Date of Award

Fall 12-2014

Degree Type

Doctoral Nursing Capstone Project

Degree Name

Doctor of Nursing Practice (DNP)

Committee Chair

Dr. Anita Davis Boykins

Committee Chair Department

Nursing

Committee Member 2

Dr. Sheila Davis

Committee Member 2 Department

Nursing

Abstract

Aggressive behaviors exhibited by patients with a serious mental illness (SMI) hospitalized in inpatient psychiatric hospitals are a challenging safety problem. Early identification of aggressive behaviors is vital to helping nursing staff develop proactive interventions that focus on prevention. Structured risk assessments identify the level of risk and allow for early interventions.

The purpose of the doctoral capstone project was to: (a) provide education to nursing staff on implementing a structured risk assessment tool in order to identify risk for imminent aggression, manage risk for imminent aggression, and record aggressive behaviors among adult males with severe mental illness (SMI); (b) implement the structured risk assessment tool; (c) determine by retrospective chart review if the structured risk assessment tool is used by nursing staff to identify and manage patients with moderate or high risk for aggression; and (d) evaluate nursing staff’s perspective of the usefulness of the structured DASA-IV tool in a psychiatric hospital.

Nursing staff conducted a continual assessment over a four-week period in which the DASA-IV risk scores were documented, prevention plans were implemented, and aggressive behaviors were recorded for seven days on all newly admitted patients with a diagnosis of SMI. A retrospective chart review was conducted to determine if the DASA-IV was completed correctly, and an evaluation survey was administered to determine the nursing staff’s perspective of the usefulness of the tool.

The nursing staff found the DASA-IV tool useful in practice and information on the tool to be useful in identifying risk for imminent aggression and recording aggressive behaviors. Of the twenty risk assessments conducted, all were completed correctly by the nursing staff documenting the risk score and rating, implementing a crisis intervention or risk management plan based on the risk rating, and recording aggression.

The results of this project demonstrate that through an evidence-based system approach, the addition of a structured risk assessment instrument for appraising risk for imminent aggression in a psychiatric hospital may assist nursing staff in the initiation of preventive interventions to manage aggressive behaviors.

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