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Updated: May 10, 2026

Setting Up a Stroke Team Algorithm and Conducting Simulation-based Training in the Emergency Department - A Practical Guide
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Published on: January 15, 2017

From Situational Awareness to Structured Action: Developing a Nurse-Led Trigger-Based Pathway for Dynamic Violence

Lanxin Ouyang1, Peiwen Zhang1, Yudi Du1

  • 1Department of Emergency, the Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.

Journal of Clinical Nursing
|May 8, 2026
PubMed
Summary

Workplace violence risk in emergency departments (EDs) is dynamic. A new nurse-led pathway using trigger-based reassessments effectively manages evolving violence risk by operationalizing situational awareness for earlier intervention.

Keywords:
emergency departmentmixed‐methods studyrisk assessmentsituational awarenesstriageworkplace violence

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Area of Science:

  • Emergency Medicine
  • Nursing
  • Healthcare Management
  • Violence Prevention

Background:

  • Workplace violence is a significant issue in emergency departments (EDs).
  • Current violence risk assessments are often static, performed only at triage.
  • Evolving risk factors during patient care necessitate dynamic assessment strategies.

Purpose of the Study:

  • To develop and pilot a nurse-led, triage-embedded pathway for dynamic violence risk management.
  • To integrate nurses' situational awareness into structured, actionable risk management protocols.
  • To pilot a trigger-based system for continuous violence risk assessment in the ED.

Main Methods:

  • A mixed-methods approach combining quantitative and qualitative data.
  • Quantitative data collection on trigger-initiated reassessments using the Dynamic Appraisal of Situational Aggression (DASA) scale.
  • Qualitative focus groups to explore trigger recognition, reassessment decisions, and response strategies.

Main Results:

  • 172 (2.0%) of 8443 ED encounters involved trigger-initiated reassessments.
  • Reassessments frequently occurred during waiting/transition phases and correlated with increased DASA scores.
  • Nearly all aggressive incidents were associated with reassessments, highlighting the pathway's effectiveness.

Conclusions:

  • Violence risk in EDs is dynamic and context-dependent.
  • A trigger-based pathway operationalizes nurses' situational awareness for proactive risk management.
  • This approach supports earlier and more feasible interventions for workplace violence in emergency care.