Prevention of Violence in an Acute Psychiatric Unit: Spanish Validation of the Brøset Violence Checklist and Assessment of Its Predictive Capacity for Physical Restraint.

BACKGROUND

The management of violence and restrictive practices in acute mental health units poses a challenge for the design of clinical nursing protocols that combine the safety of professionals and the dignified care of patients. Many of the strategies aimed at reducing seclusion and restraint practices include the use of standardised risk assessment instruments, preferably conducted by the nursing staff. Among them, the Brøset Violence Checklist (BVC) is one of the most widely supported tools.

AIM

To conduct the Spanish validation of the BVC and to explore its predictive validity for violence and for the use of restraint.

METHODS

Prospective data from 115 patients consecutively admitted to an acute unit of a general university hospital were gathered to validate the instrument. The role of risk factors for violence such as gender, age, substance use or the involuntariness of the admission was analysed, both in relation to the BVC score and to the need for physical restraint in the short and middle term (72 h and 1 week).

RESULTS

The Spanish version of the BVC maintains its predictive validity for imminent violence and guarantees excellent inter-rater reliability among mental health nurses. The score in the first shift after admission is significantly associated with increased odds of restraint at 72 h (OR = 7.272), and age with decreased odds (OR = 0.903), with no significant effect of the rest of the variables.

DISCUSSION

The BVC is a reliable tool that seems to capture the risk for violence intrinsic to other factors, such as the involuntariness of admission. Its role in the design of non-restraint policies is discussed.

IMPLICATIONS FOR PRACTICE

BVC is a useful and freely available instrument. Its Spanish version opens up its use in the fourth most widely spoken language.