Date of Award

Spring 6-2023

Scholarly Projects

Projects: SPU Access Only

Degree Name

Doctor of Nursing Practice (DNP)

Department

Nursing

Faculty Chair

Bethany Rolfe Witham DNP, FNP-BC

Faculty Reader

NA

Executive Summary

Background and Significance

Globally, violence and aggression from healthcare patients are a growing issue, particularly in emergency departments (ED) and mental health settings (Hallett & Dickens, 2017). There is a general lack of public awareness about this issue and research suggests that workplace violence in healthcare settings has become normalized within the healthcare sector. As the prevalence of violence in healthcare settings increases, de-escalation techniques are first-line interventions to reduce potential violence or aggression. The Joint Commission describes de-escalation as a set of strategies, techniques, and tools to reduce patient's’ agitation and aggression through communication, self-regulation, assessment, actions, and safety maintenance (Daum, 2019). In the United States, EDs have one of the highest rates of workplace violence, which means there is a particular need to protect staff in this department. The risk of violence could be reduced with implementation of de-escalation training for nurses and healthcare staff.

Problem and Purpose Statement

De-escalation training is commonly utilized in healthcare settings and can improve the confidence of staff and their ability to manage aggressive patients (Daum, 2019). ED staff must be trained to de-escalate aggressive patients and reduce the incidence of violence. This study assessed the effectiveness of de-escalation training, as well as staff self-efficacy, and confidence in managing aggressive patients.

Methods

Participants for this study were recruited from the ED of the Medical Center Hospital in Seattle, Washington. A pretest-posttest design was used, alongside two interventions: an educational module and scenario simulation. Initially, participants completed a pre-assessment survey to assess their knowledge and confidence with aggressive patients. The assessment surveys used a combination of the Management of Aggression and Violence Attitude Scale and the Confidence and Coping with Patient Aggression Instrument. Participants were later asked to complete a learning education module on de-escalation training. Upon completing the education module, in-person live simulation scenarios were conducted. This allowed participants to apply their knowledge obtained from the module to a simulation environment, followed by a debrief after each scenario.

Results/Outcomes

When comparing the pre-assessment and post-assessment; the overall self-evaluated mean score of the Confidence in Coping with Patient Aggression Instrument (CCPAI) improved. There was also a significant decrease in reported verbal abuse and physical assault post interventions. However, there was a small number of participants in simulation and post-assessment results.

Sustainability

This project brought awareness to the lack of training provided at the Medical Center Hospital and the need to implement change. Staff brought a request to the emergency department’s Behavioral Health Task Force that de-escalation training be implemented. The Medical Center is currently in contact with an outside agency to provide accredited de-escalation training.

To ensure that this project is effective long term, it’s implementation should comply with educational requirements for nurses and be conducted during the orientation of staff to the ED. The educational module will be given to the ED educator, along with electronic versions of scenario scripts for future training purposes. The educational material will be maintained through the employee education system, HealthStream, as mandatory training. The simulation scenario will continue to be taught in-person and conducted by educators at the Medical Center.

In proceeding with this project, the next step would be to share the project outcomes with Washington State Nurses’ Association and Emergency Nurses’ Association (ENA) for broader dissemination and implementation in Washington State.

Implications

Providing de-escalation training to ED staff may increase staff efficacy, confidence, and skills. It may also lead to a safer work environment, reduce staff turnover, reduce the use of restraints and medications, and increase patient and staff satisfaction.

Conclusion

De-escalation training effectively improved ED staff's confidence and self-efficacy in managing aggressive patients. Educating staff on de-escalation training through the education module, then allowing them time to practice in scenario simulation, gave staff an opportunity to apply of their newly acquired knowledge. Increasing staff's knowledge, skills, and confidence in managing aggressive patients can reduce the incidence of workplace violence through staff being proactive instead of reactive. Being proactive allows staff and the agency to stay ahead and provide education, skills, and training before an incident occurs instead of delivering these trainings after staff has been injured. De-escalation training creates a safer working environment for staff and improves patient safety and outcomes.

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