Using Simulation Methodology to Teach De-escalation Techniques and Behavioral Emergency Response

The purpose of this project was to educate behavioral emergency response team (BERT) members in de-escalation techniques using best practices in simulation methodology. The goal was to increase confidence in dealing with potentially violent situations. The University of Utah Hospitals and Clinics have experienced an increase in both verbal and physical violence by patients and visitors. Acute-care nurses and health care assistants recently reported more than 800 behavioral incidents in one month. In addition, 80% of surveyed staff reported little or no training in de-escalation techniques. Simulation has become an effective teaching methodology for skills, self-efficacy, and satisfaction with the learning experience. Scenarios were created using the Standards of Best Practice in simulation design from the International Nursing Association of Clinical Simulation and Learning (INACLS). Data collection included a pre-/posttest modified General Self-Efficacy Scale and a post open-ended questionnaire regarding simulation effectiveness for future system implementation. Institutional review board exemption for the quality-improvement project was obtained. Pre- and postdata were analyzed using a Wilcoxon signed-ranks test for paired ordinal variables. A significant difference (< 0.05) was found in most comparisons, notably in "solving difficult problems," "dealing with unexpected events," "handling unforeseen situations," and "using advanced communication for patient safety" post implementation. Simulation education for de-escalation techniques was shown to be an effective methodology for de-escalation and advanced communication. Open-ended questions showed the simulation program to be "realistic" and "straightforward," and that staff would appreciate "more simulation" training in the future.