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

• Published in: Emergency medicine Australasia 2024-06, Vol.36 (3), p.459-465
• Main Authors: Ilarda, Elisa, Senz, Ainslie, Tynan, Anna, McIlveen, Peter
• Format: Article
• Language: English
• Subjects: Adult; Attitude of Health Personnel; Bröset Violence Checklist; Checklist; emergency department; Emergency Service, Hospital; Female; Focus Groups - methods; Humans; Male; Middle Aged; Nurses - psychology; Nurses - statistics & numerical data; Nursing Staff, Hospital - psychology; patient violence; Risk Assessment - methods; Risk Factors; Workplace Violence - psychology; Workplace Violence - statistics & numerical data
• ISSN: 1742-6731; 1742-6723
• DOI: 10.1111/1742-6723.14388

Objective Work‐related violence remains a significant problem in healthcare settings, including EDs. Violence risk assessment tools have been developed to improve risk mitigation in this setting; however, incorporation of these tools into standard hospital processes remains scarce. This research aimed to explore nurses' perspectives on the Bröset Violence Checklist used in routine violence risk assessment and their recommendations for additional items. Methods Thirty nursing staff who used the Bröset Violence Checklist (BVC) as standard practice for 5 years participated in two focus groups where 23 violence risk factors were presented. Using multiple methods, participants were asked to select and elaborate from a pre‐determined list what they considered most useful in violence risk assessment in respect to descriptors and terminology. Results Quantitative data showed most risk factors presented to the group were considered to be predictive of violence. Ten were regarded as associated with risk, and overt behaviours received the highest votes. The terms ‘shouting and demanding’ was preferred over ‘boisterous’, and ‘cognitive impairment’ over ‘confusion’. Patient clinical characteristics and staff perceptions of harm, inability to observe subtle behaviour, imposed restrictions and interventions and environmental conditions and impact were also important considerations. Conclusions We recommend that violence risk assessment include: history of violence, cognitive impairment, psychotic symptoms, drug and alcohol influence, shouting and demanding, verbal abuse/hostility, impulsivity, agitation, irritability and imposed restrictions and interventions. These violence risk factors fit within the four categories of historical, clinical, behavioural and situational. This research aimed to explore nurses' perspectives on the Bröset Violence Checklist used in routine violence risk assessment. The findings produced recommendations for additional items.