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Background: As violence in health care settings increases, the need for using de-escalation techniques has become more prevalent as a first-line response to reduce potential violence and aggression. The Centers for Disease Control and Prevention (CDC) has noted a rise in workplace violence, with the greatest increases of violence occurring against nurses and nursing assistants (Brous, 2018). Nurse residents (NRs) in an academic Magnet® facility noted frequent use of behavioral 1:1 sitters and patient restraint use in their 30-bed step-down trauma unit. Clinical nurses received network-supported crisis management training annually; however, nurses verbalized the need for ongoing education and support in order to incorporate these practices naturally and confidently into their daily clinical practice. Additionally, novice nurses to the unit often began clinical practice before receiving the benefit of this training designed to promote safety and reduce harm to both patients and staff.
Purpose: This presentation shares a nurse resident-led evidence-based practice project designed to offer strategies to promote de-escalation behaviors in combative and agitated trauma patients and emphasizes the vital role of the trauma nurse in the promotion of trauma-informed health care.
The learner will gain strategies to
• Prevent violent behavior in the agitated/combative trauma patient.
• Enable patients to manage their own emotions and to regain personal control.
• Decrease the use of patient restraints.
• Maintain the safety of staff and patients.
• Improve staff/patient connections and relationships.
Description: A pre-survey was created and distributed to assess clinical nurses’ awareness and confidence in utilizing non-pharmacological de-escalation methods in the trauma population. Results revealed 40% of unit RNs were both confident using and aware of non-pharmacological de-escalation methods. Nurse residents incorporated a
behavior management technique, T-A-DA (tolerate, anticipate, don’t agitate) which allows behaviors which do not have the potential for harm, anticipates patient needs (i.e., food and toileting), and reduces agitation by using distraction and redirection. Nurse residents created an educational handout detailing the technique, which was reviewed with nurses at daily unit safety huddles and shift change, posted on the unit, and provided to staff caring for behavioral 1:1 patients. Post-implementation survey results revealed 92% of RNs felt confident and 100% of RNs verbalized knowledge of non-pharmacological de-escalation resources to use in the trauma patient population.
Evaluation/outcomes: Key project outcomes included an increase in staff mindfulness recognizing and responding to signs of agitation and anxiety in the trauma patient by possessing enhanced skills to reduce violent patient behaviors. “Lessons learned” include the need to provide education to new unit and float unit staff and intermittently reinforce education with all unit staff to promote awareness and maintain competency. Additionally, sharing information on individual successful behavior management techniques in bedside shift report is beneficial to promote consistency and reduce violent behaviors in this population. Potential future recommendations can include monitoring unit restraint use in trauma patients who received the intervention to assess for a reduction in physical restraint utilization. Attendees at this session will gain knowledge/pragmatic strategies to reduce violent behavior in the agitated/combative trauma patient.
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