Determining the frequency, kinds and cues of violence displayed by patients in an acute older person ward environment: findings from an observational study

Abstract

Background. Workplace violence is one of the most complex and significant occupational hazards experienced by nurses in healthcare settings. Verbal abuse and physical violence are particularly prevalent in older person assessment wards, owing to the prevalence of illnesses involving cognitive dysfunction; the high frequency and nature of contact with staff; and the frustration caused by high levels of disability. Aim. To determine the frequency, kinds and cues of violence displayed by patients towards nurses in an acute older person assessment ward environment using a structured observational tool - the Violence Assessment Tool (VAT). Design. Observational study. Method. Non-participant structured observations of behavioural cues for violence towards nurses in an acute older person hospital ward were gathered and analysed. Results. One hundred and twelve hours of observations were undertaken, resulting in 95 behavioural cues for violence in 19 patients. Four of these patients subsequently escalated to physical violence. Pacing around the bed was the only commonality in the behavioural cues of patients who became violent. All patients who became violent had previously demonstrated shoving. Conclusions. To date, the assessment of potentially violent older patients has not been adequately addressed. The VAT may be one way of addressing this challenge through early identification of the more subtle behavioural cues that could indicate potential for violence. Further research on the VAT using a larger data set could determine its predictability for physically violent acts displayed by older people. Implications for practice. The VAT will allow early identification, early deescalation and ultimately a reduction in violence against nurses in acute older person wards.