Evaluating the impact of an electronic application of the Dynamic Appraisal of Situational Aggression with an embedded Aggression Prevention Protocol on aggression and restrictive interventions on a forensic mental health unit

Abstract

Risk assessment is a pre‐requisite for violence prevention in mental health settings. Extant research concerning risk assessment and nursing intervention is limited and has focused on the predictive validity of various risk assessment approaches and instruments, with few attempts to elucidate and test interventions that might prevent aggression, and reduce reliance on coercive interventions. The integration of risk assessment and violence prevention strategies has been neglected. The aim of this feasibility study was to test a novel Aggression Prevention Protocol designed to prioritize the instigation of less restrictive interventions on an acute forensic mental health unit for female patients. A prospective quasi‐experimental study was designed to test an Aggression Prevention Protocol, linked to an electronic application of the Dynamic Appraisal of Situational Aggression (DASA). Following introduction of the DASA and Aggression Prevention Protocol, there were reductions in verbal aggression, administration of Pro Re Nata medication, the rate of seclusion, and physical and mechanical restraint. There was also an increase in documented nursing interventions. Overall, these results support further testing of the electronic application of the DASA and the Aggression Prevention Protocol.

Models of care in forensic psychiatry

“…Progress along the pathway from admission and subacute to medium secure and pre-discharge wards is based on routine assessment of risk of violence (Abidin 2013; Dolan 2010; Müller-Isberner 2007; Pillay 2008) and suicide (Abidin 2013) using structured professional judgement instruments. In intensive care, acute and subacute settings, daily short-term assessments such as the Dynamic Assessment of Situational Aggression (DASA) and the Brøset Violence Checklist (BVC) are used (Maguire 2019). Equally important is the use of repeated measures of treatment programme completion and forensic recovery (Davoren 2013, 2015b; McCullough 2020) to inform individual care planning and reports to mental health review boards.…”

A tool to evaluate proportionality and necessity in the use of restrictive practices in forensic mental health settings: the DRILL tool (Dundrum restriction, intrusion and liberty ladders)

“…While there is some evidence that uses of restrictive and coercive practices are not reducing [16,31,32], there is evidence that the systematic introduction of structured risk assessment can reduce levels of violence and aggression in psychiatric wards [33,34] and that the use of short term risk assessment to reduce violence does so by leading to appropriate interventions [35]. There is evidence that short term risk assessment reduces coercive practices [36] and aggression [37,38] along with other preventive measures [14,39]. The use of short term risk assessments such as Dynamic Assessment of Situational Aggression (DASA) [40] and Brøset Violence Checklist [41] on acute and intensive care wards provide a starting point for a description of the context and decision pathways involved.…”

“…Since this was not an A-B study of a change in practice, a corrected regression analysis [35] was also not appropriate. Recent progress in correcting for repeated measures in similar settings and paradigms to this [36][37][38] indicated the use of General Estimating Equations (GEE). Repeated measures in the same individuals were studied using General Estimating Equations in SPSS-25 [70].…”

Occurrence of workplace violence and the psychological consequences of it among nurses working in psychiatric outpatient settings

“…Also, there is scant evidence that recovery‐focused care could reduce violence and aggression (Lim et al., 2017) as well as a structured behavioural plan (Bisconer et al, 2006). There are also a few interventions that seek to assess the risk of violence to reduce escalation, like START (O’Shea & Dickens, 2015) or DASA (Maguire et al., 2019). Based on the results of this study and previous research, we suggest that the use of de‐escalation interventions should be implemented and evaluated systematically in psychiatric outpatient settings as well.…”