Document Type

DNP Project


School of Nursing

Date of Degree

Summer 2019


Doctor of Nursing Practice (DNP)

Primary Advisor

Beverly Lunsford, PhD, RN, FAAN; Karen Kesten, DNP, APRN, FAAN


Background: Violence against healthcare professionals is a growing phenomenon, and mental health care has the highest risk (Phillips, 2016). The experience of workplace violence is demoralizing, resulting in low job satisfaction, decrease productivity, physical injury, and potential Post-Traumatic Stress Disorder (Phillips, 2016; Howerton & Mentes, 2010). The Joint Commission and The Centers for Medicare and Medicaid identify patient perpetrated violence as a significant workplace risk, and they endorse education and training for risk reduction and safe intervention (The Joint Commission, 2018, 2019).

Objective: The purpose of this evidence-based practice initiative was to evaluate the impact of staff training with the Safewards model on rates of restraint, and subsequent injuries, for patients and staff, on four inpatient psychiatric units in a large state hospital.

Methods: This Evidence-Based practice initiative used a pre- and post-intervention design to evaluate the implementation of Safewards (Bowers, 2014). Hospital staff (n=128) were trained using a train-the-trainer model, and interventions were incorporated into unit practice over five weeks on four inpatient psychiatric units. Hospital risk data for rates of patient restraints and injuries for patients and staff were evaluated using the Wilcoxon signed-rank test.

Results: There were no statistically significant differences between the medians of restraints and injuries pre- and post-Safewards implementation.

Conclusions: Safewards (Bowers, 2014) is an evidence-based model of care to reduce patient violence. Training and implantation of the model on four inpatient psychiatric units did not yield statistically significant results after training, but a decrease trend in restraints was noted. Recommendations for continued use of interventions and mentorship to foster fidelity in use has the potential for long-term benefits on restraint and injury rate reductions (Fletcher et al., 2017).

Open Access


Included in

Nursing Commons



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