D1 Dedicated De-escalation Training for Nurse Navigators
Elizabeth Wigozki, MSN, RN, OCN, CNL; Shanna Sullivan, MSN, RN, AGCNS-BC; Michelle Jacobo, PhD
Dana-Farber Cancer Institute, Boston, MA
Background: Oncology nurse navigators (ONNs) are the first point of contact for Dana-Farber Cancer Institute patients when they call or message their oncologist. During the COVID-19 pandemic, verbal and physical abuse experienced by nurses was exacerbated. It became imperative to provide education and support to staff to manage escalating patient distress.
Objective: To provide dedicated de-escalation training specific to ONN workflows and experiences, to better prepare ONNs in their day-to-day interactions.
Methods: Education was primarily provided at the virtual ONN Practice Committee meeting, which most staff attend. This meeting was followed by 2 small-group sessions on the Zoom platform. Content was delivered in terms of de-escalation tips and best practices, as well as role-playing. Role-playing consisted of a case study portraying an ONN and difficult spouse that was based on real themes and scenarios that ONNs have previously experienced. A content expert and director of psychology led the discussion and presentation and provided tools and strategies for ONNs. It was the first time that ONNs received dedicated training on difficult patients and scenarios using real scenarios reflecting their unique role. The additional smaller breakout sessions allowed the opportunity for ONNs to further dive into strategies in a more intimate setting.
Results: The engagement and attendance of ONNs in the committee and follow-up sessions were high. An electronic posttraining survey was sent to ONNs for feedback. Eighty-three percent (n=48) of ONNs reported that they found the content of programming relevant to current practice; 85% (n=39) reported they wanted more trainings and programming on the de-escalation topic. When asked how they wanted to receive the additional content, 35% requested another committee training, 35% requested a separate workshop, and 25% recommended new-hire training. When asked how the session impacted their practice, themes of the qualitative responses included: “it helped to discuss situations that come up and how to deal with them; examples and role-playing helped a lot; information was very useful and provided tools for patient interaction; great examples to follow in practice; helped inform my practice; role-playing provided helpful tips to de-escalate situations.”
Conclusion: It is known that healthcare workers need de-escalation training to appropriately manage aggressive patients and family members while still maintaining trust with the care team. The feedback from the ONNs confirmed the value of the additional dedicated training and provided validation and assertion in their practice. Creating content that is directly applicable to ONN challenges proved to be effective. How to best educate and support nurses managing aggression and abuse via telehealth visits may be a gap in practice and research.
Sources
Jones N, Decker VB, Houston A. De-escalation training for managing patient aggression in high-incidence care areas. J Psychosoc Nurs Ment Health Serv. 2023;61(8):17-24. Accessed June 30, 2023. https://dx.doi.org/10.3928/02793695-20230221-02
Thompson SL, Zurmehly J, Bauldoff G, Rosselet R. De-escalation training as part of a workplace violence prevention program. J Nurs Adm. 2022;52(4):222-227. Accessed June 30, 2023. https://dx.doi.org/10.1097/NNA.000000000 0001135
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