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Using high fidelity simulation to provide Management of Clinical Aggression Training - a pilot study.

Tuesday, May 15
11:00 - 12:30
Location: Neptune 1&2

Background: : Children and young people exhibit challenging behaviours daily in the hospital environment which may result in injury or distress for the child (Johnson, Bekhet, Robinson & Rodriguez, 2014; Johnson & Rodriquez, 2013). The training program prior to this study, to manage clinical aggression (Code Grey response), involved a full day of lectures and short skill sessions. All new security staff, graduate nurses, and the mental health ward staff managing these patients are required to attend this training annually, whilst other staff involved in managing clinical aggression, are encouraged to attend. Despite delivery of this program, code grey activations are increasing each year.

Research Question: : This study aimed to assess if the addition of a high fidelity 2 hour simulation training program designed to provide participants with experience in managing challenging behaviours in a hospitalized young person, increased confidence and perceived competence in managing challenging behaviours.

Methodology: : Two separate simulation exercises (of escalating difficulty) were delivered utilising a professional actor to play the role of the adolescent within the Management of Clinical Aggression (MOCA) training days. A structured debrief at the completion of each exercise was led by 2 trained members of the Simulation Faculty. Participants completed a written survey prior to, at completion of the simulation training program, and at 3-6 months following the MOCA training.
Ethical approval from the institution’s Human Research Ethics Committee was received (HREC 37142A). This study described confidence before and after the intervention and at follow-up using Likert scale questions. Themes were allocated for using qualitative methods for written comments.


Results: : Nine training days were conducted in 2017 with a total of 139 participants. Most (68%) participants had experienced clinical aggression as part of their routine work, with 51% overall reporting a lack of confidence managing these patients. Immediately following this training, 79% of all participants reported feeling more confident in managing clinical aggression. At an individual level, 47% reported a 1 point increase in confidence while 32% of participants reported a 2 or 3 point increase. Immediately following the training, 78% stated they felt they would be able to manage a situation involving clinical aggression. At 3-6 months following MOCA training, 65% of respondents (N=26) had been the recipient of clinical aggression. Continued confidence in managing clinical aggression was reported by 73% of respondents. Simulation based education was acceptable to participants with 100% stating they would recommend this training to colleagues. Reflective comments included: “extremely useful and practical,” “insightful, fun, thought-provoking,” and “engaging and practical,” “a great opportunity to be exposed and practice a clinical aggression incident. The debrief/deconstruction of events was such an important learning experience.”

Discussion/Conclusions: : The high exposure to clinical aggression in this paediatric hospital reinforces the need for effective staff training. This is the first study of this kind and demonstrates high-fidelity simulation training increased confidence in participant’s ability to manage challenging behaviours of young people in the clinical setting with retention of perceived skills at 3-6 months following training.





Marijke J. Mitchell, RN, BN, PgD Advanced Clinical Nursing (Paeds), (Paed Int Care), MN

PhD Candidate
The University of Melbourne, Royal Children's Hospital, Melbourne
Williamstown, Victoria, Australia

Ms. Marijke Mitchell BN (Deakin); MN (Melb), Royal Children’s Hospital, The University of Melbourne, Murdoch Children’s Research Institute, Melbourne, Australia.

Marijke has worked in the field of paediatrics for the past 25 years in a variety of nursing and education roles and has extensive experience working with children and young people with neurodisability. Marijke is currently the project lead for numerous clinical, quality and training projects for Neurodevelopment and Disability at The Royal Children’s Hospital and is a Lecturer in the Masters of Nursing program at The University of Melbourne. Marijke completed a Simulation Fellowship with the Royal Children’s Hospital Simulation Program in 2017 and currently is a PhD candidate developing a simulation training program for staff to manage clinical aggression in young people with neurodisability.

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Katrina Williams, PhD

Professor
The University of Melbourne, Royal Children's Hospital, Melbourne
Melbourne, Victoria, Australia

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Fiona Newall, PhD

Professor
The University of Melbourne, Royal Children's Hospital, Melbourne
Melbourne, Victoria, Australia

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Colin White, RN

Code Grey Coordinator
Royal Children's Hospital
Melbourne, Victoria, Australia

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Jenni Sokol, MBBS, FRACP, FCICM, MHPE

Clinical Lead in Simulation and Neonatologist, Paediatric, Infant, Perinatal Emergency Retrieval Service, Victoria
Royal Children's Hospital, Melbourne, The University of Melbourne
Melbourne, Victoria, Australia

Jenni Sokol (FRACP, FCICM, MHPE, GCCS) is the Royal Children’s Hospital (RCH) Head of Simulation and has been involved in Simulation-based Education for the past 14 years. She has led the RCH Simulation Program and the Simulation Team since its commencement in June 2015, focusing on training to improve patient safety, management of the deteriorating patient, and communication within teams and with families and patients, to improve clinical outcomes across the hospital. Jenni also works as Consultant Neonatologist with the Victorian Paediatric, Infant, Perinatal, Emergency Retrieval (PIPER) Service at the RCH and is trained in Neonatology and Paediatric Intensive Care Medicine.

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