The Usefulness of the Violence Assessment Tool (VAT) in Assessing Potentially Violent Patients in the Acute Care Setting

Wednesday, 1 August 2012: 3:50 PM

Lesley M. Wilkes, PhD, MHPEd, GradDipED, CM, RN
Clinical Nursing Research Unit, Nepean Blue Mountains Local Health Area/University of Western Sydney, Penrith, Australia
Debra Jackson, RN, PhD
Faculty of Nursing, Midwifery and Health, University of Technology Sydney, Sydney, Australia
Lauretta Luck, RN, BA, MA, PhD
School of Nursing and Midwifery, University of Western Sydney, Penrith South DC NSW, Australia

Learning Objective 1: Recognise the common behavioural cues in patients with potential for violence.

Learning Objective 2: Understand the significance of behavioural cues in predicting potential violence.


Violence against nurses has increased exponentially in the past decade. This research project aimed to test the usefulness of a violence assessment tool (VAT ) using behavioural cues to identify potentially violent  patient in  the acute care setting.


Non participatory observation in acute care area were use to test the VAT which was developed from  prior work of the team using  observation in the emergency department to determine behavioural cues  and a Delphi technique to refine the cues that  were considered to  be displayed by violent patients. A subsequent  check list of 18 cues and nine potential nonphysical and physical violent acts was used by the observers.  Descriptive statistics were used to the frequencies of cues and violent  acts observed, Odd ratios were calculated to determined the usefulness of the behavioural cues to predict violent acts with a p value of less than 0.05 considered significant. 


A  total of 1150 hours of observation were undertaken  in  four acute hospital units with most being undertaken in emergency department as over time this was seen to be the most common area where patients were most commonly observed  to be  violent.

Two hundred and twenty patient displayed violent behavioural cues  these patient often displayed more than one cue during the observation period. Total number of cues observed was 1432.  The most common cues were increased volume of speech , irritability and intense glaring.  Forty four patient who displayed cues became violent. The most common violent acts were escalated yelling, kicking and shoving.

Using odds ratio calculation eight behavioural cues were seen to significantly predict violent acts.   

Conclusion: The VAT using the eight predictive behavioural cues can be use to assess potentially violent patients. The cues are easily observed and can  be used  by nurses with minimal mental health education