Predictive Behavioral Cues of Patient Violence in the Emergency Department

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