Title : Effectiveness of de escalation education on nurses confidence and aggressive patient outcomes
Background: Workplace violence is a priority safety concern in healthcare settings. Exposure to patient aggression is associated with major consequences such as increased injury, loss of productivity, psychological distress, medical costs, reduced job satisfaction, and higher turnover rates. The purpose of this project was to determine if de-escalation education improves medical-surgical nurses’ confidence in managing aggressive patient behaviors, leading to better outcomes. The aim was also to demonstrate whether there was sustained application of the de-escalation skills to clinical practice as evidenced by reduced violent incidents.
Methods: The population included nurses employed on 24 bed medical-surgical unit at a large, metropolitan hospital. The sub-population were the patients admitted to the floor who demonstrated aggressive behavior. Pre-post intervention aggressive incident data was collected. Participants completed a pre-intervention survey to measure confidence in managing aggressive behaviors using Thackrey's (1987) Confidence in Coping with Patient Aggression Instrument (CCPAI). Following survey completion, a PowerPoint presentation based on Richmond's (2012) Ten Domains of De-Escalation was delivered to participants. Learners also engaged in a 15-minute live standardized simulation learning experience. A post-intervention survey was administered to compare results prior to and after the educational intervention.
Evaluation/Results: Pretest-posttest data were analyzed using a paired t-test and confidence intervals. The lower and upper estimates for the aggressive incidence rate prior to the educational intervention at p < .000, d = 19.3 was 95% CI [18.30, 34.40]. At the later post-intervention follow-up, an average increase in scores was evidenced at the specified p < .000, d = 20.20, 95% CI [20.59, 38.04]. Pre-intervention data showed 51.8 % reported two or more aggressive incidents in the past month. No aggressive incidents were recorded at four weeks post-intervention.
Implications: This educational intervention increased nurses’ confidence in managing aggressive patient incidents in short and long-term time periods. As there were no recorded aggressive incidents four weeks post-intervention, it is likely the educational intervention improved patient outcomes. The implications of this project suggest the importance for all medical-surgical nurses to undergo de-escalation training. To improve patient and staff safety, healthcare organizations should consider making de-escalation training a mandatory competency for all medical-surgical nurses.