Awareness of Risk Factors

A vulnerability assessment is the process of identifying, examining and prioritizing the vulnerabilities in a system. Vulnerability assessment involves a conscious awareness of risk factors in the work environment that could increase the potential for injury during violent episodes. This is also known as "target hardening," which is a process of strengthening of the security of an environment to reduce or minimize the risk of attack or injury.

This is of particular importance for nurses since typically, when violence erupts in the hospital setting, it often is the nurse who is the focus of the threats and related acting out, or the person who is expected to intervene as a part of the patient-care role. Subsequently, it is important for nurses to examine methods of vulnerability assessment and strategies for safety promotion.

To conduct a thorough vulnerability assessment, several questions need to be explored:

 • What factors should be considered to be part of a vulnerability assessment?

• When should such an assessment be conducted?

• Why is it so important?

Vulnerability assessment is both internal (personal) and external (environmental). Internal assessment requires the nurse to consider the following:

• What types of patient and family behaviors "push your buttons?"

• Why does it push your buttons?

• How do you tend to respond when your buttons are pushed?

• Do you tend to become angry with an angry patient or family member?

• When you become fearful of an angry client or family member, do your attempts at regaining control increase your level of anger?

Honest introspection to these questions is important since such angry interactions tend to escalate a potentially dangerous situation. Such assessment involves understanding when you are in an emergent and potentially unsafe situation with a patient or their family member.

For example, you are at risk when a client or family member:

• makes verbal threats;

• shows physical aggression toward people or objects; or

• threatens or attempts self-harm or suicide.

You are not necessarily in an unsafe situation when a patient:

 • raises his voice;

• blames you for something that has gone wrong;

• tells you that you are not listening; or

• walks away from you.

External Assessment

External assessment surrounds the potential dangers of the work environment itself. For example, an environmental vulnerability assessment includes a safety examination of the work environment.

Consider the following:

• What are the closest exits in case violence occurs?

• If using an office, how are you seated in relation to the patient? It is always best to sit closest to the door so that if a patient becomes agitated, he cannot block the exit.

• What are the weapons of opportunity in the environment? Weapons of opportunity are blunt or sharp objects that could be used to attack the nurse because they are within arm's reach and readily available.

• What is the emergency call mechanism in case there is violence? If that mechanism cannot be activated or does not work, what is a plan B for safety?

The overarching goal of a vulnerability risk assessment is to prevent harm or injury while simultaneously implementing professional nursing care, support and guidance. This is best achieved when you are able keep yourself and others safe.

Examining the risks of the environment, while maintaining therapeutic surroundings, can maximize patient care and enhance safety. Units can accomplish this goal by considering the following:

• Developing response plans and procedures for potentially violence/escalating situations.

• Improving capability of crisis management teams (and if there is no crisis management policy, working toward developing one).

• Increasing communication and awareness.