Staff Perception of Interprofessional Simulation for Verbal De-escalation and Restraint Application to Mitigate Violent Patient Behaviors in the Emergency Department.

PROBLEM: Violent behaviors in the emergency department are on the rise. Mitigation efforts are essential for staff and patient safety. The goal of this quality improvement project was to improve staff perception of knowledge, skills, abilities, confidence, and preparedness when managing violent patient behaviors using interprofessional simulation training and to evaluate staff learning style satisfaction and self-confidence using simulation.

METHODS: Interprofessional participants received individual computer-based training and simulation training on de-escalation techniques and restraint application. The participants' perceptions were collected in a pre- and postsurvey and analyzed using Bowker's test of symmetry. Revised tools from the National League for Nursing were used, including the Simulation Design Scale and Satisfaction and Self-Confidence in Learning, and results were analyzed by one-way analysis of variance, comparing results within and between the disciplines involved.

RESULTS: Group comparison (nursing, providers, security staff, and social services staff) using contingency tables illustrated a significant improvement (P < 0.0001) in knowledge (21%), skills (20%), abilities (19%), confidence (20%), and preparedness (30%). Satisfaction among nurses (P = 0.0021), patient care assistants (P = 0.0134), and security staff (P = 0.0060) was significantly greater than among social services staff. No significant differences were found among providers or by sex. Participants with less experience were more satisfied than those who have been in their role for 16 years or more (P = 0.0290).

IMPLICATIONS FOR PRACTICE: Participants' self-reported changes in knowledge, skills, ability, confidence, and preparedness demonstrated significance for a short-term change, with preparedness having the greatest increase. Simulation debriefing allowed participants to provide feedback; satisfaction was higher for persons with less experience. The application of skills through simulation can prepare staff to handle difficult patient encounters.