Effect of Verbal De-Escalation-Based Simulation on Agitation Management, Perception of Aggression, and Impact of Aggression in Emergency Department Nurses

NCT07784868 | Not Yet Recruiting

• 1 other identifier: 2026-88
• Study Type: interventional
• Target: 78
• Locations: 1 country
• Sites: 1

Brief Summary

This mixed-methods randomized controlled study aims to evaluate the effects of verbal de-escalation-based simulation training on emergency department nurses' knowledge of agitation management, perceptions of aggression, and the extent to which they are affected by aggressive and violent behaviors. A total of 78 emergency department nurses will be randomly assigned to an intervention group (n=39) or a control group (n=39). Both groups will receive the same standard training program on verbal de-escalation-based agitation management. After the standard training, the intervention group will participate in standardized patient simulation and debriefing sessions. Outcomes will be assessed before the intervention, after the intervention, and at a three-month follow-up. In addition, focus group interviews will be conducted with participants in the intervention group at the three-month follow-up to explore their experiences with the simulation-based training.

Conditions

Agitation Management; Aggression; Verbal De-Escalation

Keywords

Verbal De-Escalation; Agitation Management; Aggression; Simulation Training; Patient Simulation; Nurses; Emergency Nursing; Aggression Perception; Impact of Aggression

Outcome Measures

Primary Outcomes (4)

• Change in Agitation Management Knowledge Test Score

  Agitation management knowledge will be assessed using the researcher-developed Agitation Management Knowledge Test. The test consists of 25 items with three response options: True, False, and Don't Know. Total scores range from 0 to 100, with higher scores indicating greater knowledge of agitation management and verbal de-escalation.

  Baseline; immediately after completion of the simulation and debriefing sessions in the intervention group (with the control group assessed at the corresponding time point); and 3 months after completion of the intervention period.

• Change in Functional Perception of Aggression Score

  Functional perception of aggression will be assessed using the functional subscale of the Perception of Aggression Scale (POAS). The POAS consists of 29 items rated on a 5-point Likert scale. The functional subscale consists of 12 items. The mean subscale score is calculated by dividing the sum of the item scores by the number of items in the subscale and ranges from 1 to 5. Higher scores indicate a greater tendency to perceive aggression as functional, acceptable, and a healthy response.

  Baseline; immediately after completion of the simulation and debriefing sessions in the intervention group (with the control group assessed at the corresponding time point); and 3 months after completion of the intervention period.

• Change in Dysfunctional Perception of Aggression Score

  Dysfunctional perception of aggression will be assessed using the dysfunctional subscale of the Perception of Aggression Scale (POAS). The POAS consists of 29 items rated on a 5-point Likert scale. The dysfunctional subscale consists of 17 items. The mean subscale score is calculated by dividing the sum of the item scores by the number of items in the subscale and ranges from 1 to 5. Higher scores indicate a greater tendency to perceive aggression as dysfunctional, unacceptable, and undesirable.

  Baseline; immediately after completion of the simulation and debriefing sessions in the intervention group (with the control group assessed at the corresponding time point); and 3 months after completion of the intervention period.

• Change in Impact of Patient Aggression Score

  Impact of patient aggression will be assessed using the Impact of Patient Aggression on Carers Scale (IMPACS). The scale consists of 7 items and two subscales: Corruption of Relation Between Care Provider and Patient and Not Feeling Confident. Total scores range from 7 to 35, with higher scores indicating a greater negative impact of patient aggression.

  Baseline; immediately after completion of the simulation and debriefing sessions in the intervention group (with the control group assessed at the corresponding time point); and 3 months after completion of the intervention period.

Secondary Outcomes (1)

• Perceived Simulation Effectiveness Score

  Immediately after completion of the debriefing session following the simulation.

Other Outcomes (1)

• Qualitative Themes From Semi-Structured Focus Group Interviews on Verbal De-Escalation-Based Simulation Training

  3 months after the intervention.

Study Arms (2)

Intervention Group

EXPERIMENTAL

Participants in this arm will receive the standard training program on verbal de-escalation-based agitation management, followed by standardized patient simulation and debriefing sessions.

Behavioral: Standard Verbal De-Escalation Training; Behavioral: Verbal De-Escalation-Based Simulation Training

Control Group

ACTIVE COMPARATOR

Participants in this arm will receive the standard training program on verbal de-escalation-based agitation management.

Behavioral: Standard Verbal De-Escalation Training

Interventions

Standard Verbal De-Escalation Training BEHAVIORAL

Participants will receive a five-session standard training program on verbal de-escalation-based agitation management. The program covers recognition of agitation and aggression, perceptions and interpretation of aggression, assessment and safe management of the agitated patient, verbal de-escalation principles and techniques, and approaches to protect and strengthen nurses' well-being.

Control Group; Intervention Group

Verbal De-Escalation-Based Simulation Training BEHAVIORAL

Following the standard training, participants in the intervention group will take part in a standardized patient simulation involving an agitated patient. The simulation includes prebriefing, scenario-based practice, and structured debriefing based on the PEARLS framework. A structured observation form will be used to provide feedback during debriefing and will not be used as an outcome measure.

Intervention Group

Eligibility Criteria

• Sex: all
• Healthy Volunteers: Yes
• Age Groups: Child (0-17), Adult (18-64), Older Adult (65+)

You may qualify if:

• Working as a nurse in the adult emergency department of the hospital where the study will be conducted
• Working full-time as a nurse
• Willing to participate in the study

You may not qualify if:

• Being on leave or otherwise unable to work during the study period
• Having previously received simulation-based training on verbal de-escalation

Sponsors & Collaborators

• Uskudar University: lead

Study Sites (1)

Public Hospital

Bursa, Bursa, 16000, Turkey (Türkiye)

Location

MeSH Terms

Conditions

Aggression

Condition Hierarchy (Ancestors)

Aberrant Motor Behavior in Dementia; Behavioral Symptoms; Behavior; Social Behavior

Study Officials

• Elçin Babaoğlu Gülseven, Assoc. Prof. Dr.

  Uskudar University

  STUDY DIRECTOR

Central Study Contacts

Şeyma Erkuş, PhD Student

CONTACT

+90 537 065 92 68; seymaaerkuss@gmail.com

Elçin Babaoğlu Gülseven, Assoc. Prof. Dr.

CONTACT

+90 552 541 70 69; elcin.babaoglu@uskudar.edu.tr

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: SINGLE
• Who Masked: OUTCOMES ASSESSOR
• Masking Details: The statistical analyst will be blinded to group allocation during the statistical analysis.
• Purpose: OTHER
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: Principal Investigator

Study Record Dates

• First Submitted: August 17, 2026
• First Posted: August 25, 2026
• Study Start (Estimated): October 1, 2026
• Primary Completion (Estimated): February 1, 2027
• Study Completion (Estimated): February 1, 2027
• Last Updated: August 25, 2026

Record last verified: 2026-08

Data Sharing

• IPD Sharing: Will not share

Locations

TU (1)