Tess Maguire¹
Georgina Willetts² and Loretta Garvey²
1 Centre for Forensic Behavioural Science, Swinburne University of Technology and Forensicare
2 Federation University

The Dynamic Appraisal of Situational Aggression (DASA) is an instrument designed to assess risk of imminent aggression. The Aggression Prevention Protocol (APP) was designed to structure nursing intervention according to the level of risk assessed by DASA, (together DASA+APP). Two studies testing the DASA+APP produced reductions in aggression and restrictive interventions, however a barrier to implementation is training (Griffith et al., 2021; Maguire et al., 2019). A recent study investigated approaches used in aggression prevention training to determine DASA+APP education for nurses. One recommendation was to include built-in assessment to ensure learners acquire adequate levels of competence to deliver APP interventions. 

Entrustable Professional Activities (EPAs) are a way of defining and assessing complex clinical interventions (Croft et al., 2020) such as the APP interventions. This presentation will discuss the development of seven APP/EPA’s, via focus groups with 11 expert prevention of aggression trainers. The APP/EPAs were then tested with graduate nurses via training including active-learning with expert trainers and simulation actors, to determine the suitability of the APP/EPAs as an assessment framework. 

Results suggest APP/EPAs can be used to assess learners’ readiness for professional DASA+APP practice and set the standard of practice for complex skills required to prevent aggression. 

EPAs filled a practice-gap, where focus of assessment has been on physical techniques, as opposed to de-escalation and limit-setting skills. EPAs provided consistency in practice, can enhance documentation and define standards of practice. The training provided a safe environment to practice these important skills. 

Defining, applying and assessing APP activities that prevent aggression is essential, although methods to assist with this task have been lacking. Results suggest APP/EPAs and associated training provided a suitable method to define and assess practice the complex APP clinical activities. 

The APP/EPAs offer a framework to assist aggression prevention and encourage reflection and practice improvement.



References (maximum three) 

Croft, H., Gilligan, C., Rasiah, R., Levett-Jones, T., & Schneider, J. (2020). Development and inclusion of an entrustable professional activity (EPA) scale in a simulation-based medicine dispensing assessment. Currents in Pharmacy Teaching and Learning, 12(2), 203-212. 

Griffith, J. J., Meyer, D., Maguire, T., Ogloff, J. R. P., & Daffern, M. (2021). A clinical decision support system to prevent aggression and reduce restrictive practices in a forensic mental health service. Psychiatric Services, 72(8), 885-890. 

Maguire, T., Daffern, M., Bowe, S. J., & McKenna, B. (2019). 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. International Journal of Mental Health Nursing, 28(5), 1186-1197. http://doi.org/10.1111/inm.12630