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The Resident-intruder Paradigm: A Standardized Test for Aggression, Violence and Social Stress
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Aggressive Behaviour Risk Assessment Tool for Hospitalised Patients in Non-Psychiatric Inpatient Units.

Son Chae Kim1, Chris Vejnovich2, Lyndsi Hall2

  • 1School of Nursing, Point Loma Nazarene University, San Diego, California, USA.

Journal of Advanced Nursing
|October 7, 2024
PubMed
Summary

A refined tool, the Aggressive Behaviour Risk Assessment Tool for Hospitalised Patients (ABRAT-H), effectively identifies potentially violent patients in general hospital units. This validated electronic assessment aids in targeted interventions to enhance patient and staff safety.

Keywords:
inpatient unitsnon‐psychiatricscreening toolsensitivityspecificityworkplace violence

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Area of Science:

  • Clinical Psychology
  • Healthcare Management
  • Patient Safety

Background:

  • Assessing and managing aggressive behavior in non-psychiatric inpatient settings is crucial for patient and staff safety.
  • Existing tools may require refinement for electronic use and validation in diverse hospital units.

Purpose of the Study:

  • To electronically refine and validate the Aggressive Behaviour Risk Assessment Tool (ABRAT).
  • To determine the sensitivity and specificity of the refined tool for identifying potentially violent patients in non-psychiatric inpatient units.

Main Methods:

  • A prospective cohort study included 1179 patients across three inpatient units in Nebraska.
  • The 10-item ABRAT was administered daily for the first three days, with violent events categorized until discharge.
  • Statistical analyses, including Kendall's tau and logistic regression, were used to select predictive items.

Main Results:

  • The revised six-item tool, ABRAT for Hospitalised Patients (ABRAT-H), demonstrated an Area Under the Curve of 0.82.
  • Sensitivity was 68.1% and specificity was 85.2% at a cutoff score of two.
  • A higher ABRAT-H score correlated with an increased likelihood of violent events, with 55.2% of patients scoring ≥5 exhibiting violence.

Conclusions:

  • ABRAT-H is a useful tool for identifying potentially violent patients in non-psychiatric inpatient units, offering satisfactory sensitivity and specificity.
  • The tool can facilitate targeted preventive measures, reducing violent incidents and improving the safety of the healthcare environment.
  • Implementing ABRAT-H can enhance a culture of safety, positively impacting nursing staff well-being and overall patient care quality.