Risk factors for violence in an emergency department: Nurses' perspectives

Area of Science:

• Healthcare Management
• Nursing Practice
• Patient Safety

Background:

• Work-related violence is a persistent issue in healthcare, particularly in emergency departments (EDs).
• Existing violence risk assessment tools are underutilized in standard hospital procedures.
• Nurses' insights are crucial for refining violence risk assessment strategies.

Purpose of the Study:

• To explore nurses' perspectives on the Bröset Violence Checklist (BVC).
• To identify nurses' recommendations for improving violence risk assessment tools.
• To enhance the incorporation of violence risk assessment into routine hospital practices.

Main Methods:

• Two focus groups were conducted with 30 nurses who had used the BVC for at least 5 years.
• Participants evaluated 23 pre-determined violence risk factors for their utility in assessment.
• Qualitative and quantitative methods were used to gather feedback on descriptors and terminology.

Main Results:

• Most presented risk factors were deemed predictive of violence, with overt behaviors receiving high ratings.
• Preferred terminology included 'shouting and demanding' over 'boisterous' and 'cognitive impairment' over 'confusion'.
• Key considerations included patient clinical characteristics, staff perceptions of harm, and environmental factors.

Conclusions:

• Recommended additions to violence risk assessment include history of violence, cognitive impairment, psychotic symptoms, and substance influence.
• Behavioral indicators such as shouting, verbal abuse, impulsivity, agitation, and irritability are vital.
• Situational factors like imposed restrictions and interventions should also be incorporated into a comprehensive risk assessment framework.