Implementation of De-Escalation Training to Medical-Surgical Nurses

Abstract

Problem: The American Nurses Association reports only 20% of nurses’ feel safe in their area of practice with patient violence towards nurses happening more frequently on medical-surgical units (Cahill, 2008; OSHA, 2004). Purpose: To determine the effectiveness of de-escalation training on medical-surgical nurses’ confidence levels in handling agitated patients. Methods: This quality improvement project employs a non-experimental, single group, pre- and post-test design. Thackrey’s (1987) Confidence in Coping with Patient Aggression Instrument (CCPAI), a 10-item questionnaire, evaluates nursing confidence levels in dealing with agitated patients before and after implementing Richmond’s et al. (2012) Ten Domains of De-escalation. Outcomes: A one-sample t test comparing the pre- and post-test confidence scores showed the mean as significantly different from 55, a hypothetically neutral score. The post-test mean significantly increased (68.82, 95% CI [6.84 to 20.81]) from the pre-test, t(33) = 4.03, p = <.001 and showed a moderate to large effect size d = .72 (Pilot, 2010). A paired-sample two-tailed t test significantly increased from Time 1 pre-test (M = 49.82, SD = 10.11) to Time 2 post-test (M = 72.82, SD = 14.41), t(10) = 4.46, p < .001. The mean increase was 23.00 [95% CI, 11.51 – 34.49]; d = 1.84 indicating a large effect size (Pilot, 2010). A sensitivity analysis (Wilcoxon Signed Rank Test) showed a median difference amongst the matched pairs with a significant increase in confidence levels post-training, z =-2.847, p < .004. The median score increased from the pre-test (Md =51) to the post-test scores (Md = 71) (Pallant, 2013). Implications: This pilot project demonstrates improved medical-surgical nursing confidence in dealing with agitated patients. Further research using a larger sample size in several nursing units would add validity to the results.