The Integration of Risk Assessment and Risk Management: A Qualitative Interview Study of Dynamic Appraisal of Situational Aggression Use in Real-World Practice

The Dynamic Appraisal of Situational Aggression (DASA) is a tool designed to assess the risk of violence in inpatient adult mental healthcare. Despite its empirical support, there is limited understanding of how the DASA is used to guide risk management. We interviewed twelve nursing staff across two forensic hospitals, exploring how the tool is operationalised and how nursing staff use the DASA score to guide their risk management. In the services studied, the DASA was being used as intended to assess violence risk. A key theme was the use of the DASA to share risk information, the initial step of the pathway from assessment to risk management. When integrating the DASA output with risk management, the DASA prompted nurses to undertake further assessment and/or put patient care plans into action, rather than choose an intervention stratified from the DASA score. The findings identify an important consideration of whether an assessment tool is designed to structure one's judgement (whilst not entirely displacing the user's experience and knowledge), or whether the tool needs to prescriptively guide clinical decision-making. This study builds an understanding of how risk assessment tools are implemented in real-world practice and the pathway from risk assessment to management outcomes.