Healthcare employees are twenty times more likely to experience workplace violence (WPV) than any other profession. This statistic continues to rise in the United States. Healthcare providers experience patient violence due to various reasons such as altered mental status, agitation or fear. Violence is often predictable due to escalating verbal or paraverbal signs. Still, in some cases, it is not practical training that can reduce the significance of the injury. This piece will address three questions:

• How does coaching and simulation training improve workforce behaviors and outcomes?
• Are there typical coaching methods used in healthcare that are more effective?
• Does the utilization of simulator training and team coaching have an impact on healthcare workplace violence?

This piece will introduce five articles that argue coaching and simulator training effectiveness. It reduces workplace violence prevention through hands-on training that provides the workforce with the knowledge, awareness, skills and confidence to manage situations. The first argument will prove that coaching and simulator training provide antecedent skills to prevent an event from escalating and react effectively should a situation escalate towards verbal or physical violence. The second argument supports simulation training followed by immediate coaching through debriefing and posits that it is effective in helping or modifying behaviors or techniques. Finally, the third argument utilizes research data to prove simulation and coaching improves workforce behaviors and outcomes.

Article 1

Eppich and Cheng initiated a three-year mixed-methods multi-step research process at three hospitals in Canada. The research aimed to justify the need for a standardized debriefing framework, development of the framework and simulation training on how to adapt the framework. The study resulted in the development of the “Promoting Excellence and Reflective Learning in Simulation” (PEARLS) coaching framework. The research identified a few practical guides and framework available; therefore, developing a new framework was necessary.

Article 2

W. J. Eppich et al. provides a narrative assessment of a qualitative study they conducted at several hospitals in Canada on the east coast of the United States. The article aimed to broaden the scope of and opportunities for additional debriefings as coaching conversations. The study found that participating in reoccurring simulation and coaching conversations contributes to healthier workplace culture.

Article 3

Martinez conducted a pilot simulation study of fifteen undergraduate nurses enrolled in a psychiatric class at a public university in a large, urban city in the U.S. The study aimed to enhance students’ knowledge about workplace violence; increase their confidence and ability to recognize signs of aggression; practice evidence-based interventions to de-escalate agitated patients; and evaluate the simulation.

Article 4

Robson et al. assessed 22 Occupational Health and Safety (OHS) program literature research papers. The research studied simulation training benefits and effectiveness regarding staff’s knowledge, attitude, beliefs and behaviors. The studies were conducted in different occupations and bundled together, impacting data specific to one industry.

Article 5

Wong et al. conducted a study of 162 Emergency Department staff members consisting of medical residents, nurses and police officers in a New York trauma hospital. The research was conducted over three months and aimed to develop a multi-disciplinary training program and assess attitudes pre- and post-didactic training and simulation. The study utilized the Management of Aggression and Violence Attitude Scale (MAVAS) tool.

In the above five articles, simulator training was typically referenced as a realistic but safe venue to act out situations to address issues. Additionally, the articles utilized the word “coach” or “coaching” as one’s observations and perspectives on specific matters; it may involve confirming or challenging learners’ self-assessment of their performance by providing effective feedback and focused teaching. To better understand simulator training and coaching effectiveness, I focused on: 

1. the impact of simulation training and coaching
2. practical methods 
3. results and impact on the participants

Simulation training and coaching impact 

Simulation training is a highly utilized method in healthcare to provide skills-based, hands-on training in a team approach. It provides close to real-life experiences in a safe environment, allowing participants to play out scenarios as they would in reality. Robson reported that simulator training positively affects staff regarding knowledge, attitudes and behaviors. More engaging (hands-on) workplace violence (WPV) training had a higher impact than less engaging (classroom) training. Martinez’s pre- and post-surveys after a WPV simulation training also showed a statistically significant confidence level that simulations increase participants’ knowledge, skills and confidence.

Coaching during and after simulation events provides participants the opportunity to reflect on their performance and opportunities for improvement. Typically, a debrief is conducted at the end of the simulation, asking open-ended questions regarding how participants felt about their performance and areas for improvement. Eppich utilized a standardized, four-step debrief model: obtain a reaction, describe the event, analyze opportunities and summarize the discussion. Healthcare coaches have also conducted “micro-briefings” in the middle of simulations to provide immediate coaching allowing participants to review the process. Standardization of debriefs and coaching response has also shown positive impacts on training.

Simulation-coaching methods 

These articles addressed limited resources, tools and a standardized framework surrounding WPV simulations and coaching. The studies also addressed limitations of experience and knowledge of coaches themselves. During a multi-year study, Eppich and Cheng developed a coaching tool called Promoting Excellence and Reflective Learning in Simulation (PEARLS).  The PEARLS framework consists of a standardized coaching script followed by questions.  Regardless of the coach’s experience or skills, this standardized framework is thriving. The coach can select questions based on gaps addressing knowledge, skills or behaviors. Eppich and Wong support simulation training, aligned with a pragmatic coach to experiment with different responses to have the most significant impact.

Standardized simulator training and use of a standardized debriefing tool by a coach have shown improvement to prepare healthcare workers against workplace violence, their responses and confidence levels. Martinez utilized the Mental Health Nursing Clinical Confidence Scale (MHNCCS) to measure impact. Wong et al. measured training impact using the Management of Aggression and Violence Attitude Scale (MAVAS). Some can argue that because clinicians are prepared and confident, they can handle the event, which will reduce events from occurring as they identify escalation behaviors and can react before it turns to violence. In essence, they can differentiate the “how” and “why” of a WPV event and mitigate the situation earlier.

Unfortunately, the articles did not prove that the simulations and coaching mitigated future violent events. However, simulation and team coaching have proven successful in addressing staff knowledge, skills, behaviors and confidence.

This article originally ran in Security, a twice-monthly security-focused eNewsletter for security end users, brought to you by Security Magazine. Subscribe here.