Date of Conferral



Doctor of Nursing Practice (DNP)




Joan E. Hahn


When working with patients who have the potential to become physically aggressive, verbal de-escalation is an important technique that can defuse a dangerous situation. At the project site in the mental health emergency department (MHED), workplace violence was on the rise based on the reported use of physical interventions (rates of brief holds and physical restraint use). The purpose of this quality improvement evaluation project was to determine whether an educational training program on verbal de-escalation techniques would increase staff's confidence in the use of verbal de-escalation and decrease the rate of physical interventions used in the MHED. The change theory of nursing guided the project. At the project site, 19 interdisciplinary staff from the MHED including 10 registered nurses, 5 patient care technicians, and 4 security personnel, participated in a learning activity and completed the Thackery Confidence in Coping with Patient Aggression Instrument. The education intervention was presented using a PowerPoint presentation and simulation exercises. Descriptive statistics were used to analyze the data to determine the differences in the mean confidence scores and physical intervention rates from the baseline to 30, 60, and 90 days posteducation. The physical intervention rates decreased over the 90 day period. The self-assessed rating of confidence showed an increase. However, these changes were not statistically significant based on the ANOVA analysis. Positive social change might occur in the mental health emergency setting by increasing staff's confidence in using de-escalation skills and thereby decreasing the need to use physical interventions when working with an aggressive patient.