Application of the Plan-Do-Check-Act Management Model to Violence Risk Management in a Psychiatric Ward: Impact on Patient Safety and Nurse-Patient Relationships.

BACKGROUND: Violence in psychiatric wards poses significant risks to patients, staff and the therapeutic environment. Patients with schizophrenia frequently exhibit violent behaviours that compromise safety and disrupt therapeutic relationships. Although reactive crisis management remains the norm, systematic, proactive strategies for violence prevention are scarce. The Plan-Do-Check-Act (PDCA) cycle provides a structured quality improvement framework, yet its effectiveness in psychiatric violence risk management has not been well established. OBJECTIVE: This study aimed to evaluate the effectiveness of the PDCA cycle management model in reducing violent incidents and improving patient satisfaction with nursing care in inpatients with schizophrenia. METHODS: A quasi-experimental study was conducted between April 2021 and April 2022 at Tianshui Third People's Hospital, Gansu Province, China. Four hundred patients with schizophrenia were enrolled and allocated to either a research group (n = 200), receiving PDCA cycle management in addition to standard care, or a control group (n = 200), receiving standard care alone. The Modified Overt Aggression Scale, violence behaviour recording forms and patient satisfaction surveys were used to assess outcomes over an 8-week period. RESULTS: Of the 400 enrolled patients, 331 completed the 8-week study (research group: n = 162; control group: n = 169). After implementing PDCA cycle management, the research group demonstrated significantly lower aggression scale scores (7.54 ± 2.07 vs 10.53 ± 3.99, p < 0.001) and reduced frequencies of verbal aggression, property damage, self-harm and physical assault compared with controls. Patient satisfaction increased significantly in the research group (60.5% "very satisfied" vs 51.5% in controls, p = 0.015). CONCLUSION: The PDCA cycle management model effectively reduces violent behaviour incidence and enhances patient satisfaction in psychiatric wards, offering a systematic approach to violence risk management that strengthens nurse-patient relationships and improves overall care quality.