Assessing nurses performance on a violence risk assessment instrument paired with structured intervention guidelines to prevent aggression

Forensic mental health nurses are responsible for maintaining safety and ensuring a positive therapeutic climate, in complex secure settings, where aggression occurs frequently. A validated risk assessment instrument, the Dynamic Appraisal of Situational Aggression (DASA), paired with a structured Aggression Prevention Protocol (APP) have been associated with reduction in aggression and restrictive practices. However, limited attention has been paid to evaluating the assessment methodologies used to support forensic mental health nurses learning to apply DASA + APP. The aim of this paper is to explore Entrustable Professional Activities (EPAs) as a teaching and assessment framework for supporting learning and appraisal of performance of DASA + APP. An EPA framework was developed for DASA + APP and trialled using simulation in two separate but linked studies. Participants had the opportunity to complete the DASA assessment (study one) and apply interventions (study two) derived from the APP in a simulation. The EPA framework was used to examine how effectively the EPA captured the processes involved in risk assessment and associated intervention decision making. Data were collected in focus groups and analysed using thematic analysis. Participants recognised how an EPA framework could be used to structure assessment conversations, support reflective learning, and clarify expectations for practice. Participants appreciated the strengths-based feedback and chance to self-reflect via the EPAs. The opportunity to receive supportive feedback via EPA frameworks could enhance nursing risk assessment and aggression prevention practices. EPA’s offer potential to enhance preparation for safe, independent practice in aggression prevention. Not applicable.