Psychometric Analysis of the Brøset Violence Checklist in Medical-Surgical Nursing Units

Background: Workplace violence against nurses is a pervasive problem within hospital settings. Predictive tools which could assist with identifying patients who may commit violence while hospitalized are needed in the medical surgical care areas. The Br & oslash;set violence checklist (BVC) is a six-item checklist to assess patients and determine if the patient may become violent within the next 24 hours. The BVC has been validated in psychiatric and emergency department settings but not yet established in the medical-surgical inpatient settings. The purpose of this retrospective secondary data study was to determine validity and reliability metrics for the BVC within medical-surgical inpatient settings. Methods: This study utilized data from the electronic health record and safety reporting system from four medical-surgical settings within a large academic healthcare system to establish sensitivity and specificity of the BVC as well as establish inter-reliability of BVC users. Findings: Of the 36,155 BVC assessments on 4437 patients included in the analysis, the BVC was a good predictor of violence. As expected, the analysis found that the BVC was more specific to accurately identifying negative cases than it was sensitive to identifying positive cases with a specificity of 98% and a sensitivity of 64% and receiver operating characteristics yielded an area under the curve of 0.8. The BVC reliability indicated a strong positive association between nurses and auditors' scores as confirmed by Kendall's coefficient of concordance (W = 0.71, p<0.001). Discussion: The BVC is a valid, reliable, and simple assessment tool to identify patients who may pose a risk for violence in medical-surgical units with strong inter-reliability. Implications to Practice: Integrating the BVC into the medical-surgical clinical areas may provide a validated tool to support proactive interventions to care practices and reduce physical harm of healthcare workers.