The Staff Observation Aggression Scale \u2013 Revised (SOAS-R) \u2013 adjustment and validation for emergency primary health care

Tone Morken,Grethe E Johnsen,Tom Palmstierna,Knut Rypdal,Ingrid Hjulstad Johansen,Valborg Baste

doi:10.1186/s12913-018-3157-z

Abstract

BackgroundMany emergency primary health care workers experience aggressive behaviour from patients or visitors. Simple incident-reporting procedures exist for inpatient, psychiatric care, but a similar and simple incident-report for other health care settings is lacking. The aim was to adjust a pre-existing form for reporting aggressive incidents in a psychiatric inpatient setting to the emergency primary health care settings. We also wanted to assess the validity of the severity scores in emergency primary health care.MethodsThe Staff Observation Scale - Revised (SOAS-R) was adjusted to create a pilot version of the Staff Observation Scale – Revised Emergency (SOAS-RE). A Visual Analogue Scale (VAS) was added to the form to judge the severity of the incident. Data for validation of the pilot version of SOAS-RE were collected from ten casualty clinics in Norway during 12 months. Variance analysis was used to test gender and age differences. Linear regression analysis was performed to evaluate the relative impact that each of the five SOAS-RE columns had on the VAS score. The association between SOAS-RE severity score and VAS severity score was calculated by the Pearson correlation coefficient.ResultsThe SOAS-R was adjusted to emergency primary health care, refined and called The Staff Observation Aggression Scale - Revised Emergency (SOAS-RE). A total of 350 SOAS-RE forms were collected from the casualty clinics, but due to missing data, 291 forms were included in the analysis. SOAS-RE scores ranged from 1 to 22. The mean total severity score of SOAS-RE was 10.0 (standard deviation (SD) =4.1) and the mean VAS score was 45.4 (SD = 26.7). We found a significant correlation of 0.45 between the SOAS-RE total severity scores and the VAS severity ratings. The linear regression analysis showed that individually each of the categories, which described the incident, had a low impact on the VAS score.ConclusionsThe SOAS-RE seems to be a useful instrument for research, incident-recording and management of incidents in emergency primary care. The moderate correlation between SOAS-RE severity score and the VAS severity score shows that application of both the severity ratings is valuable to follow-up of workers affected by workplace violence.

Highlights

Many emergency primary health care workers experience aggressive behaviour from patients or visitors
A total of 350 Staff Observation Aggression Scale - Revised Emergency (SOAS-RE) forms from ten different casualty clinics were registered of which 26 forms lacking Visual Analogue Scale (VAS) severity scores and 33 forms lacking SOAS severity scores were excluded from the analysis
The Staff Observation Scale - Revised (SOAS-R) was adjusted to emergency primary health care, and found to be well suited for this context, as it is short, easy to fill in, and combines the visual analogue severity scale with a description of elements of the actual incident

Summary

Introduction

Many emergency primary health care workers experience aggressive behaviour from patients or visitors. A substantial number of workers in emergency primary health care experience aggressive behaviour such as verbal aggression, threats or physical violence from patients or visitors [1] These incidents are a threat to the safety and wellbeing of both health care workers and patients [2, 3] A review on workplace violence states that adopting simple incident-reporting procedures is helpful in ensuring safe working environments [4]. Health care services providing emergency and accident medical care are services at high risk of workplace violence [6,7,8] These services differ from inpatient, psychiatric care by providing accessible and unscheduled care for an unselected and largely unfamiliar patient population. They deal with the whole range of clinical scenarios, from minor medical illnesses to serious medical conditions, traumas, toxic exposures, substance abuse and psychiatric emergencies

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