WellSpan Health, York, PA, USA.
WellSpan Ephrata Community Hospital, Ephrata, PA, USA.
West J Nurs Res. 2024 Sep;46(9):685-691. doi: 10.1177/01939459241271393. Epub 2024 Aug 22.
Workplace violence persists in health care with nurses reporting physical and verbal abuse from aggressive patients causing emotional stress and lost workdays. The Dynamic Appraisal of Situational Aggression-Inpatient Version (DASA-IV) was developed to measure risk for aggression in patients with behavioral health conditions in psychiatric and emergency department settings. The DASA-IV has not been validated with adult patients admitted to medical-surgical units.
To determine whether DASA-IV scores are predictive of aggressive events in adults hospitalized on medical-surgical units.
This multisite study used a case-control design. DASA-IV scores and acts of aggression were extracted from the medical record retrospectively to validate the appraisal's predictability. Receiver operating characteristic (ROC) and area under the curve (AUC) were used to correlate DASA-IV scores with aggressive events.
DASA-IV assessments (N=156 999; mean [SD] 10.1 [10.7]/patient; range 1-220) were collected from 13 611 patients. Patients were primarily White (86.1%) and female (51.7%). Aggression (n = 509 patients; 3.7%) was significantly associated with older age, male sex, smoking, illicit drug use, and high DASA-IV scores. AUC of the ROC analysis for the DASA-IV showed a 97% probability (95% confidence interval [CI] 0.964-0.977) that an aggressive patient would have a higher score on the DASA-IV than a nonaggressive patient. Binary logistic regression predicted that for every point increase in the DASA-IV, there was a 3.51 (95% CI 3.38-3.63) times increased risk for aggression ( 1.255, SE = 0.18, Wald = 4766.6, < .001).
This study is the first to validate use of the DASA-IV in medical-surgical populations, demonstrating predictive ability for aggressive incidents. The DASA-IV can be used successfully in medical-surgical populations for early identification of potential aggression.
医疗机构中的工作场所暴力持续存在，护士报告称，来自攻击性患者的身体和言语虐待导致情绪压力和工作日损失。动态评估情境攻击-住院患者版（DASA-IV）旨在衡量精神科和急诊科行为健康状况患者的攻击风险。DASA-IV 尚未在接受外科和内科治疗的成年患者中得到验证。
确定 DASA-IV 评分是否可预测外科和内科住院患者的攻击事件。
这项多中心研究采用病例对照设计。从病历中回顾性提取 DASA-IV 评分和攻击行为，以验证评估的预测能力。使用接收器工作特征（ROC）和曲线下面积（AUC）将 DASA-IV 评分与攻击事件相关联。
共收集了 13611 名患者的 156999 次 DASA-IV 评估（平均[标准差]10.1[10.7]/患者；范围 1-220）。患者主要为白人（86.1%）和女性（51.7%）。攻击（n=509 名患者；3.7%）与年龄较大、男性、吸烟、非法药物使用和 DASA-IV 评分较高显著相关。ROC 分析 DASA-IV 的 AUC 显示，患有攻击性疾病的患者的 DASA-IV 评分高于非攻击性患者的概率为 97%（95%置信区间 [CI]0.964-0.977）。二元逻辑回归预测，DASA-IV 每增加 1 分，攻击性风险增加 3.51 倍（95%CI 3.38-3.63）（比值比 [OR]3.51，95%CI 3.38-3.63； 1.255，SE =0.18，Wald =4766.6， < .001）。
这项研究首次验证了 DASA-IV 在外科和内科人群中的使用，表明其对攻击事件具有预测能力。DASA-IV 可成功用于外科和内科人群，以早期识别潜在的攻击行为。
