Predictive Behavioral Cues of Patient Violence in the Emergency Department

Abstract

Nurses are often subject to violence at the hands of their patients. The Emergency Department (ED) has become the area most vulnerable in the hospital setting, with contributing factors including the rise of polysubstance drug abuse, the increasing psychiatric population, and overall stressors related to the economy. The ED is the "gateway" to the availability of shelter, medications, and resources for many people that pass through every year. Accurate and timely identification of the most common and easily identifiable precursors of violence is essential in order to develop and implement effective de-escalation techniques that have the potential to reduce actual events. The purpose of this research project was to demonstrate the usefulness of a behavioral cue assessment tool in providing a simple predictor for potential violence in the ED setting.The methodology included a behavioral assessment checklist containing 17 cues developed by Wilkes, Mohan, Luck and Jackson (2010). Nurses completed the 17 item behavioral assessment on all patients being treated in the ED during a three-week time period. All 17 behavioral cues demonstrated a positive predictive factor for violence based on statistical analysis. Given the simplicity, cost effective nature, and predictability, the checklist appears to be feasible to use to potentially reduce healthcare costs related to injuries and emotional distress of nurses at the hands of violent patients.Further research is indicated. This study further exemplifies the qualities of an advanced practice registered nurse (APRN), including research, education, cost containment, and improved patient care. Statement of ProblemWorkplace violence is a complicated and often underreported occupational hazard that has become almost a social norm in the health care setting (Pich, Hazelton, Sundin, & Kable, 2010). In 2002, the National Institute for Occupational Safety and Health (NIOSH) defined workplace violence as violent acts (including physical assaults and threats of assaults) directed towards persons at work or on duty. Workplace violence is further defined as physical assault, emotional or verbal abuse, and threatening, harassing or coercive behavior that causes physical or emotional harm (NIOSH, 2002). At particular risk are members of the nursing profession and others with continued patient contact in high anxiety-type situations.The most common types of physical violence reported by the nurse respondents in a study conducted by the Emergency Nurses Association (ENA) included being "spit on", "hit", "pushed/shoved", "scratched" or "kicked" (Gacki-Smith et al., 2009). Verbal abuse was reported by nearly 70% of respondents, with the most common examples being "yelled/cursed at", "intimidated" and "harassed with a sexual language/innuendo". (2012) discussed the psychometric properties of violence assessment tools and identified the need for such tools to determine overall usefulness as demonstrated by a satisfactory sensitivity, specificity, and inter-rater reliability. Also to...