Acceptability and psychometric properties of Brøset Violence Checklist in psychiatric care settings in China

Abstract

Short-term risk assessment instrument owns great importance for psychiatric nurses in China; however, the lack of a standardized violence risk assessment instrument has disadvantaged them in clinical practice. The Brøset Violence Checklist (BVC), a behavioural observation tool, is the most frequently cited instrument available for evaluating violence risk in psychiatric inpatients, then worth to be tested in Chinese culture. This study, conducted in two closed wards in a psychiatric hospital in Beijing, revealed that the instrument has favourable reliability, validity and predictive accuracy in Chinese population. BVC provides nurses with a quick and easily administered method to screening out patients with violence potential, thus allowing for early intervention. Feedback from the nurses was quite encouraging and the further use of BVC seems promising. The lack of standardized violence risk assessment instrument has disadvantaged nurses in clinical practice in China, where violent behaviour is an increasing problem. This study conducted a validation of the Brøset Violence Checklist that has proven effective in violence risk prediction in other countries. A sample of 296 patients consecutively admitted to two wards of a psychiatric hospital in Beijing was recruited. These patients were assessed on day shift and evening shift for the first seven days of hospitalization. Violence data and preventive measures were concurrently collected from nursing records and case reports. A total of 3707 assessments for 281 patients were collected revealing 93 episodes of violence among 55 patients. Receiver operating characteristics yielded an area under the curve of 0.85. At the cut-off point of one, its sensitivity/specificity was 78.5%/88.2% and the corresponding positive/negative predictive value was 14.6%/99.4%. In some false positive cases, intense preventive measures had been implemented. Positive feedback from the nurses was gained. The Brøset Violence Checklist was proved as an easy-to-use and time-saving instrument, therefore, regarded as a promising tool to determine if the psychiatric users are potentially violent in the short term.

Risk assessment and subsequent nursing interventions in a forensic mental health inpatient setting: Associations and impact on aggressive behaviour

“…Several studies have investigated the psychometric properties of the BVC (Almvik, Woods, & Rasmussen, 2000;Bjorkdahl, Olsson, & Palmstierna, 2005;Hvidhjelm, Sestoft, Skovgaard, & Bue Bjorner, 2014;Yao et al, 2014) and the DASA (Barry-Walsh, Daffern, Duncan, & Ogloff, 2009;Chu et al, 2013;Dumais, Larue, Michaud, & Goulet, 2012;Griffith, Daffern, & Godber, 2013;Vojt, Marshall, & Thomson, 2010). Two cluster randomised controlled trials have demonstrated that the use of the BVC resulted in less aggression and a decreased use of restrictive practices (e.g., seclusion, mechanical restraint and the forced injection of medication) (Abderhalden et al, 2008;van de Sande et al, 2011).…”

The validity and utility of violence risk assessment tools to predict patient violence in acute care settings: An integrative literature review

“…Inter‐rater reliability for the BVC has been reported in four studies. In the Yao et al () study, the inter‐rater reliability for single item ranged from ICC = 0.41–0.76 with a total ICC = 0.84. Similarly, Almvik et al () reported Kappa values ranging from 0.48 to 1.0 for single item with 100% agreement for the ‘attacking objects’ item, and r = 0.64–1.0 reported by Abderhalden et al ().…”

Assessing the risk of violence in a psychiatric clinic: the Brøset Violence Checklist (BVC) Turkish version—validity and reliability study

“…This checklist is regarded as a tool that can predict violent behavior, it is fast and easy to use, and it can readily be integrated with day‐to‐day clinical applications to supplement clinical evaluations . The BVC is widely used in a variety of settings worldwide, for example, Norway, Sweden, Switzerland, Canada, Denmark, Portuguese, and China …”

“…5,11 The BVC is widely used in a variety of settings worldwide, for example, Norway, 11 Sweden, 18 Switzerland, 16 Canada, 5,22 Denmark, 2 Portuguese, 12 and China. 23 The determination of risks, such as the risk of suicide, risk of falling, and risk of violence, as well as taking necessary measures, is necessary for the psychiatric clinics to ensure the safety of workers and patients. As in all countries, violent behavior in psychiatric inpatients in Turkey can be common.…”

“…It was argued that unnecessary preventive precautions for violence could be decreased in this manner. 25 Yao et al, 23 carried out a study in China in which a cutoff of 2 points resulted in an AUC of 0.87; the sensitivity was 62.8% and the specificity was 96.2. In contrast, it was determined in the current study, carried out in Turkey that a cutoff of 2 points was sufficient for predicting violence within 24 hours.…”