VIOLENT PATIENTS

You have started the shift and you are walking down the ward corridor to introduce yourself to your patients.

As you walk past a patient, you observe that they are mumbling incoherently, pacing back and forwards and they are staring right at you.

At the shift change, you were advised that one of the patients on the ward had a high risk for violence.

Workplace violence (WPV) is a global problem.

And one quarter of all workplace violence occurs in healthcare.

The usual workplace practice is to give nurses a generic training session about WPV which usually is not followed up with any meaningful refreshing of knowledge.

A West Australian hospital tried ward specific training of how to identify patients with a high risk of violence.

The study “Assessing the effectiveness of clinical education to reduce the frequency and recurrence of workplace violence.”1. used educational intervention to reduce the incidents of violence.

The study looked at violent perpetrators on general medical wards with medical disorders.

The common characteristics of the perpetrators that posed a high risk of violence were

  1. a history of violence
  2. substance abuse
  3. cognitive dysfunction.

A past history of violence is the greatest predictor of future violence.2

The behaviours that are warnings of potential violence are known as STAMP.3

1. Staring and eye contact

2. Tone and volume of voice

3. Anxiety

4. Mumbling

5. Pacing

 

Recognising predictors of violence and implementing de-escalation influences the outcome of potentially violent situations.

Early contact with clinical experts should be made when high risk patients are identified, not after an incident has occurred.

Nurses who are most vulnerable to patient violence were alone and had less than four years experience.

So nurses should not enter the patient room alone.

Once the risk has been identified as high for a patient, it is important the risk is documented, verbally reported at shift changes and everyone on the ward is made aware of the risk.

It is not only nurses in hospitals that are the victims of WPV.

It is all your hospital colleagues.

Verbal de-escalation was effective in reducing the incidents of WPV. 

To learn more about violent patients:

  1. Adams, Jillian. “Assessing the effectiveness of clinical education to reduce the frequency and recurrence of workplace violence.” Australian Journal of Advanced Nursing 34.3 (2017).
  2. Ferns, Terry. “Violence in the accident and emergency department–An international perspective.” Accident and emergency nursing 13.3 (2005): 180-185.
  3. Luck, Lauretta, Debra Jackson, and Kim Usher. “STAMP: components of observable behaviour that indicate potential for patient violence in emergency departments.” Journal of Advanced Nursing 59.1 (2007): 11-19.