Risk Assessment of Violence to Others: Time for Action
Brian McKenna, RCpN, BA, MHSc (Hons) Senior Lecturer, Division of Nursing, the University of Auckland Nurse Advisor, Auckland Regional Forensic Psychiatric Services Waitemata District Health Board
Reference: McKenna, B. (2002). Assessment of violence to others: Time for action. Nursing Praxis in New Zealand, 18(1), 36-43.
Possible expansion in the scope of practice of mental health nurses, together with the prevalence of nurses being assaulted by patients, accentuates the need for nurses to be more skilled in risk assessment. A literature search was undertaken on the topics of risk assessment, dangerousness, aggression, and violence in the data bases of CINAHL, MEDLINE and PSYCHLIT, in order to determine an evidence based approach to risk assessment of patient violence towards others. In the absence of reliable and valid nursing risk assessment measures, the approach suggested here focuses on the use of observation skills to detect behaviour antecedent to physical assault, and the ability to systematically assess evidence based risk factors of violent action. Given this rudimentary framework, there is the need to adapt it to specific clinical settings. Failure to proceed rapidly with such developments may jeopardise the safety of both patients and staff.
Risk assessment, aggression, dangerousness, violence
Nurses in New Zealand face challenges which highlight the need for a systematic approach to the risk assessment of violence by patients towards others. Firstly, there is the potential for mental health nurses to expand their scope of practice by being appointed as 'responsible clinicians' under the Mental Health (Compulsory Assessment and Treatment) Act 1992 (Ministerial Taskforce on Nursing, 1998). This role involves the overall management of the care and treatment of patients, who in meeting the legal criteria for involuntary treatment, are often deemed to be at risk of harming others (Department of Health, 1992). Competency in risk assessment is a requirement for undertaking this role, yet inquiries into homicides and serious violence by psychiatric patients, indicate that this skill requires further development (Simpson, Allnutt, & Chaplow, 2001).