Nurses' Perception of the Use of the Dynamic Appraisal of Situational Aggression (DASA) in an Emergency Psychiatric Setting

Abstract

Background: The use of the Dynamic Appraisal of Situational Aggression (DASA) in acute psychiatric settings to identify aggressive and/or violent patients upon admission. Objective: Determining nurses' perception of the usefulness of the Dynamic Assessment of Situational Aggression (DASA) in a psychiatric emergency room setting. Theoretical Background: Langley, Nolan, Nolan and Provost’s (2009) Model for Improvement, which incorporates Deming’s Plan-Do-Study-Act (PDSA) cycle, was utilized as the theoretical framework to guide this DNP project. Setting: An adult psychiatric emergency room in urban Phoenix, Arizona. Measurement: A six-item survey questionnaire measured on a five-point Likert scale ranging from "Strongly Disagree" (1) to "Strongly Agree" (5) describes and measures nurses' perception on the usefulness of the DASA. An additional question explored the influence of static nursing factors (gender, years of experience, level of education, years at the facility), on nurses' perception of the usefulness of the DASA. Results: Overall, nurses (90%) of the study participants perceived the DASA to be effective in identifying aggressive violent patients and 70% of the participants would like to continue to use the DASA. Static nursing factors showed no difference in nurses' perception of usefulness. Limitations: Further exploration in similar settings such as regular emergency departments and psychiatric emergency and crisis settings are recommended. In this study only nursing perception was explored. Analysis of the validity of the DASA tool in the psychiatric emergency room setting in addition to nursing perceptions would be more beneficial in determining the DASA’s true usefulness. Conclusion: The results of this DNP project demonstrate that nurses at the SAUPC perceive the DASA to be a useful addition to their admission assessment. Overall nursing response was positive and the SAUPC seclusion and restraint committee recommended incorporating the DASA into the triage nursing admission assessment.