Date of this Version

11-21-2025

Document Type

DNP Project

Abstract

Workplace violence is a growing concern in healthcare, especially in psychiatry. Nurses working in inpatient psychiatry struggle with identifying signs of potential violence in psychiatric patients. These violent behaviors often escalate into forms of aggression or assault, both physical and verbal. At the project site, there are two alerts that occur: a ‘Gray Alert’, that sends an alert to security to assist an aggressive patient, and a ‘Signal 82’ which is an alert to security to assist in medication administration for an agitated patient. Currently, there is no debriefing tool at this organization after these alerts. This study aims to implement a debriefing tool after each ‘Gray Alert’ and ‘Signal 82’ for nurses to use, improving knowledge of debriefing and to reduce workplace violence in inpatient psychiatry. The study recruited 20 registered nurses. Participants completed a pre-posttest to assess current knowledge, followed by a selfevaluation survey on the nurses’ feelings associated with violence in psychiatry. An educational session was then provided on identifying early signs of aggression and how to use the debriefing tool. Nurses used the tool after each alert for an eight-week period. At the end of the study, participants completed a follow-up self-evaluation survey and posttest. The average knowledge gained in this study was 23%, with the highest knowledge gain at 55%. A total of six debriefing forms were collected on 3A, and 15 on 3B. The ‘Gray Alerts’ were measured with a paired t-test (7.56, p-value = 0.0171). Results are statistically significant, indicating ‘Gray Alerts’ improved after intervention. The ‘Signal 82s’ paired t-test (1.48, pvalue = 0.2770) indicated results are not considered to be statistically significant. Staff confidence improved overall, with an increase in ‘strongly agree’, ‘slightly agree’ and ‘agree answers for all five categories of the six-point Likert scale. The project can improve clinical practice by encouraging staff to identify patients at a high-risk for violence and to prevent ‘Gray Alerts’ and ‘Signal 82s’ from occurring. The debriefing tool stimulates conversation between staff members on how the codes went, as well as what could have been improved.

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