Index Nature of Violence Violence Risk Assessment Tools Identifying Early Warning Signs In this case, a client named Wong Kai Long who is a 56-year-old taxi driver. He lives with his wife and son in a pub. He worked as a bus driver for 23 years and was fired 1 year ago after being involved in a traffic accident on a bus. According to the information gathered by Mr. Wong, Mr. Wong had mental problems since 3 months ago and repeatedly aroused paranoid ideas that the staff of the previous bus company had banded together to persecute him in the traffic accident. Additionally, his wife stated that he was having trouble sleeping, was mumbling, and even scolded her and their son with foul language for no apparent reason. Three days earlier he had scolded on air as if he heard voices and verbal threats that he would kill the people who were against him in the road accident. On 5 September 2017, in the morning, Mr Wong's wife discovered that Mr Wong had drunk 8 cans of beer. Subsequently, she had a heated conflict with him when she attempted to stop him from drinking beer further. He initially punched her and later attempted to attack her with a knife after discovering she had called the police for help. She left the house immediately and was not seriously injured. Say no to plagiarism. Get a tailor-made essay on "Why Violent Video Games Shouldn't Be Banned"? Get an original essay At 2.30pm, with the assistance of police officers, he was escorted to the emergency department (AED) of Princess Margaret Hospital accompanied by his wife and ambulance officers. When he arrived at the emergency room, he was strapped to a stretcher and struggled vigorously. He was surrounded by the smell of alcohol, emotionally agitated and spoke loudly with foul language. Constantly, he claimed that he was conspired by the staff of the former bus company and expressed ideas of revenge as well as shouting in the air. Mr Wong was subsequently admitted to an inpatient ward at Kwai Chung Hospital under Section 31 of the Mental Health Ordinance. Introduction Mr Wong's threats of violence, active paranoid ideation, persecutory delusions and history of violence were predicted to commit violence after being admitted to the ward. In one study, violence was committed by 20% of people posing a death threat in the past 12 months (Warren, 2011). Violence by a patient poses serious risks to the patient, co-patients and staff (Kettles, Woods & Collins, 2001). Mr Wong is likely to commit serious violence towards others. Nursing staff are always at high risk of being attacked by patients. In a recent survey of 762 registered nurses, 54.2% of them had experienced verbal abuse from patients and 29.9% of them had experienced physical abuse from patients ( Speroni, Fitch, Dawson, Dugan, & Atherton, 2014). Especially in mental health settings, the rate of violence against mental health professionals is three times higher than in general healthcare settings (Hartley & Ridenour, 2011). Within a forensic psychiatric setting, 70% of nursing staff reported having been assaulted in the previous year (Kelly, Subica, Fulginiti, Brekke, & Novaco, 2015). Violence usually occurs when a patient is detained for observation and treatment (Flannery, LeVitre, Rego, & Walker, 2011). Undoubtedly, the violent incident is problematic in the process of providing care (Kettles, Woods & Collins, 2001). It deviates from the quality of care, patient integrity and safety ofnursing staff. Regarding short-term consequences, co-patients and nurses may suffer head injuries, open wounds and bruises (Daffern, Ogloff & Howells, 2003). Furthermore, violence between co-patients can worsen the mental state of other patients such as anxiety and depression. Acutely, victims may suffer from post-traumatic stress disorder with symptoms including sleep disturbances, social withdrawal and difficulty trusting others. In the long term, patients' aggressive behavior would compromise the psychological and social well-being of nurses (Fujishiro, Gee & De Castro, 2011). The impact of patient aggression towards nurses is likely to induce knock-on effects for the patient themselves. Perhaps, the nurse's performance in implementing health care and routine ward tasks could be disturbed (Bowers et al., 2011). Although many psychiatric nurses say that violence is to be expected in their nature of work, there is still a demand for prevention to ensure the safety and delivery of therapeutic healthcare. Considering the high incidence and serious consequences of violent patient behavior in psychiatric health settings, the assessment and prevention of patient violence is crucial as a safety measure for the patient and staff in general and important as a learning issue for expand knowledge (Underwood, 2017). Nature of Violence Hospital violence refers to a series of behaviors or actions by patients who abuse, threaten, harm objects, co-patients and nursing staff. (Nicholls, Brink, Greaves, Lussier & Verdun-Jones, 2009) There are three forms of hospital violence: verbal threats, physical aggression against objects and physical aggression against other people. 3.1 Verbal threats Verbal threats mean that patients make intimidating statements to hurt others regardless of whether they actually intend to do so or have performed any concrete act. For example, patients may make loud noises, shout angrily, swear viciously, use foul language in anger, and make clear threats of violence toward others such as “I'll kill you.” 3.2 Physical aggression against objects Patients may express their aggression or throw tantrums by throwing objects on the ground, kicking furniture and marking the wall. Some patients may even break objects, break windows and start fires. 3.3 Physical aggression against other people Outraged patients may initially make threatening gestures and turn to other people (Jalil, Huber, Sixsmith & Dickens, 2017). Next, they can grab their clothes, pull them by their hair, and push them down. This type of violence can cause minor physical injuries to victims, such as bruises and sprains. Some harsh attacks can cause serious physical injuries to victims such as broken bones, deep lacerations and internal injuries. Violence Risk Assessment Tools Dynamic Situational Aggression Assessment (DASA) has been used in several mental health settings, such as psychiatric intensive care units, involuntary inpatient units, and involuntary inpatient units (Griffith, Daffern, & Godber, 2013). The DASA assessment is a concise and organized tool developed for the assessment of impending aggressive behavior within the next 24 hours. It consists of seven elements which are: negative attitudes, impulsiveness, irritability, verbal threats, sensitivity to perceived provocation, easily angered when requests are denied and reluctance to follow instructions (Ogloff & Daffern, 2006). Furthermore, these items aim to improve predictive validity and help,.