Date of Degree


Document Type

Doctoral Project

Degree Name

Doctor of Nursing Practice (DNP)




Christopher P. Weidlich


The use of physical restraints within psychiatric units is problematic since it raises a range of legal, ethical, and clinical questions (American Psychiatric Nurses Association, 2014). The use of physical restraint has become a common practice in many psychiatric units despite the negative effects associated with its use. Selecting strategies such as verbal de-escalation to manage aggressive psychiatric inpatients shows promise with patients when used by providers and staff in mental health facilities. The purpose of this evidence-based project was to introduce and train staff to utilize the Modified Overt Aggression Scale (MOAS) and verbal de-escalation in psychiatric units in a residential psychiatric treatment center with aggressive female inpatients aged 13-17 years. The primary objectives were to reduce the selection of physical restraints and time used to restraint to less than an hour, assess 100% of the target population, educate providers/staff the use of MOAS and verbal de-escalation, and review intervention choices selected by staff. The intervention included implementing MOAS scale, training staff to use verbal de-escalation, and pre/posttest surveys to evaluate the effectiveness of verbal de-escalation techniques. Between January and April 2019, 20 patients met the inclusion criteria. Following the intervention, documented physical restraints decreased by 89%, time spent in restraints decreased to 10 minutes, 100% of the staff was trained, 18 patients were assessed, and 18 intervention choices were reviewed. Results suggest that a combination of MOAS scale along with staff training on verbal de-escalation can influence and reduce the selection of physical restraints in the inpatient psychiatric unit.