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sure, sleep deprivation, exposure to infectious diseases, needle stick injuries, lack of social support at work (especially from supervisors, head nurses, upper management), and exposure to work-related violence or threats. The DANGEROUS Behavior Screening Guide was developed from the literature and designed to be used purely as a guide to screening for violence risk factors. According to the author, Mary Muscari, PhD, CRNP, this guide is an acronym-labeled list that helps practitioners remember the elements of an assessment for disruptive behavior and violence. It has not been empirically tested, and it should not be used to diagnose patients, families, or other coworkers. However, the guide is instructive because it reminds nurses to consider potential Morris, P. E., & Dracup, K., (2008). Time for a tool to measure moral distress. American Journal of Critical Care 17(5). pp.398-401 Muscari, M. E., (2009). How can I detect the warning signs of extreme violence in my patients? Topics in Advanced Practice eJournal 9 (3). Retrieved on November 14, 2011 from http://www.medscape.com/viewarticle/708159_2 Nachreiner, N. M., Gerberich, S. G., Ryan, A. D., McGoevern, P. M. (2007) Minnesota nurses��� study: perceptions of violence and the work environment. Industrial Health, 45, 672-678. Namie, G., & Namie, R. (2000, 2003). The Bully at Work: What You Can Do to Stop the Hurt and Reclaim Your Dignity on the Job. Sourcebooks, Inc. Naperville, Illinois. National Advisory Council on Nurse Education and Practice. (2007) Violence Against Nurses: An Assessment of the Causes and Impacts of Violence in Nursing Education and Practice. Retrieved October 26, 2011 from www.hrsa.gov/advisorycommittees/bhpradvisory/nacnep/Reports/fifthreport.pdf - 2011-09-23 Olweus, D. (2001). ���Peer Harassment: A Critical Analysis and Some Important Issues,��� in Peer Harassment in School, ed. J. Juvonen and S. Graham. Guilford Publications. New York. Pacquiao, D. F. (2008). Nursing care of vulnerable populations using a framework of cultural competence, social justice and human rights. Contemporary Nurse 28 (1-2). 189-197. Park, M. (2010) Bitten, shot, spat on: Violence in hospitals common for staff-CNN.com. Retrieved on November 14, 2011 from http://cnn.com/2010/HEALTH/09/16/hospital.violence.hopkins/index.html Roberts, M. M. (1956). Lavinia Lloyd Dock���Nurse, Feminist, Internationalist. American Journal of Nursing (56) 2. 176-179. Smyth, J. C., Violent assaults on ER nurses rise as programs cut. August 10, 2010. Retrieved on November 14, 2011 from http://www.msnbc.msn.com/id/38645144/ns/healthhealth_care/t/violent-asaults-er-nurses State of California, Division of Occupational Safety and Health (2011). Citation and Notification of Penalty. Inspection Number 314325325; Inspection Dates: 11/02/2010-03/21/2011; Issuance Date: 03/21/2011, pp. 5-7. MARCH 2012 social and demographic determinants of impulsive behavior and diminished reasoning capacity. Using the guide, the following risk factors can be elicited during routine psychosocial assessment: The DANGEROUS Behavior Screening Guide (Muscari, 2009) D ��� Deviant thinking: homicidal or suicidal ideation; feelings of persecution; paranoia; projection of blame onto others; intolerance for differences or prejudicial attitudes; entitlement; narcissism; low frustration tolerance A ��� Alienation and rejection: loner; social isolation; no friends; victim of bullying; acts/dresses in manner that adds to alienation; feelings of rejection or failure; depression and despair N ��� Negative home environment: family values violence as a way State of California, Division of Occupational Safety and Health (2011). Citation and Notification of Penalty. Inspection Number 300752581; Inspection Dates: 10/25/2010-; Issuance Date: 04/12/2011, pp. 1-14. Stokowski, L. A., and (2010) Violence: Not in my job description. Workplace violence in healthcare settings. Retrieved on November 14, 2011 from http://www.medscape.com/viewarticle/727144 The Joint Commission. Behaviors that undermine a culture of safety. Sentinel Event Alert, Issue 40, July 9, 2008. Retrieved on November 14, 2011 from http://www.jointcommision.org/SentinelEvents/Sentineleventalert/sea_40.htm The Joint Commission. Preventing violence in the healthcare setting. Sentinel Event Alert, Issue 45, June 3, 2010. Retrieved on November 14, 2011 from http://www.jointcommission.org/SentinelEvents/SentinelEventAlert/sea_45.htm Trinkoff, A. M., Geiger-Brown, J. M., Caruso, C. C., Lipscome, J. A., Johantgen, M., Nelson, A. L., Sattler, B. A., & Selby, V. L. (2008). Personal safety for nurses. Chapter 39, 1-36. In Hughes, R. G. (ed). Patient Safety and Quality: An EvidenceBased Handbook for Nurses. Agency for Healthcare Research and Quality. Publication 08-0043. Rockville, Maryland. Retrieved November 14, 2011 from http://www. ahrq.gov/qual/nurseshdbk/ United States Department of Justice, Office of Justice Programs, Bureau of Justice Statistics, Special Report, Workplace Violence, 1993-2009, March 2011. Retrieved on October 26, 2011 from http://www.bjs.gov/index.cfm?ty=pbdetail &iid=2377 United States Department of Labor, Occupational Health and Safety Administration (2004). Guidelines for Preventing Workplace Violence for Healthcare and Social Service Workers. Retrieved on November 14, 2011 from http://www.osha.gov/Publications/OSHA3148/osha3148.html Wagner, J., & Garrison, J., Long Beach hospital shootings make ���no sense.��� April 18, 2009. Retrieved on November 14, 2011 from http://articles.latimes.com/print/2009/apr/18/local/mehospital-shooting18 W W W. N AT I O N A L N U R S E S U N I T E D . O R G N AT I O N A L N U R S E 19