Article Critique: Vital Signs as Predictors of Aggression in Hospitals

This article critique analyzes a prospective case-control study examining the relationship between vital signs and aggressive behavior in hospital patients. The study, conducted in two Australian health services, included 999 patients, with 333 cases experiencing Code Grey events (requiring emergency response for aggression). The critique discusses the study's setting, sample, and methodology, highlighting the appropriateness of the case-control design. Results indicated that patients with Code Grey events had less physiological assessment documentation and more physiological abnormalities. The critique also explores the study's implications for future practice, emphasizing the potential to enhance patient care and staff safety. The findings suggest that monitoring vital signs could help predict and prevent aggressive behavior, ultimately improving patient outcomes and reducing staff injuries. The critique concludes with a reflection on how the study's findings can inform nursing practice.

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ARTICLE CRITIQUE
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Introduction
The topic for this study is to examine the vital signs in the form of predictors to describe
the association among the aggression and psychological status of the hospital patient. The
research question addressed are as follows (Considine et al., 2017):
 What is the nature and frequency of the physiological evaluation within 12 hours prior
to the aggressive behaviour?
 What is the nature and frequency of the physiological abnormalities within 12 hours
prior to the aggressive behaviour?
 Can the physiological abnormality practiced to predict the aggressive behaviour and
violence among the hospital patient?
 Is there any difference among the physiological abnormality and assessment in the
patient with emergency response and for the patient who do not require?
This research is important for the nurse because it will help them to reduce the staff injury
and also assist them to handle the aggressive patients appropriately and enhancing the health
outcome of such patients (Bernaldo et al., 2015).
Setting
The study was conducted in two different health services present in Victoria,
Australia. Health service A, was considered as the metropolitan health service (Eastern
Health) and Health service B, was considered as the regional health services located in
Victoria (Barwon Health).
Yes, the setting is appropriate for the research question and is generalised for the
broader population (Considine et al., 2017).

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Sample
Yes, the sample was appropriate according to the research question, where total of
999 patients were included in the study and distributed as 666 controls and 333 cases
(Considine et al., 2017). Yes, the sample was large enough to justify he conclusion as the
participants were designated from four different hospitals with minimum selection biasness.
Yes, the sampling methodology was appropriate i.e. case-control sampling strategy that will
aim to enhance the efficiency of the study.
Methodology
Yes, the methodology i.e. prospective case-control study was appropriate according to
the research question and it was clearly defined to describe and evaluate the association
amongst the clinical aggression and vital signs for the patients in hospitals (Lamanna et al.,
2016). The only issues that was identified is that some of the patient data was missing and
could not be included in the research findings. No, any other methodology cannot be
considered as this study was completely base on the case and control group (Considine et al.,
2017).
Result
The result exhibited that the patients belonging to the code grey department had
minimal physiological assessment documentation and were thus more expected to suffer from
heart rate, conscious state and respiratory rate abnormalities within 12 hours of the prior
Code Grey. After analysing the confounders, it was identified that the threat of Code Grey
was considered as the highest for the patients suffering from confusion (Considine et al.,
2017).
Future Practice

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In future, such research can be used to enhance the physiological evaluation of the
patient suffering from behavioural disturbance by safe-guarding the staff safety. It can also be
used to prevent the behavioural escalation among the patient belonging to the Code Grey
department and manage the physiological factors that enhances the risk of behavioural
escalation (Richardson et al., 2018).
Conclusion
Hence, it is concluded from the study that the patient who are suffering behavioural
disturbance have reduced patient assessment standards, enhanced inpatient death and greater
physiology abnormalities prevalence. It can change my practice, as I can determine the
approach to prevent the behavioural escalation and reduce the staff injury.

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References
Bernaldo-De-Quirós, M., Piccini, A. T., Gómez, M. M., & Cerdeira, J. C. (2015).
Psychological consequences of aggression in pre-hospital emergency care: cross
sectional survey. International Journal of Nursing Studies, 52(1), 260-270.
Considine, J., Berry, D., Johnson, R., & Sands, N. (2017). Vital signs as predictors for
aggression in hospital patients (VAPA). Journal of clinical nursing, 26(17-18), 2593-
2604.
Lamanna, D., Ninkovic, D., Vijayaratnam, V., Balderson, K., Spivak, H., Brook, S., &
Robertson, D. (2016). Aggression in psychiatric hospitalizations: a qualitative study
of patient and provider perspectives. Journal of mental health, 25(6), 536-542.
Richardson, S. K., Grainger, P. C., Ardagh, M. W., & Morrison, R. (2018). Violence and
aggression in the emergency department is under-reported and under-appreciated. NZ
Med J, 131(1476), 50-8.