent Psychiatric Nursing, 27(4), 183-189. https://doi.org/10.1111/jcap.12091

Practice what you preach: developing person-centered culture in inpatient mental health settings through strengths-based, transformational leadership:
Beckett, P., Field, J., Molloy, L., Yu, N., Holmes, D., & Pile, E. (2013). Practice what you preach: developing person-centred culture in inpatient mental health settings through strengths-based, transformational leadership. Issues in mental health nursing, 34(8), 595–601. https://doi.org/10.3109/01612840.2013.790524

The inpatient psychiatric unit as both a safe and unsafe place: Implications for absconding:
Muir‐Cochrane, E., Oster, C., Grotto, J., Gerace, A., & Jones, J. (2013). The inpatient psychiatric unit as both a safe and unsafe place: Implications for absconding. International Journal of Mental Health Nursing, 22(4), 304-312.

Effectiveness of formal observation in inpatient psychiatry in preventing adverse outcomes:
Manna, M. M. (2010). Effectiveness of formal observation in inpatient psychiatry in preventing adverse outcomes: the state of the science. Journal of Psychiatric and Mental Health Nursing, 17(3), 268-273. https://onlinelibrary.wiley.com/doi/10.1111/j.1365-2850.2009.01512.x

A Review of Ecological Factors Affecting Inpatient Psychiatric Unit Violence: Implications for Relational and Unit Cultural Improvements:
Hamrin, V., Iennaco, J., & Olsen, D. (2009). A Review of Ecological Factors Affecting Inpatient Psychiatric Unit Violence: Implications for Relational and Unit Cultural Improvements. Issues Ment Health Nurs, 30(4), 214-226. https://doi.org/10.1080/01612840802701083.

Peplau’s Theory of Interpersonal Relations
Peplau, H. (1997). Peplau’s Theory of Interpersonal Relations. Nursing Science Quarterly. 1997;10(4):162-167. https://journals.sagepub.com/doi/10.1177/089431849701000407

Watson’s Caring Science
Watson, J. (1979)). Watson’s Caring Science. https://www.watsoncaringscience.org/about-wcsi/jean-bio/caring-
science-theory/