Document Type

DNP Project


School of Nursing

Date of Degree

Spring 2021


Doctor of Nursing Practice (DNP)

Primary Advisor

Mary Jean Schumann, DNP, MBA, RN, CPNP-PC, FAAN; Bernice D. Mowery, PhD, RN


patient violence, emergency department, nurses, providers, Brøset Violence Checklist


Background: Patient violence in healthcare is an issue across many departments, but many staff members in the emergency department (ED) are directly affected by violent incidents.

Objectives: Three primary purposes determined the success of this Quality Improvement (QI) project: 1) to evaluate the effectiveness of utilizing the Brøset Violence Checklist (BVC) and implementing appropriate interventions to reduce the number of physical assault occurrences against healthcare providers in the ED; 2) to assess if there was an increase in reporting patient violence incidents; and 3) to assess for any improvements in perceived safety in the ED among the nurses.

Methods: Adult patients ages 18-years and older seen in the ED received a risk score based on the BVC. The nurse implemented appropriate interventions according to a Patient Violence Score and Interventions Algorithm. Second, each nurse was asked to complete an online pre- and post-implementation survey to assess improvements in nurses’ perception of safety regarding patient violence. Third, the number of reported physical assault incidents in the ED during two months was compared to the same two months in the year prior.

Results: It was challenging to assess the BVC’s effectiveness due to the limited sample size and short duration of the project. During the two months, 2.7% of the 29.8% of adult patients assessed had a high risk score > 2. However, there were more physical assault incidents reported compared to the previous year. While 24 nurses participated in the pre-implementation survey, 11 nurses participated in the post-implementation survey. More nurses felt safe in their workplace compared to those who did not in both surveys. A Fisher’s Exact test (FET) was conducted for the survey, along with a Chi-square test (χ2) only when FET was not available. Statistical significance was set at p < .05.

Conclusion: Results identified there was an increase in reporting violent incidents. However, it was difficult to assess whether the BVC and implementation of appropriate interventions decreased physical assault occurrences in the ED. Although more nurses felt safe at their workplace than not, it was difficult to determine if there was an improvement in their perception of safety due to less than half of the nurses completing the post-implementation survey.

Recommendations: Having the BVC and associated interventions electronically available as part of the Electronic Medical Records (EMR) will improve its use by nurses in the ED, as would simplifying the process of reporting incidents of violence using the hospital reporting system.

Open Access


Included in

Nursing Commons



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