5 EVALUATING DE-ESCALATION TRAINING
Research on the efficacy of de-escalation training programs is somewhat limited, partially because of a lack of validated evaluation metrics.[i] Evaluation frameworks are important to healthcare organization decisions on whether or not to implement de-escalation training, and if so, which one. Three frameworks were identified in the literature: De-escalating Aggressive Behavior Scale, Confidence in Managing Patient Aggression Scale, and Kirkpatrick’s Training Evaluation Model.
5.1 De-escalating Aggressive Behavior Scale
The De-escalating Aggressive Behavior Scale (DABS) is a seven-item Likert Scale assessment developed by Nau et al. (2009). It requires that a clinician directly evaluate a de-escalator handling a tense situation or use a simulation patient for evaluation purposes. Nau (2011) validates this metric as reliable but acknowledges that it is not the most accessible due to its requirement of direct evaluation.
5.2 Confidence in Managing Patient Aggression Scale
Thackery’s (1987) Confidence in Managing Patient Aggression Scale assesses de-escalation training efficacy via de-escalator confidence metrics. Nau (2011) found that it had fairly high sensitivity (84%), specificity (79%), and positive and negative predictive values (0.87 and 0.76, respectively). However, the model did a poor job of assessing de-escalation competency on an individual basis, and is thus not suited to fully replace the DABS.
5.3 Kirkpatrick’s Training Evaluation Model
The Kirkpatrick Training Evaluation Model (1959, 1975, 1993) is used for evaluation training generally, and is not designed specifically for de-escalation training. However, it is mentioned in this review for its repeated validation over several decades. The model consists of four levels of evaluation, adapted to a de-escalation framework in this description: reaction (do trainees like the course), learning (did trainees learn the material), behavior (are trainees able to practice de-escalating behaviors), and results (impact of the training on workplace violence in a healthcare setting). While somewhat dated, Kirkpatrick’s model benefits from including a “results” section; ultimately, the goal of de-escalation training is to reduce incidents of violence, injuries, and restraint and seclusion practices in healthcare settings.
5.4 Evaluation Going Forward
Several evaluation metrics, including the Confidence in Managing Patient Aggression Scale, evaluate de-escalation training approaches using metrics of gained knowledge and self-confidence. While these measures are important to gather following the implementation training, they do not answer the question of greatest priority: does de-escalation work in on-the-ground clinical practice? Proper evaluation of de-escalation training efficacy must occur case-by-case, in all units in which a new de-escalation intervention is implemented. It is imperative that healthcare organizations emphasize reporting violent incidents, and that they publish data regarding aggressive incidents, instances of restraint, instances of seclusion, and injuries to patient and staff.