Using the Brøset Violence Checklist Beyond Behavioral Health and the ED: A Mixed-Methods Study

Violence initiated by hospitalized patients is increasingly common, prominently affecting nurses. Workplace violence has profound effects beyond physical injury and can lead to nurse turnover and even to nurses leaving the profession entirely. The primary aim of this study was to determine the relationship between Brøset Violence Checklist (BVC) scores and the incidence of violent behavior within 12 hours of BVC assessment among patients on adult medical-surgical, telemetry, progressive care, and intermediate and intensive care units. A secondary aim was to identify nurse perceptions of barriers and facilitators related to BVC use. This mixed-methods study used a retrospective, descriptive cohort study design and included psychometric evaluation of BVC use. Focus groups were held to elicit nurses' perceptions of BVC barriers and facilitators. Psychometric evaluation of BVC use on inpatient adult care units found that the instrument predicted violent behavior within 12 hours at a cutoff score of 1 or higher with a sensitivity of 0.85, a specificity of 0.83, and an area under the curve of 0.89, performing well overall. Five themes emerged from qualitative analysis of the focus group transcripts: feasibility and acceptance, a new awareness allows a proactive approach, the information process, collaboration and coordination, and barriers to implementation. Use of the BVC in inpatient adult care areas presents an opportunity for nurses to plan safer workplace environments.