Reducing Patient-to-Staff Aggression in an Inpatient Psychiatric Unit Through De-escalation Training for Staff
Date of Doctor of Nursing Practice Project Completion
Spring 2026
Faculty Advisor
Ololade Bello, DNP, APRN, PMHNP-BC
Abstract
Abstract
Introduction/Background
Patient-to-staff aggression in adult inpatient psychiatric settings is an urgent matter that significantly contributes to workplace injury, staff burnout, and compromised patient safety.
Purpose
The aim of this quality improvement (QI) project is to reduce the patient-to-staff aggression in an adult inpatient psychiatric unit by 10% by implementing a 3-month systematic de-escalation compliance training program for direct care staff.
Methods
A Plan-Do-Study-Act (PDSA) model guided the project. The intervention included SAMA refresher training using simulation videos, role-plays, group discussions, and debriefs. Reinforcement learning strategies involved weekly huddles, micro-sessions, peer-champion coaching, and periodic fidelity checks. Data were collected using pre- and post-training staff surveys, attendance logs, trainer checklists, and incident reports.
Results
Retrospective baseline data (7 months) recorded 46 incidents (mean 6.57 incidents/month); during the 12-week implementation period, there were eight incidents (≈2.67 incidents/month), a 59.4% reduction. By week 8, almost 83% of direct-care employees had completed training, and fidelity tests showed that 90% of trained employees were following through. A two-sample t-test between baseline months and implementation months generated significant t-statistic and a two-tailed p < 0.05 using SPSS.
Implications
Staff reported increased confidence, recognized and mitigated aggressive escalation more quickly, and teamwork was improved. These findings will increase the necessity to maintain and continue the training coverage and will improve the place of de-escalation training in psychiatric care.
Keywords
SAMA, de-escalation training, quality improvement, patient-to-staff aggression, PDSA
Recommended Citation
Israel Orovwuje, "Reducing Patient-to-Staff Aggression in an Inpatient Psychiatric Unit Through De-escalation Training for Staff" (2026). Doctor of Nursing Practice Final Project Abstract. 185.
https://digitalcommons.library.tmc.edu/dnp_abstract/185