HYBRID EVENT: You can participate in person at Boston, Massachusetts, USA or Virtually from your home or work.

7th Edition of Nursing World Conference

October 16-18, 2023 | Boston, Massachusetts, USA

October 16 -18, 2023 | Boston, Massachusetts, USA
NWC 2023

Mariah Rappazzo

Speaker at  Nursing World Conference 2023 - Mariah Rappazzo
UF College of Nursing/UF Health, United States
Title : Reducing aggressive behavioral events in the psychiatric setting through caring science


OBJECTIVE: The aim of this project is to develop a system utilizing evidence-based practice and caring science to revise the current behavioral code process at a large academic healthcare system.

BACKGROUND: Psychiatric patients with aggressive/violent behaviors pose a high risk of emotional and physical harm to staff and peers in the psychiatric setting. This risk to safety and even a perception of working in an unsafe environment can lead to a decrease in staff morale, elevated job stress, potential injury, absenteeism, and staff turnover.

METHODS: This project will use a mixed-method longitudinal design. Data from patient safety reports specific to violent/aggressive patient behavior occurrences will be analyzed. The project will implement staff training on the revised behavioral code process at the facility that will integrate the Safewards Model, Watson’s Caritas Factors and Processes. Qualitative data will be collected using the Staff Debriefing Encounter Form and quantitative data will be collected from patient safety reports and from the Watson Caritas Patient Score tools® following behavioral events that occur after training has been completed. Staff training and debriefing sessions will be conducted on a rolling basis, beginning March 27, 2023, to June 1, 2023. Comparative de-identified violent episode data collected before and after implementation of the project training model will be collected retrospectively.

CONCLUSION: This project is still in progress. Available evidence about strategies to prevent and de-escalate aggressive behaviors in the psychiatric patient population is limited, as are resources to address this growing phenomenon and its negative impact on staff retention and morale in the field of mental health. Findings will contribute to the development of a system that ensures both patient and staff safety while enhancing the quality of care delivered to the community.

Audience Take Away Notes:

  • Nurses and other healthcare professionals may be able to implement some or all our interventions to reduce workplace violence as they see fit. The project provides tools that are evidence based to improve nursing confidence in their ability to de-escalate patient with the potential to become violent before it occurs. This project may help with nursing and healthcare staff retention, as staff will feel safer at their place of work if they feel that they have the tools to prevent patient escalation respond to patient who pose a threat to staff due to their verbally and/or physically aggressive behaviors.
  • This research could be expanded upon to other inpatient settings that are not psychiatric facilities as psychiatric patients are everywhere in the healthcare system. There is always a risk for staff injury due to behavioral outbursts. Specifically, staff buy in is a big component of adopting a new behavioral code process which was a barrier experienced. Seeing how other facilities garner staff support would be useful in successful adoption and implementation of the process.


Mariah Rappazzo studied Health Education and Nursing at the University of Florida, graduating with a BSN in 2020. She then started her career as a staff nurse at the UF Health Psychiatric Hospital. Mariah is a University of Florida DNP student on the Psychiatric Nursing track with graduation in August of 2025 with a focus in Psychiatric Nursing. She is co-chair of her hospital’s Workplace Violence Committee as well as a part of the Unit Practice Council, and Nursing Research Fellowship Program at UF Health.