Using simulated patients to teach de-escalation during Registered Nurses' onboarding

Background

Workplace violence and aggression toward healthcare professionals are concerning trends in the industry, with increasing incidents over the last decade. The COVID-19 pandemic put additional stress on health systems, healthcare workers, patients, and family members. These additional stressors resulted in increased aggressive behaviors. Education and training on de-escalation techniques is paramount to increased safety of health professionals and patients. Nursing education programs and hospital orientation programs often lack de-escalation training.

Methods

From January to October 2023, 102 nurses participated in a de-escalation simulation encounter. Quantitative and qualitative data was captured via Redcap survey. Facilitators tracked behaviors of the simulated patients and reactions of the nurses, in real-time, using a survey designed by the education team. Participants completed a post-survey which elicited information about prior de-escalation training and application of skills learned during the de-escalation simulation encounter to future practice.

Results

Sixty-five percent of new graduate nurses revealed that they had some form of de-escalation training most of which was provided through a lecture (36%) or online module (19%). Following participation in the simulation encounter, 98.5% of participants felt better prepared to manage an escalating patient/family member situation. Structured debriefings identified educational gaps regarding hospital resources, behavioral strategies for averting escalating incidents, methods for maintaining safety, and discreetly seeking assistance.

Conclusion

The simulated patient training offered participants an opportunity to apply de-escalation techniques in a safe environment. Targeted de-escalation training using simulated patients increased the authenticity and realism of the immersive experience and resulted in enhanced de-escalation skill development in new hire nurses.