Educational Interventions to Improve Aggressive Behavior Recognition for an Acute Psychiatric

106 Pages·2017·0.84 MB·English

Walden University
ScholarWorks
Walden Dissertations and Doctoral Studies
Walden Dissertations and Doctoral Studies
Collection
2017
Educational Interventions to Improve Aggressive
Behavior Recognition for an Acute Psychiatric
Setting
Marie Elois Ortiz
Walden University
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Walden University

College of Health Sciences

Marie Ortiz

This is to certify that the doctoral study by

has been found to be complete and satisfactory in all respects,
and that any and all revisions required by
the review committee have been made.

Review Committee
Dr. Marisa Wilson, Committee Chairperson, Nursing Faculty
Dr. Murielle Beene, Committee Member, Nursing Faculty
Dr. Jonas Nguh, University Reviewer, Nursing Faculty

Chief Academic Officer
Eric Riedel, Ph.D.

Walden University
2017
Abstract
Educational Interventions to Improve Aggressive Behavior Recognition for an Acute
Psychiatric Setting
by
Marie Ortiz
MS, Walden University, 2013
BS, Norfolk State University, 2002

Project Submitted in Partial Fulfillment
of the Requirements for the Degree of
Doctor of Nursing Practice

Walden University
November 2017
Abstract
Nurses working in an acute psychiatric setting within a veterans’ administration hospital
must maintain a therapeutic milieu by recognizing and managing aggressive behaviors
before violence ensues to reduce injuries to staff nurses and patients. The purpose of this
project was to develop an evidence-based and theoretically grounded educational program
that will help staff nurses manage escalating aggression, violence, and acting out
behaviors to provide a safe environment for patients and staff through high risk identifier
recognition and intervention training. During the data and information gathering stage, 23
articles were reviewed, rated, and graded to provide the most significant information used
to complete the project. The project is a workshop made up of a 6-module curriculum that
will be used to train staff nurses. This workshop will be shared with the partnering
organization including the recommendation that it is adopted and implemented at a later
date. The educational training program will have the potential to become a practice
standard for other acute psychiatric settings within the Veterans Integrated Service
Network to provide a tool that will assist the nurses as they care for the patient and
maintain safety. Social change will occur through the empowerment of nurses who
interact with veterans to bring them better and safer care.
Educational Interventions to Improve Aggressive Behavior Recognition for an Acute
Psychiatric Setting
by
Marie Ortiz
MS, Walden University, 2013
BS, Norfolk State University, 2002

Project Submitted in Partial Fulfillment
of the Requirements for the Degree of
Doctor of Nursing Practice

Walden University
November 2017
Dedication

This project is dedicated to mental health nurses who have chosen to work with the
unique veteran population. It takes a strong individual to come to work each day knowing
that you may be targeted by a cognitively impaired patient who is actively hallucinating
and views you as the enemy. Nevertheless, you return and stand steadfastly to provide the
necessary care. You are strong when your patient is weak and in need of your strength
and guidance.
Acknowledgments
First and foremost, I would like to thank my faculty committee members, Drs.
Marisa Wilson and Murielle Beene. You were there to inspire me and keep me on the
right path since the very beginning. I was comforted when I learned that you would
continue to see me and my project to the end. You silenced my doubts when I wanted to
quit. You motivated me to stay in the game when I grew tired after each inning. It is
because of you that I have stayed the course and carried on. Dr. Wilson, there are no
words that can possibly explain how you have helped me. Your collaborations kept me
centered as I was able to tackle each rewrite.
Secondly, to my husband, Jose, you have been a soft place to land. You have been
more than understanding when dinner consisted of yet another order of take-out instead of
something home cooked. Thank you for being my biggest cheerleader by reassuring me
that I could do anything, regardless of the fact that I know I cannot do anything as
evidenced by my inability to give you the moon and the stars. You have been my rock.
To my sons, I just want you to know that I see you. I know I have had my head in the
books for years, but I see you. I want you to know that if I can do it, you certainly can
too. I wanted to be your inspiration, just as you have inspired me.
Lastly, to my friends, colleagues, my Preceptor, Dr. Clark, and the best boss in the
world it has been a great journey. You each kept me grounded in various ways. I
appreciate the doses of reality when my head would wander off into the clouds. I am most
appreciative to you for always being there. Dr. Clark and Dr. Harris thank you for making
it look easy. It is because of you I convinced myself that this was something I could do.
Table of Contents
List of Figures .................................................................................................................... iv
Section 1: Nature of the Project ...........................................................................................1
Introduction ....................................................................................................................1
Problem Statement .........................................................................................................2
Purpose Statement ..........................................................................................................3
Project Objectives ..........................................................................................................4
Significance/Relevance to Practice ................................................................................5
Evidence-Based Project Significance ............................................................................6
Implication for Social Change in Practice .....................................................................7
Definitions of Terms ......................................................................................................7
Assumptions and Limitations ........................................................................................8
Assumptions ............................................................................................................ 8
Limitations .............................................................................................................. 9
Summary ................................................................................................................. 9
Section 2: Review of Literature and Conceptual Framework ............................................11
Review of Literature ....................................................................................................11
Prevention as a Strategy ...............................................................................................11
Impact of Mental Illness ..............................................................................................11
General Literature ........................................................................................................13
Maintaining a Therapeutic Milieu ........................................................................ 14
Contributing Factors ............................................................................................. 15
i
Recognizing the Need for Training....................................................................... 17
Theoretical Foundation ................................................................................................18
Project Questions .........................................................................................................22
Summary ......................................................................................................................22
Section 3: Collection and Analysis of Evidence ................................................................24
Introduction ..................................................................................................................24
Practice-Focused Questions .........................................................................................24
Gap in Practice .............................................................................................................27
Policy Impact ...............................................................................................................28
Clinical Practice ...........................................................................................................29
Sources of Evidence .....................................................................................................30
Social Change ..............................................................................................................31
Summary and Conclusion ............................................................................................31
Course Objectives ........................................................................................................32
Course Modules ...........................................................................................................42
Method .........................................................................................................................33
Develop an Implementation Plan .................................................................................51
Assemble a Project Team.............................................................................................61
Initial Project ......................................................................................................... 52
Expanded Implementation .................................................................................... 54
Anticipated Population and Sampling .........................................................................55
Data Collection ............................................................................................................56
ii
Instrument ....................................................................................................................56
Review of Pertinent Evidence, Resources, and Literature ...........................................57
Development of High Risk Identifier Training Program .............................................59
Curriculum Development...................................................................................... 59
Educational Delivery Modalities .......................................................................... 59
Development of Evaluation Plan .................................................................................59
Summary ......................................................................................................................63
Section 4: Findings, Discussion and Implications .............................................................65
Introduction ..................................................................................................................65
Findings and Implications ............................................................................................65
Recommendations ........................................................................................................66
Contribution of the Doctoral Project Team .................................................................67
Strength and Limitations of the Project .......................................................................68
Section 5: Dissemination Plan ...........................................................................................70
Poster Board and PowerPoint Presentations ................................................................70
Analysis of Self ............................................................................................................71
Summary ......................................................................................................................72

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