Student nurses' de-escalation of patient aggression: a pretest-posttest intervention study

Abstract

Background: Experts recommend staff training to prevent and manage aggressive situations involving patients or their relatives. However, in many countries this subject is not covered in pre-registration nursing education. In addition, the evidence regarding its impact on practical placements remains weak.

Objective: This study examines the influence of an aggression management training programme for nursing students on their performance in de-escalating aggressive patients.

Design: Pretest-posttest within-and-between-groups design.

Setting: A School of Nursing in Germany.

Participants: Convenience sample out of six classes of nursing students at differing educational levels (10th to 28th month of nursing education, n=78, mean age=22).

Methods: In a cross-sectional and longitudinal two groups before and after design nursing students encountered two scenarios (A or B) with simulation patients. After completing the training, each student was confronted with the unknown other scenario. De-escalation experts from three German-speaking countries evaluated 156 video scenes using the De-escalating Aggressive Behaviour Scale (DABS), not knowing whether the videos had been recorded before or after the training. Mean values and statistical significance tests were computed to compare the results.

Results: The performance levels of students who had been trained rose significantly from 2.74 to 3.65 as measured by the DABS on a 5-point Likert scale (Wilcoxon test p<.001). The trained students managed scenario A significantly better than the untrained students (untrained 2.50, trained 3.70; Mann-Whitney-U-test p<.001,). Similar results were found for scenario B (untrained 3.01, trained 3.61; Mann-Whitney-U-test p<.001). No significant differences were found in the pretest results irrespective the students' age or duration of previous nursing education.

Conclusions: Aggression management training is able to improve nursing students' performance in de-escalating aggressive behaviour. A maturation-effect on the de-escalating performance due to general nursing education or age is unlikely.