Issues in the measurement of violent incidents and the introduction of a new scale: the 'attacks' (attempted and actual assault scale)

Objective: To review the strengths and weaknesses of existing violent incident measures, and introduce a new scale, the 'attacks'. The new scale provides an objective measure of incident severity and focuses on interpersonal physical violence in isolation from other behaviours. Method: The new scale was piloted on six psychiatric wards in the East End of London over a period of 16 weeks. Descriptive data were obtained and validated against official violent incident records. Results: There were 40 incidents by 21 aggressive patients, most of which occurred on the psychiatric intensive care unit. Striking assaults predominated. Continuous holding of the patient by nurses occurred after 17% of incidents. Special observation was also used as a subsequent management method in more than half of the incidents. Conclusion: The scale is acceptable to nurses and valid. Interesting questions are raised about the content of training for staff in the prevention and management of violent incidents.