Simulation-Based Education for Staff Managing Aggression and Externalizing Behaviors in Children With Autism Spectrum Disorder in the Hospital Setting: Pilot and Feasibility Study Protocol for a Cluster Randomized Controlled Trial

Mitchell, Marijke; Newall, Fiona; Sokol, Jenni; Williams, Katrina

doi:10.2196/18105

Cited by 11 publications

(11 citation statements)

References 26 publications

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“…Aggression demonstrated by patients in the acute paediatric hospital setting can result in serious self-injury and threaten the safety of their family, staff and other patients [1]. Clinical aggression episodes in child health facilities warranting a coordinated, systematic response are increasing [2][3][4][5][6]. Paediatric hospital staff, whilst required to regularly demonstrate competence in resuscitation and management of the deteriorating child, are often not trained nor tested in the management of clinical aggression [7][8][9][10][11][12][13].…”

Section: Introductionmentioning

confidence: 99%

Simulation-based education to promote confidence in managing clinical aggression at a paediatric hospital

et al. 2020

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Background: An increasing number of incidents involving aggressive behaviour in acute care hospitals are being witnessed worldwide. Acute care hospital staff are often not trained or confident in managing aggression. Competent management of clinical aggression is important to maintain staff and patient safety. Training programmes for acute care staff are infrequently described in the literature and rarely reported for paediatric staff. Simulation training allows practice of skills without patient risk and may be more effective than traditional teaching formats for aggression management. Aim and design: The aim of this proof of concept study was to develop a simulation-based education session on aggression management for acute care paediatric staff based on best practice principles, to evaluate the acceptability of this training programme and to gain an understanding of the impact of the training on participants' perceived confidence in managing clinical aggression. Two separate simulation exercises were delivered as a 2-h component of a hospital management of clinical aggression (MOCA) training day. Participants completed a written survey immediately prior to, at completion of the simulation-based group training, and at 3-6 months following the simulation training. Findings: Nine training days were conducted in 2017 for nursing, medical, allied health, education and security staff with a total of 146 participants (83% were acute care nurses). Two thirds (68%) of participants had experienced clinical aggression as part of their routine work, with 51% overall reporting a lack of confidence managing these patients. Immediately following the simulation training, 80% of all participants reported feeling more confident in managing clinical aggression, 47% reported a 1-point increase in confidence, whilst 33% of participants reported a 2-or 3-point increase. At 3-6 months post-training, 66% of respondents (N = 44) reported continued confidence in managing aggression with 100% of participants stating they would recommend simulation training to colleagues.

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Section: Introductionmentioning

confidence: 99%

Simulation-based education to promote confidence in managing clinical aggression at a paediatric hospital

et al. 2020

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“…[31] A detailed study protocol has been published. [32] A brief description of those methods follows.…”

Section: Methodsmentioning

confidence: 99%

“…The Kirkpatrick Model was used to measure the impact of the training as described in the protocol. [32] This 4-level model evaluates training according to (1) reaction; (2) learn-ing; (3) behavior and ( 4) results. [26,27,34] Outcome measures used in this study are detailed in Table 3.…”

Section: Data Collection Management and Analysismentioning

confidence: 99%

Simulation-based education for staff managing aggression and high-risk behaviors in children with autism spectrum disorder in the hospital setting: A pilot and feasibility cluster randomized controlled trial

Mitchell

Newall

Heywood

et al. 2021

JNEP

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Background and objective: Aggression and high-risk behaviors, which can result in behavioral emergencies, are common in children with autism and can be magnified in the hospital environment. Children with autism, with or without intellectual disability, have complex communication needs which require a sophisticated level of knowledge, understanding and skill from health care professionals. Pediatric acute care nursing staff are often not trained and lack confidence in managing children with autism. The purpose of this study was to conduct a pilot and feasibility cluster randomized controlled trial (RCT) of simulation-based education for staff in managing behavioral emergencies with autism spectrum disorder (ASD) in the hospital setting.Methods: This study used a mixed method, to explore the acceptability and feasibility of delivering a large-scale cluster RCT and assess trial processes including recruitment, completion rates, contamination, and outcome measures. The simulation-based training format comprised two scenarios involving an adolescent with autism, intellectual disability and aggressive behaviors. Two pediatric wards of similar size and patient complexity were selected to participate in the study and randomized to receive either simulation-based education plus web-based education materials or web-based education materials only. Results: The RCT design is feasible with recruitment, acceptability and completion rates reaching target. Self-perceived baseline levels of confidence in managing aggression in children were mid-range and lower for children with autism and intellectual disability. Forty to fifty percent of intervention participants rated the training highly in terms of developing skills and knowledge respectively. The mean group score for observer ratings of de-escalation across four simulations was 20 out of a possible 35. Data for ward aggression were not collected.Conclusions: Simulation-based education is an acceptable training format for acute care pediatric nurses. This study is feasible to conduct as a cluster RCT with some modifications to this protocol including assessment of baseline differences in confidence. Observer ratings of de-escalation skills indicated that more than one episode of training may be required for acute care pediatric staff to successfully de-escalate aggressive incidents. As such, we will use repeated simulation scenario exercises for each intervention group in the next trial.

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“…Increase in the number of episodes of clinical aggression is not unique to the adult setting. Paediatric hospitals are reporting increased levels of aggression [19][20][21] with over 1600 events at one Australian paediatric tertiary hospital reported in 1 year [22]. Aggression, destruction of property, wandering, and self-harm can result in injury to self and others [23][24][25][26][27][28].…”

Section: Rationalementioning

confidence: 99%

“…In the adult setting, patients most likely to exhibit aggressive behaviours are those diagnosed with psychiatric or personality disorders, dementia, acute confusion, or drug-related problems [34]. In the paediatric setting, approximately 50% of aggressive episodes have been noted to be initiated by children with a neurodisability [22].…”

Section: Rationalementioning

confidence: 99%

Simulation-based education for teaching aggression management skills to health care providers in the acute health care setting: a systematic review protocol

et al. 2020

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Background: Clinical aggression episodes, that is aggression and externalising behaviours that create risk, in acute care hospitals are increasing. Acute care staff are often not confident or trained in the management of aggression. Various aggression management training formats have been described in practice including face to face training, written learning resources, web-and media-based training resources, and simulation training. The aim of this systematic review is to assess whether simulation-based training is effective in increasing de-escalation knowledge, skills, and behaviour of staff working in the acute care setting. Methods: We designed and registered a study protocol for a systematic review of studies evaluating simulationbased training for the management of patients with aggression. We will include randomised controlled trials, nonrandomised controlled trials, quasi-experimental studies, and observational studies including health care professionals and trainees in acute health care settings. Comprehensive searches will be conducted in the following databases (from January 1980 onwards): PubMed, MEDLINE, PsycINFO, CINAHL, and the Cochrane Library. The reference lists of selected studies, trial registers, and leading journals will also be searched. Two reviewers will independently screen all citations, full-text articles, and abstract data. Potential discrepancies will be resolved through discussion. The primary outcomes will include patient outcomes (e.g. frequency of clinical aggression), quality of care (e.g. frequency of emergency situations, physical/chemical/mechanical restraint), and adverse effects (e.g. patient/family complaints, patient harms, staff harms). Secondary outcomes will include workplace resource use, health care provider-related outcomes, knowledge (de-escalation techniques), performance, attitudes, and satisfaction. The study methodological risk of bias will be appraised using appropriate tools. A narrative synthesis will be performed for included studies. If feasible, we will conduct random-effects meta-analysis of data. Additional analyses will be conducted to explore the potential sources of heterogeneity (e.g. participant characteristics, interventions, and follow-up).

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Simulation-Based Education for Staff Managing Aggression and Externalizing Behaviors in Children With Autism Spectrum Disorder in the Hospital Setting: Pilot and Feasibility Study Protocol for a Cluster Randomized Controlled Trial

Cited by 11 publications

References 26 publications

Simulation-based education to promote confidence in managing clinical aggression at a paediatric hospital

Simulation-based education to promote confidence in managing clinical aggression at a paediatric hospital

Simulation-based education for staff managing aggression and high-risk behaviors in children with autism spectrum disorder in the hospital setting: A pilot and feasibility cluster randomized controlled trial

Simulation-based education for teaching aggression management skills to health care providers in the acute health care setting: a systematic review protocol

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