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Care Environment with the Aid of Simulation

Jaroslav Pekara

Background: Experience of workplace violence is pervasive in health and social care settings and there is an urgent need for target-group-specific preventative measures. This study investigated the impact of a unique, specifically tailored training programme for de-escalation and prevention of violence in healthcare settings. Through a simulation training for healthcare professionals, aiming at preventing patient and visitor violence, the simulated or standardized patients were shown to play an increasingly important role. Either professional or amateur performers, and sometimes "real " patients, called expert patients, were acting in the simulation. The realism they contribute to the training simulation is an undisputable enhancement of this teaching tool. The main aim of this study was to describe and evaluate the impact of a simulation course on the confidence of health care providers in their management of violent situations and verify if the simulation could provide individual safety space for education. This research was connected with project of Technology Agency of the Czech Republic (Personal educational environment for university students of medical disciplines, project number: TL03000205).

Methods and findings: Our course was designed as a practical 6-hour training and was divided into three parts: (1) training of non-verbal communication and de-escalation; (2) training of the safe restraint of a very restless/violent patient using bed restraints; and (3) training of coping strategies in several simulation scenes tailored to the needs, abilities and background of the participants. All course participants answered two questionnaires. The first focused on the extent and frequency of their experience of violence in the past year; and the second focused on their personal experiences and perceptions, utilizing a scale of self-confidence during contact with a violent patient. In our study 80% of participant’s experienced verbal violence and 20% of participants experienced both verbal and physical violence in the year preceding the course. The attacker was most often a patient or a patient’s relative, the assaults took place more often during night shifts rather than day shifts. The attendees achieved a most significant progress in the areas of physical intervention during the contact with a violent patient and in their perceived self-confidence in the presence of a violent patient.

Conclusions: This course proved to be beneficial to the participating healthcare providers, in particular regarding their confidence in managing violent situations and in preparing them better for practice. This course also verified that the simulation is very good part of individual education space for students.