Simulation-based education to promote confidence in managing clinical aggression at a paediatric hospital

Abstract

Background: An increasing number of incidents involving aggressive behaviour in acute care hospitals are being witnessed worldwide. Acute care hospital staff are often not trained or confident in managing aggression. Competent management of clinical aggression is important to maintain staff and patient safety. Training programmes for acute care staff are infrequently described in the literature and rarely reported for paediatric staff. Simulation training allows practice of skills without patient risk and may be more effective than traditional teaching formats for aggression management. Aim and design: The aim of this proof of concept study was to develop a simulation-based education session on aggression management for acute care paediatric staff based on best practice principles, to evaluate the acceptability of this training programme and to gain an understanding of the impact of the training on participants' perceived confidence in managing clinical aggression. Two separate simulation exercises were delivered as a 2-h component of a hospital management of clinical aggression (MOCA) training day. Participants completed a written survey immediately prior to, at completion of the simulation-based group training, and at 3-6 months following the simulation training. Findings: Nine training days were conducted in 2017 for nursing, medical, allied health, education and security staff with a total of 146 participants (83% were acute care nurses). Two thirds (68%) of participants had experienced clinical aggression as part of their routine work, with 51% overall reporting a lack of confidence managing these patients. Immediately following the simulation training, 80% of all participants reported feeling more confident in managing clinical aggression, 47% reported a 1-point increase in confidence, whilst 33% of participants reported a 2-or 3-point increase. At 3-6 months post-training, 66% of respondents (N = 44) reported continued confidence in managing aggression with 100% of participants stating they would recommend simulation training to colleagues.

Simulation-based education for staff managing aggression and high-risk behaviors in children with autism spectrum disorder in the hospital setting: A pilot and feasibility cluster randomized controlled trial

“…[29] Measurement of these concepts in clinical practice are difficult to achieve as this pilot study indicates. The intervention group rated the simulation training lower than expected, similar to results from our previous study, [12] and others, [14,43] for its ability to develop skills and knowledge in managing aggression. This may be due to the complexity of the two scenarios which required participants to use multiple strategies to communicate effectively with the adolescent and their parent.…”

“…The response rate for the follow-up survey was higher than anticipated and more than double the response rate in our previous study, which utilized hardcopy responses. [12] Electronic survey completion rates were comparable to hardcopy surveys administered while attending the training, if participants receive two reminder emails to complete the surveys prior to and following the training.…”

“…Based on our experiences in an earlier study, [12] recruitment of ten staff to each study arm was deemed to be a suitable size for a pilot and feasibility study to assess recruitment, data collection and contamination. Ward-based education for nursing staff about the study was provided by a study investigator, with opportunity to ask questions prior to commencement of the study.…”

“…A previous simulation program we designed and evaluated for managing aggression was embedded into a full day study day and built on concepts discussed in the face-to-face workshops. [12] Attendance was pre-planned but restricted to 1-2 staff members per clinical area. This study required five staff at a time to be released from one ward.…”

“…[11] Behavioral emergencies in hospitals often trigger a team response utilizing staff from a range of clinical areas and roles. [12] Training should ideally replicate the clinical experience through multidisciplinary team training and the opportunity for repetitive practice of de-escalation and restraint skills without patient risk. [13,14] Coupled with this, reflective debriefing and feedback on performance are important adjuncts to promote deeper learning.…”