Engaging with nurses to develop an occupational violence risk assessment tool for use in emergency departments: A participatory action research inquiry

Validity and reliability of the novel three‐item occupational violence patient risk assessment tool

“…Overall, results indicated that: None of the six individual risk items listed in under patient history achieved a relevant I‐CVI (≥0.78). After discussion and reflection on existing evidence (Cabilan et al, 2020; Pich et al, 2017; Spelten et al, 2020), consensus moderation directed that previous history of aggression (CVI = 0.71) be included as a relevant risk domain of OV. Three of the 15 specific behaviours had a relevant I‐CVI (I‐CVI = 0.86): (a) clenched fist; (b) demanding; and (c) use of threatening language (Table 1). Again, consensus moderation informed by end user input and consideration of previous evidence (Cabilan et al, 2020; Spelten et al, 2020) directed that (d) angry and (e) resisting care behaviours be included as prompting items in the tool, under the domain of behavioural concern, despite both scoring a I‐CVI below the 0.78 threshold. Of the 13 item characteristics associated with clinical presentation domain, two were considered highly relevant (I‐CVI = 0.88).…”

“…Second, while there are prompting or validated tools exploring risks of patient violence in existence, they do not specifically address these important domains. Lastly, when nurses were questioned about essential tool attributes, they believed that for an OV risk assessment tool to be clinically useful it must be comprehensive, brief (i.e., three to five items) and objective (Cabilan et al, 2020).…”

“…• Three of the 15 specific behaviours had a relevant I-CVI (I-CVI = 0.86): (a) clenched fist; (b) demanding; and (c) use of threatening language (Table 1). Again, consensus moderation informed by end user input and consideration of previous evidence (Cabilan et al, 2020;Spelten et al, 2020) directed that (d) angry…”

“…Recognition of the value of patient risk assessment as a tool for OV prevention is growing. For example, ED nurses believe that OV‐specific patient risk assessment could provide them with the opportunity to pre‐emptively identify patients who could perpetrate violence enabling staff to undertake appropriate precautions and instigate early interventions (Cabilan et al, 2020 ). Indeed, several studies exploring the impact of risk assessment affirm that a routine patient risk assessment could reduce OV incidents, negate the need for coercive restraints and/or limit detrimental impacts of OV in EDs (Daniel, 2015 ; Kling et al, 2011 ; Senz et al, 2020 ; Sharifi et al, 2020 ).…”

“…They are present at every stage of the patient's journey from admission to discharge. Generally, ED nurses have a positive attitude towards risk assessment (Cabilan et al, 2020 ; Daniel et al, 2015 ), but their adherence to and perceived utility of risk assessment tools hinge on their compatibility with existing clinical processes (Viljoen et al, 2018 ). For example, in one study (Daniel et al, 2015 ), the implementation of violence risk assessment through direct questioning at triage was unsuccessful because it was incompatible with the usual nursing processes.…”