According to this study:

* Staring and lack of eye contact, altered tone and increased volume of voice, anxiety, mumbling, and pacing in the ED can indicate that an act of violence might be committed against nurses.

Although acts of violence committed against nurses constitute a growing problem in all areas of medical practice, especially the ED, strategies for assessing its imminence have yielded little success.

Research conducted in Australia has produced a violence assessment framework called STAMP (Staring and [lack of] eye contact, Tone and volume of voice, Anxiety, Mumbling, Pacing) that can be used to assess the possibility that acts of violence might be committed against nurses in the ED by patients, members of their families, or their friends.

In a study conducted over a five-month period in 2005 at a 33-bed ED in a large, rural community in Australia, researchers observed and interviewed 20 RNs selected through convenience nonprobability sampling.

During the study, five associated behavioral signs were identified in 16 acts of violence (defined as personal physical injury, damage to property, or the use of threatening or abusive language). In nine of the incidents, either staring or glaring at or avoiding eye contact with the nurse was observed, and escalation to physical violence was possibly averted when nurses responded by addressing the concerns of the patient, family member, or friend. Thirteen of the incidents involved the possible perpetrators of violence either raising their voices or speaking sarcastically or in a caustic tone. Anxiety (as evidenced by a flushed appearance, rapid speech, or hyperventilation, or by attending signs of pain, disorientation, and the perception of expectations not being met), was also associated with violence in the ED. Only one act of violence was associated with anxiety not exacerbated by disorientation, while 13 such acts were committed by patients who were both anxious and disoriented. Mumbling, sometimes accompanied by slurred or incoherent speech, and repetitive questioning or declarations were perceived as indicative of mounting frustration and were noted in 11 of the acts of violence. Pacing, taken as an indication of agitation, was observed in nine of the 16 incidents.

Use of the STAMP framework might help ED nurses recognize behavioral signs indicative of the possibility of violence, enabling them to attempt to avert it.

JC