Abstract
Purpose: This study evaluated whether nursing de-escalation interventions implemented during routine care reduce subsequent aggression risk and aggressive behaviors among hospitalized adults on medical-surgical units.
Background: Violence toward healthcare personnel is increasingly common beyond traditional high-risk settings. Guidance encourages pairing validated aggression-risk assessments with risk-responsive, evidence-based interventions. However, evidence supporting such approaches in medical-surgical units remain limited, despite rising global attention to workforce safety.
Methods: This retrospective cohort study analyzed 277,221 Dynamic Appraisal of Situational Aggression-Inpatient Version (DASA-IV) assessments from six hospitals collected between March and December 2024. Descriptive statistics characterized intervention use across DASA-IV risk levels. Time-lagged linear mixed-effects models tested whether interventions were associated with reductions in subsequent DASA-IV scores and generalized linear mixed-effects models evaluated associations with subsequent documented aggressive events.
Results: Across 31,873 encounters, interventions were documented in 6% of moderate-risk and 21% of high-risk assessments. Frequently used strategies included active listening, reassurance, and empathy. Intervention use generally aligned with patients’ risk level, indicating appropriate clinical prioritization. Intervention documentation was associated with small but statistically significant decreases in subsequent DASA-IV scores, reflecting lower short-term aggression risk. However, interventions did not demonstrate a measurable impact on reducing subsequently documented aggressive behaviors.
Conclusion: Nurses in medical-surgical settings apply de-escalation interventions in ways that mirror structured risk-assessment findings, and these actions correspond with modest improvements in short-term aggression risk. The absence of association with aggressive events suggests opportunities to strengthen intervention fidelity, documentation accuracy, and alignment with risk-responsive care frameworks. These findings support ongoing global efforts to enhance workforce safety and guide the integration of structured violence-prevention strategies beyond behavioral health settings.
Notes
References:
Shirk H, Kreider C, Bell T, Gervase S, Buchko BL, Danford CA. Predictive ability of the DASA-IV in medical–surgical units. West J Nurs Res. 2024;46(9):685-691.
Fricke J, Siddique SM, Douma C, et al. Workplace violence in healthcare settings: a scoping review of guidelines and systematic reviews. Trauma Violence Abuse. 2023;24(5):3363-3383.
Somani R, Muntaner C, Hillan E, Velonis AJ, Smith P. Effectiveness of interventions to de-escalate workplace violence against nurses. Saf Health Work. 2021;12(3):289-295.
Griffith JJ, Meyer D, Maguire T, Ogloff JR, Daffern M. A clinical decision support system to prevent aggression and reduce restrictive practices in a forensic mental health service. Psychiatr Serv. 2021;72(8):885-890.
Maguire T, McKenna B, Daffern M. Aggression Prevention Protocol User Manual. Centre for Forensic Behavioural Science, Swinburne University; 2021:1-33.
Sigma Membership
Non-member
Type
Presentation
Format Type
Text-based Document
Study Design/Type
Cohort
Research Approach
Quantitative Research
Keywords:
Nursing Interventions, De-Escalation, Violence--Prevention and Control, Aggression--Diagnosis, Aggression, Hospital Units, Medical-Surgical Nursing
Recommended Citation
Gervase, Suzanne; Shirk, Heather A.; Markwordt, Felicia; Bell, Theodore; and Saconi, Bruno, "Nursing De-Escalation Interventions and Aggression Outcomes Using DASA-IV in Medical–Surgical Units" (2026). International Nursing Research Congress (INRC). 240.
https://www.sigmarepository.org/inrc/2026/presentations_2026/240
Conference Name
37th International Nursing Research Congress
Conference Host
Sigma Theta Tau International
Conference Location
Toronto, Ontario, Canada
Conference Year
2026
Rights Holder
All rights reserved by the author(s) and/or publisher(s) listed in this item record unless relinquished in whole or part by a rights notation or a Creative Commons License present in this item record. All permission requests should be directed accordingly and not to the Sigma Repository. All submitting authors or publishers have affirmed that when using material in their work where they do not own copyright, they have obtained permission of the copyright holder prior to submission and the rights holder has been acknowledged as necessary.
Review Type
Abstract Review Only: Reviewed by Event Host
Acquisition
Proxy-submission
Date of Issue
2026-08-29
Nursing De-Escalation Interventions and Aggression Outcomes Using DASA-IV in Medical–Surgical Units
Toronto, Ontario, Canada
Purpose: This study evaluated whether nursing de-escalation interventions implemented during routine care reduce subsequent aggression risk and aggressive behaviors among hospitalized adults on medical-surgical units.
Background: Violence toward healthcare personnel is increasingly common beyond traditional high-risk settings. Guidance encourages pairing validated aggression-risk assessments with risk-responsive, evidence-based interventions. However, evidence supporting such approaches in medical-surgical units remain limited, despite rising global attention to workforce safety.
Methods: This retrospective cohort study analyzed 277,221 Dynamic Appraisal of Situational Aggression-Inpatient Version (DASA-IV) assessments from six hospitals collected between March and December 2024. Descriptive statistics characterized intervention use across DASA-IV risk levels. Time-lagged linear mixed-effects models tested whether interventions were associated with reductions in subsequent DASA-IV scores and generalized linear mixed-effects models evaluated associations with subsequent documented aggressive events.
Results: Across 31,873 encounters, interventions were documented in 6% of moderate-risk and 21% of high-risk assessments. Frequently used strategies included active listening, reassurance, and empathy. Intervention use generally aligned with patients’ risk level, indicating appropriate clinical prioritization. Intervention documentation was associated with small but statistically significant decreases in subsequent DASA-IV scores, reflecting lower short-term aggression risk. However, interventions did not demonstrate a measurable impact on reducing subsequently documented aggressive behaviors.
Conclusion: Nurses in medical-surgical settings apply de-escalation interventions in ways that mirror structured risk-assessment findings, and these actions correspond with modest improvements in short-term aggression risk. The absence of association with aggressive events suggests opportunities to strengthen intervention fidelity, documentation accuracy, and alignment with risk-responsive care frameworks. These findings support ongoing global efforts to enhance workforce safety and guide the integration of structured violence-prevention strategies beyond behavioral health settings.
Description
Nursing de-escalation interventions on medical–surgical units aligned with patients’ aggression risk levels and were associated with modest reductions in short-term DASA-IV risk scores. No reduction in documented aggressive behaviors was observed. Findings identify opportunities to strengthen intervention fidelity and documentation to improve aggression-prevention efforts.