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To examine triggers, responses, and outcomes for patient-related violence and/or aggression events during acute hospitalisation.
This was a descriptive observational study undertaken at two healthcare organisations.
Pre-existing data were extracted from organisational incident reports and individual medical records during a retrospective period (1/1/2023 to 30/6/2023) and a prospective period (7/6/2024 to 16/11/2024). Violence and/or aggression events requiring an organisational response that involved patients hospitalised in general ward areas at a metropolitan (Site A) and a regional (Site B) site were included. Data were analysed using descriptive statistics and content analysis.
The sample included 100 retrospective cases and 42 prospective cases. The most prevalent causes for hospitalisation related to a medical or mental health condition and dementia. Confusion and irritability were the most common forms of behaviour of concern prior to the event. Physical restraint was utilised more frequently in the prospective period compared with the retrospective period. Chemical restraint was used in approximately half of the cases in both study periods. A form of physical violence was the most prevalent behavioural symptom in both periods, followed by verbal aggression and inability to be re-directed.
Patients with a pre-existing medical condition, confusion and/or dementia are frequently involved in violent and/or aggressive events in ward settings. Physical and chemical restraints are commonly used to manage violence and aggression.
Alternative strategies are needed to manage occupational violence and aggression to minimise the need for physical and/or chemical restraint.
This study addresses a gap in evidence regarding triggers, responses and outcomes for patients exhibiting violence and aggression in ward settings during hospitalisation. Patients with dementia, confusion and irritability frequently exhibit behaviours of concern, exposing healthcare workers to potential physical and psychological harm.
STROBE checklist.
This study did not include patient or public involvement in its design, conduct, or reporting.
To evaluate the relationship between the Bröset Violence Checklist and additional risk factors identified in prior research by our team to determine which combination best predicted an emergency response to a violent incident in an emergency department.
A prospective observational study was used to collect data about a single cohort of adult patients admitted in August 2024.
Nurses who use the Bröset Violence Checklist as part of routine observations scored eight additional violence indicators and recorded security incidents.
Data from 5634 observations, 1762 patients, and 68 emergency incidents was analysed using a combination of descriptive and inferential statistics to evaluate the relationship between factors and incidents. Seven factors correlated significantly with violence (p < 0.05). Three factors (verbal threats, physical threats, and attacking objects) were excluded as they represent manifestations of violence rather than predictive indicators. Receiver Operating Characteristics analysis of the combination of the remaining four factors (history of violence, drug and/or alcohol influence, agitation/restlessness, and imposed restrictions) revealed an Area Under the Curve of 0.98.
The findings were integrated to develop a revised instrument—the Aggression and Violence Evaluation of Risk Tool. This new tool demonstrates equivalent predictive capability to the Bröset Violence Checklist, yet it is simpler and easier to use.
Context-specific violence assessment schemes are needed to strengthen risk mitigation strategies. The Aggression and Violence Evaluation of Risk Tool incorporates unique situational risks developed specifically for emergency departments. It has the potential to effectively ameliorate violence risk and enhance worker and patient safety.
STROBE has been followed.
The findings produced an instrument that can be translated to emergency departments to reduce the prevalence of violence.
Limited patient and public involvement comprising observations of adult patients in an emergency department in Melbourne, Australia.
FreshRSS 