Journal of the American Psychiatric Nurses Association, Ahead of Print.
BACKGROUND: Mental health workers frequently encounter situations in which patients display agitation and escalating behaviors, increasing the risk for assaults, injuries, time off, and possible termination. These factors contribute to increased fear and anxiety when engaging with agitated patients in the psychiatric setting. OBJECTIVE: The aim of this quality improvement project was to explore how a multilevel approach of psychiatric simulation training, psychiatric emergency code support, enhanced crisis prevention intervention training, and self-care education addressed staff fear and anxiety related to managing agitated patients. STUDY DESIGN: Data collection was done by voluntary pre and post simulation training surveys, medical record review of high-risk violent patients, documented psychiatric emergency code debriefings, implementation of enhanced crisis prevention education, and voluntary self-care evaluations completed by mental health workers at staff retreats. RESULTS: Findings with psychiatric simulation showed effectiveness in improving role clarity, confidence, and feelings of preparedness for managing crisis situations. Review of code debriefings identified safety as the highest problem. Small work groups were created to address individualized elements that were expressed by mental health workers as safety concerns. Self-care education through staff retreats increased awareness on prevention of compassion fatigue and burnout, while allowing mental health workers to engage in activities that promote and improve cohesiveness of the team. CONCLUSIONS: These approaches effectively addressed management of fear and anxiety with agitated patients as well as solidified the notion that a multilevel approach is necessary.