Ethicality forms a challenge in the implementation of structured violence risk screening: a qualitative study of an intervention in two Swedish emergency psychiatric units.

Introduction: Violence is common in psychiatric settings. Routine violence risk screening in acute psychiatric settings may be used to identify needs for preventive measures. However, introducing general screening for violence risk in acute psychiatric care may evoke ethical controversy among professionals which in turn will influence implementation. This study aimed to assess professionals' ethical acceptability of an intervention introducing routine use of Violence risk screening-10 (V-RISK-10) in two psychiatric emergency units in Malmö, Sweden. Methods: Semi-structured interviews with developers and staff (n=6) based on the theoretical framework of acceptability were analyzed using content analysis, with focus on ethics and ethicality. Results: Although respondents were positive towards the use of V-RISK-10, in terms of its potential to promote uniform and fair assessments, they also expressed concerns. Respondents described ethical risks, tied to the accuracy and interpretation of results and their operationalization as an element in risk management. The perceived ethical acceptability of the intervention rested on a balance between different individual and collective interests. Discussion: Based on authentic clinical realities findings indicate an ethical complexity of routine violence risk screening. In the studied local implementation context, violence risk screening may fit with the ethical values of psychiatric staff in an emergency care setting. Care needs to be taken in the implementation process to ensure that necessary knowledge is disseminated throughout the healthcare organization, and clear guidelines are in place for the use of screening results.