Simulation-Based Training for Residents in the Management of Acute Agitation: A Cluster Randomized Controlled Trial

Vestal, Heather S.; Sowden, Gillian; Nejad, Shamim H.; Stoklosa, Joseph; Valcourt, Stephanie C.; Keary, Christopher J.; Caminis, Argyro; Huffman, Jeff C.

doi:10.1007/s40596-016-0559-2

Cited by 22 publications

(8 citation statements)

References 28 publications

(39 reference statements)

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“…[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.…”

Section: Simulation Design and Acceptabilitysupporting

confidence: 86%

“…[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. [15,16] Simulation-based education provides both training opportunities.…”

Section: Introduction 11 Background and Rationalementioning

confidence: 99%

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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

Mitchell

Newall

Heywood

et al. 2021

JNEP

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Background and objective: Aggression and high-risk behaviors, which can result in behavioral emergencies, are common in children with autism and can be magnified in the hospital environment. Children with autism, with or without intellectual disability, have complex communication needs which require a sophisticated level of knowledge, understanding and skill from health care professionals. Pediatric acute care nursing staff are often not trained and lack confidence in managing children with autism. The purpose of this study was to conduct a pilot and feasibility cluster randomized controlled trial (RCT) of simulation-based education for staff in managing behavioral emergencies with autism spectrum disorder (ASD) in the hospital setting.Methods: This study used a mixed method, to explore the acceptability and feasibility of delivering a large-scale cluster RCT and assess trial processes including recruitment, completion rates, contamination, and outcome measures. The simulation-based training format comprised two scenarios involving an adolescent with autism, intellectual disability and aggressive behaviors. Two pediatric wards of similar size and patient complexity were selected to participate in the study and randomized to receive either simulation-based education plus web-based education materials or web-based education materials only. Results: The RCT design is feasible with recruitment, acceptability and completion rates reaching target. Self-perceived baseline levels of confidence in managing aggression in children were mid-range and lower for children with autism and intellectual disability. Forty to fifty percent of intervention participants rated the training highly in terms of developing skills and knowledge respectively. The mean group score for observer ratings of de-escalation across four simulations was 20 out of a possible 35. Data for ward aggression were not collected.Conclusions: Simulation-based education is an acceptable training format for acute care pediatric nurses. This study is feasible to conduct as a cluster RCT with some modifications to this protocol including assessment of baseline differences in confidence. Observer ratings of de-escalation skills indicated that more than one episode of training may be required for acute care pediatric staff to successfully de-escalate aggressive incidents. As such, we will use repeated simulation scenario exercises for each intervention group in the next trial.

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Section: Simulation Design and Acceptabilitysupporting

confidence: 86%

Section: Introduction 11 Background and Rationalementioning

confidence: 99%

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

Mitchell

Newall

Heywood

et al. 2021

JNEP

View full text Add to dashboard Cite

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“…Programmes have not been shown to consistently reduce incidents of aggression or restraint [ 13 , 16 ]. Formats which include practice of skills combined with reflection and reinforcement, such as with simulation-based education, may be more efficacious [ 18 , 24 – 26 ].…”

Section: Introductionmentioning

confidence: 99%

“…In order to improve staff skill levels in managing aggression, it would be ideal for staff to practise de-escalation and restraint skills in an environment which closely resembles the environment in which they work [ 18 , 26 ]. Simulation training allows participants to develop or enhance their knowledge and skills, and analyse and respond to realistic situations in a simulated clinical setting without patient risk [ 27 ].…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2020

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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.

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“…3 Vestal and colleagues reported that an SP simulation was superior to lecture-based didactics in improving first-year psychiatry residents' knowledge of and performance in managing patients with acute agitation. 4…”

Section: Introductionmentioning

confidence: 99%

A Difficult Patient Encounter: Using a Standardized Patient Scenario to Teach Medical Students to Treat Medication-Seeking Patients

2017

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IntroductionSubstance dependence and the misuse of prescription narcotic medications have recently been a topic of increased national attention. Since this is both a difficult and increasingly important area for medical student training, we created an addition to our psychiatry clerkship curriculum to address this need using a standardized patient scenario.MethodsStandardized patient scenarios are a useful instructional and assessment tool for providing medical students with exposure to specific clinical scenarios that could not be consistently and reliably encountered in clinical rotations. We present a standardized patient scenario designed to challenge psychiatry clerkship students with recognizing and managing substance use disorders in patients with a difficult interaction style and medication-seeking behavior. Our scenario is unique in its expectations of students to appropriately manage a difficult clinical interaction in which collaborative treatment planning and advanced communication skills are critical to treatment success.ResultsIn a narrative analysis of student postencounter reflections on this experience, most students who provided feedback indicated that the encounter was valuable to their psychiatry clerkship education.DiscussionThe inclusion of this learning opportunity in our clerkship has added value by assessing students' interpersonal communication skills and clinical ability to evaluate and manage substance use disorders, as well as by instructing students to manage a common and difficult clinical scenario regardless of their future specialty choice.

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Simulation-Based Training for Residents in the Management of Acute Agitation: A Cluster Randomized Controlled Trial

Cited by 22 publications

References 28 publications

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

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

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

A Difficult Patient Encounter: Using a Standardized Patient Scenario to Teach Medical Students to Treat Medication-Seeking Patients

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