Developing Empathy in Emergency Nurses Using Hearing Voices Simulation.

Background: Many health professionals report feeling uncomfortable talking with patients who hear voices. Patients who hear voices report feeling a lack of support and empathy from emergency nurses. A local emergency department reported a need for training for nurses in the care of behavioral health patients. Objective: The aim of this study is to implement a quality improvement project using a hearing voices simulation. Empathy was measured using the Toronto Empathy Questionnaire, and a post-intervention survey was used to evaluate emergency nurses' perception of the professional development session. Methods: The quality improvement project included the implementation of a hearing voices simulation with emergency nurses. A paired t-test was used to determine the differences in the nurses empathy levels pre-and post-simulation. Qualitative data was collected on the nurses' experience during the simulation debriefing. A Likert-style questionnaire was used to collect data on the nurses' evaluation of the simulation. Results: The results of the hearing voices simulation were a statistically significant increase (p < .00) in empathy from baseline (M = 47.95, SD = 6.55) to post-intervention empathy scores (M = 48.93, SD = 6.89). The results of the post-simulation survey indicated that nurses felt that the hearing voices simulation was useful (n = 100; 98%) and helped them to feel more empathetic toward patients who hear voices (n = 98; 96%). Conclusions: Using a hearing voices simulation may help emergency nurses feel more empathetic toward the behavioral health patients who hear voices. Implications for Nursing: Through the implementation of a hearing voices simulation, clinical staff educators can provide support to staff nurses in the care of behavioral health patients.

A Quality Improvement Project on Agitation Management in the Emergency Department.

INTRODUCTION: Agitation is common in the emergency department. When agitation is not detected early, patients can become aggressive and violent, potentially leading to restraint use and subsequent injury. The goals of the project were early detection and management of patient agitation, reduction of restraint use in the emergency department, and determination of the usability of the Behavioral Activity Rating Scale. METHODS: This quality improvement project was assessed using a pre- and posttest single unit design, comparing 4 months of postimplementation data to historic controls at the same time of year in the previous year. The intervention was implementing the Behavioral Activity Rating Scale in the ED electronic medical record. Data were collected through retrospective chart review and nurse survey. From September through December of both 2017 and 2018, data were collected on restraint use. The 4-month 2018 data collection period included measures of Behavioral Activity Rating Scale documentation and the System Usability Scale survey for nurses to measure ease of usability of the Behavioral Activity Rating Scale. RESULTS: The Behavioral Activity Rating Scale was documented frequently (n = 4 867 documentations) by emergency nurses to assess patients with behavioral health and medical complaints (n = 780). Nurses identified 18 episodes of violent behavior in behavioral health patients on the Behavioral Activity Rating Scale (2.31%) and applied restraints 18 times. The most common chief complaints for patients who were identified as violent was suicidal ideation (n = 6; 33.33%). In 2017, there were 20 episodes of restraint use during the same time period, a nonsignificant difference (χ2 = 0.72; P = 0.40). However, only 2 patients were kept in restraints longer than 1 day in 2018 compared with 8 in 2017. Emergency nurses found the Behavioral Activity Rating Scale to be usable in the structured usability assessment (µ = 83.46; SD = 11.73). DISCUSSION: The Behavioral Activity Rating Scale is a usable tool for emergency nurses to assess for patient agitation. With the incorporation of agitation management interventions, the ED team can potentially manage agitation before violence occurs. Further studies are needed on the use of agitation or aggression assessment tools for managing patient behavioral activity such as aggression in the emergency department.