Debbie Kane RN, PhD
Faculty of Nursing, University of Windsor
Windsor, ON
Cristin Moeller B.A., M.A
Dept. of Psychology, University of Windsor
Windsor, ON
Lynda Monik RN, MBA
Sandwich Community Health Centre
Windsor, ON
Purpose: The purpose of this prospective, predictive study was twofold: (1) to evaluate compliance with the current Clinical Risk Assessment Tool and (2) determine whether the screening tool predicts future violent behaviour in patients.
Rationale: The rates of violence and aggression toward nurses in Emergency Departments (ED) are reported to be particularly high (Luck, Jackson, & Usher, 2007; Ryan & Maguire, 2006).The latest account of on-the-job abuse of Canadian nurses suggests that ED nurses report high percentages of both physical (42%) and emotional abuse (69%) at work (Shields & Wilkins, 2009).
Methodology: Registered Nurses assessed patients presenting to the emergency department utilizing their current Clinical Violent Risk Assessment checklist as well as a second AOB (acting out behaviour) checklist, consisting of 6-items. Patient charts were reviewed post discharge to evaluate the accuracy of the Clinical Violent Risk Assessment checklist and the AOB tool.
Sample: A total of 31 Emergency Department nurses participated in the study and assessed 964 patients over the course of 4 weeks.
Results: Nurses identified a total of 71 primary risk factors and 10 secondary risk factors in all patients. A total of 10 patients exhibited acting-out behaviour throughout the research period. Six out of the ten patients that acted-out had been assessed using the Clinical Risk Assessment Tool and had been deemed not at risk of acting out. Two patients that acted-out had been assessed using the Clinical Risk Assessment Tool and had been deemed at risk of acting out. Another two patients had not been assessed using the Clinical Risk Assessment Tool.
Discussion: ED nurses demonstrated strong compliance in the use of the Clinical Risk Assessment Tool but were significantly less compliant in following the AOB flagging procedure. Due to the very low number of actual acting-out behaviours recorded, predictive ability of the Clinical Risk Assessment Tool could not be completed with the present sample.