Reducing Patient Aggression Through a Nonviolent Patient De-escalation Program: A Descriptive Quality Improvement Process.

BACKGROUND: Patients commonly display aggressive and violent behaviors toward nursing staff, contributing to severe consequences. Healthcare institutions must develop and implement systems addressing this global safety problem. AIM: To improve clinical practice safety for inpatient acute care settings by providing healthcare teams throughout a large academic medical center with a Behavioral Emergency Response Team (BERT) program, that is, a system for reporting and de-escalating aggressive patient encounters. METHODS: This descriptive quality improvement process took place within two inpatient acute care departments using simulation-based training, patient safety rounds, and a BERT activation system. Participant groups included nursing personnel who completed a baseline survey (n = 302), telecommunication dispatchers (n = 20), BERT responders (n = 78), and bedside nursing staff (n = 43) recipients of BERT program resources. Methods included a baseline questionnaire, pre- and post-intervention surveys, formal reports of aggressive patient encounters, documentation from patient safety rounds, and records of activated BERT responses. Data analysis included descriptive statistics, boxplots, and the Wilcoxon signed-rank test. RESULTS: This project mitigated patient aggression episodes by successfully designing and implementing an evidence-based BERT program. Findings suggested bedside nursing program participants felt more confident and capable of managing aggressive patient behaviors. A strong partnership between security officers and nursing staff limited the risk of harm to clinical staff by identifying and intervening with 41 potentially aggressive patients. Finally, formal reports of patient aggression episodes did not increase during this project, which may have indicated early prevention and detection of aggression while reflecting the broader problem of aggression under-reporting in nursing. LINKING EVIDENCE TO ACTION: Healthcare organizations need to have robust systems to manage aggressive patient encounters. Comprehensive strategies for managing patient aggression include simulation-based training, the use of BERT responders, and a strong partnership between nursing and security officer teams.

Identifying changes in comfort and worry among pediatric nursing students following clinical rotations.

Pediatric nursing clinicals often cause feelings of worry, thus hindering students' discovery. This study sought to identify worry-provoking elements before and after pediatric clinical rotations. Participants included 100 pediatric nursing students. A descriptive, exploratory, quantitative design was used to explore student worry using the Pediatric Student Comfort and Worry Assessment Tool. Pre- and post-test scores were calculated to evaluate changes in worry and comfort. The item that changed the most was comfort in assessment, whereas worry regarding causing a child pain changed the least. These data suggest the significant need in identifying worries to improve confidence in performance for pediatric clinical.

Exploratory factor analysis of the pediatric nursing student clinical comfort and worry assessment tool.

Pediatric nursing clinical often causes feelings of fear, thus hindering students' performance. This sparked the creation of the "pediatric nursing student clinical comfort and worry assessment tool," which can be utilized to identify worry-provoking elements before and after pediatric clinical rotations. The purpose of this study is to describe the development and psychometric testing of this tool. Psychometric tests used to assess data quality, reliability, and construct validity demonstrated that the pediatric nursing student clinical comfort and worry assessment tool can be used to evaluate nursing students' comfort and worry in pediatric nursing clinical rotations.

Using Simulation in Nursing PhD Education: Facilitating Application of Responsible Conduct of Research Principles.

Simulation is a standard clinical nursing educational approach; however, simulation is rarely used in nonclinical nursing education. In doctor of philosophy (PhD) programs, ethical content about responsible conduct of research (RCR) is traditionally didactic, presented early in the program of study. Ethics content merits review before students begin the dissertation phase; thus, the purpose of this project was to design and implement simulated scenarios to help students apply RCR principles prior to beginning independent research. Two scenarios were developed: (a) a potential protocol change discussed in a research team meeting and (b) an in-home data collection experience with an elderly participant and her daughter. Actors were trained faculty volunteers, playing roles outside their usual academic positions. Faculty facilitated scenarios by posing questions as cues related to desired learning outcomes as scenarios unfolded. Eleven nursing PhD students and 6 faculty participated. Debriefing facilitated discussion of RCR principles, common research quandaries, and suggested scenario revisions. Faculty, expert observation, and video-review showed that younger and less experienced students tried to give the "right" answer rather than implement RCR appropriate solutions. Students with more clinical experience had difficulty adopting the less familiar researcher role. Overall, simulation is a novel and useful way to enhance RCR content in PhD programs.

Transcending Competency Testing in Hospital-Based Simulation.

Simulation is a frequently used method for training students in health care professions and has recently gained acceptance in acute care hospital settings for use in educational programs and competency testing. Although hospital-based simulation is currently limited primarily to use in skills acquisition, expansion of the use of simulation via a modified Quality Health Outcomes Model to address systems factors such as the physical environment and human factors such as fatigue, reliance on memory, and reliance on vigilance could drive system-wide changes. Simulation is an expensive resource and should not be limited to use for education and competency testing. Well-developed, peer-reviewed simulations can be used for environmental factors, human factors, and interprofessional education to improve patients' outcomes and drive system-wide change for quality improvement initiatives.

The Development and Validation of the Interprofessional Attitudes Scale: Assessing the Interprofessional Attitudes of Students in the Health Professions.

PURPOSE: No validated tools assess all four competency domains described in the 2011 report Core Competencies for Interprofessional Collaborative Practice (IPEC Report). The purpose of this study was to develop and validate a tool based on the IPEC Report core competency domains that assesses the interprofessional attitudes of students in the health professions. METHOD: In 2012, an interprofessional team of students and two of the authors developed and administered a survey to students from four colleges and schools at the University of Utah Health Sciences Center (Health, Medicine, Nursing, and Pharmacy). The authors randomly split the responses with complete data into two independent subsets: one for exploratory factor analysis (EFA), the other for confirmatory factor analysis (CFA). They performed these analyses to validate the tool, eliminate redundant questions, and identify subscales. Their analyses focused on aligning tool subscales with the IPEC Report core competencies and demonstrating good construct validity and internal consistency reliability. RESULTS: Of 1,549 students invited, 701 (45.3%) responded. The EFA produced a 27-item scale, with five subscales: teamwork, roles, and responsibilities; patient-centeredness; interprofessional biases; diversity and ethics; and community-centeredness (Cronbach alpha coefficients: 0.62 to 0.92). The CFA indicated that the content of the five subscales was consistent with the EFA model. CONCLUSIONS: The Interprofessional Attitudes Scale (IPAS) is a novel tool that, compared with previous assessment instruments, better reflects current thinking about interprofessional competencies. IPAS should prove useful to health sciences institutions committed to training students to work collaboratively in interprofessional teams.