Date of Award

Spring 3-19-2024

Document Type

Scholarly Project

Degree Name

Doctor of Nursing Practice (DNP)

First Advisor

David Liguori, DNP, NP-C, ACHPN

Second Advisor

Sunita Waddell, DNP, MSN, RN


Practice Problem: Inpatient mental health units are vulnerable to aggression and violence, which may lead to physical injuries. It is essential to implement proactive measures to prevent violence before it escalates.

PICOT: In an adult inpatient mental health unit (P), does the use of the Dynamic Appraisal of Situational Aggression (DASA) (I), compared to no screening for aggression (C) decrease restraints and seclusion, provide early detection and awareness of aggressive behaviors (O) within ten weeks.

Evidence: The DASA assessment tool has been tested in various settings, such as forensic and general adult mental health units. It has also been found to have good internal consistency and inter-rater reliability.

Intervention: The Inpatient DASA screening tool was used for eight weeks. A pre/post-test was given to measure RN knowledge and perceptions of using the DASA.

Outcome: The DASA is an effective tool that predicted violence in those patients with a score of greater than four and resulted in a decrease in seclusion and restraints. 85% of the nurses participating perceived the DASA to be effective in identifying aggressive patients, and 92% would like to continue the use of the DASA.

Conclusion: The DASA is an evidence-based tool that can predict violence within 24 hours before its onset. It is easy, practical, and feasible for mental health units. The DASA allows the RN to identify those at higher risk and implement a treatment plan to mitigate those risks.


Scholarly project submitted to the University of St. Augustine for Health Sciences in partial fulfillment of the requirements for the degree of Doctor of Nursing Practice.

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