Digital Repository Masters Projects Spring 2025 Agitated Patient Simulation Training Spencer Christopherson Weber State University Follow this and additional works at: https://dc.weber.edu/collection/ATDSON Christopherson, S. 2025. Agitated Patient Simulation Training Weber State University Masters Projects. https://dc.weber.edu/collection/ATDSON This Project is brought to you for free and open access by the Weber State University Archives Digital Repository. For more information, please contact scua@weber.edu. WSU REPOSITORY MSN/DNP Agitated Patient Simulation Training Project Title by Spencer Christopherson Student’s Name A project submitted in partial fulfillment of the requirements for the degree of MASTERS OF NURSING Annie Taylor Dee School of Nursing Dumke College of Health Professions WEBER STATE UNIVERSITY 4.25.25 Ogden, UT Date Spencer Christopherson RN, BSN, MSN Student 4.25.25 Student Name, Credentials (electronic signature) Date Trish Gibbs DNP, RN, CNE 4.26.25 MSN Project Faculty Date (electronic signature) Anne Kendrick, DNP, RN, CNE (electronic signature) DNP, N, CNE MSN Program Director Note: The program director must submit this form and paper. 4.26.26 Date 1 Agitated Patient Simulation Training Spencer Christopherson, BSN, RN, MSN Student Annie Taylor Dee School of Nursing Weber State University MSN Project 2 Abstract Purposes/Aims: This project aims to reduce harm to staff and patients in behavioral health settings by implementing simulation training for managing agitated patients. Rationale/Background: Rising workplace violence necessitates clear, effective protocols. The project addresses the lack of universal guidelines by developing a simulation program grounded in a comprehensive literature review. This review, encompassing qualitative, quantitative, and quality improvement studies, identified critical gaps in current practices. Methods: Utilizing the McKinsey 7S framework, the project creates a simulation training focused on safety interventions during agitated patient events, prioritizing patient privacy and dignity. The project goal is to decrease behavioral incidents, reduce injuries, and improve patient outcomes through enhanced staff competency. By providing a structured guideline and hands-on experience, the simulation fosters staff confidence and promotes effective safety interventions. Results: Successful implementation has the potential to lead to the training's broader application across all healthcare specialties, establishing a standardized approach to managing agitated patients and diminishing workplace violence. Conclusions: A structured guideline for staff members to follow allows for a smoother implementation process for behavioral events. An agitated patient simulation training will teach safety practices and allow staff members to feel confident during these events, resulting in harm reduction. With a successful project, the training can be utilized for behavioral health unit staff and universally for all healthcare providers in any specialty. Keywords: Agitated patients, workplace violence, patient safety, staff injury, behavioral health, protocols 3 Agitated Patient Simulation Training Mental health nursing has increased in demand over recent years. There are many success stories of patients healing, and mental health nursing can be very rewarding. However, one area can be very stressful and draining. Unavoidably so, some patients behaviorally escalate, which can lead to harm to both staff and patients. Being able to de-escalate these situations is crucial in preventing a ripple effect of elongated patient stays and the inability of staff to work (Im et al., 2024). Research suggests that staff members' internal confidence during behavioral events is lacking (Staffurth et al., 2024). While different facilities have protocols for these events, there is still a need to improve workplace violence safety through continued training (Ming et al., 2019). Implementing standardized training and educational protocols can potentially reduce harm to staff and patients. Additionally, improving staff knowledge of these protocols through standardized education could improve staff members' confidence in implementing these safety measures, resulting in improved outcomes (Thompson et al., 2022; Jones et al., 2023). Statement of Problem Recognizing the warning signs of patient escalation is critical to maintaining patient and staff safety (DeSouza & Bleich, 2023). Although there are guidelines per facility protocols, the differences in interventions need to be clarified. The ideal situation would be universal guidelines for keeping patients and staff safe. This change would benefit staff members of the behavioral health specialty and all healthcare team members regardless of the setting. Significance of the Project This project is essential for the behavioral health setting for many reasons. This project is necessary because it provides examples of warning signs patients exhibit before they are in an 4 unsafe situation (DeSouza & Bleich, 2023). Another reason this project is important is because this project will clearly define the roles of staff members (Davids et al., 2021). This project is essential for healthcare providers and patients because it will be a skills-based simulation training to enable staff members to perform interventions promptly, safely, and effectively (Ming et al., 2019). Doing so quickly reduces the risk of patients escalating to the point where the situation is too dangerous. Frequent simulation training makes staff members more likely to remember the policies, procedures, and skills necessary to maintain a safe environment. Nothing is worse than when a patient is so agitated that a hands-on approach is required, and staff members must be reminded how to use equipment or perform specific tasks. In these situations, the faster interventions are implemented, the safer the situation becomes. Review of the Literature Behavioral health units can offer unique challenges due to the frequency of patient-tostaff violence events (Kernaghan & Hurst, 2023). This literature review aimed to compile up-todate research regarding patient-to-staff violence, how to educate staff regarding managing violent episodes, and the best practices to implement these evidence-based interventions to improve patient and staff outcomes. Framework This project will be using the McKinsey 7S framework model. This model influences employee work behavior, which, in turn, influences and indicates organizational behavior (Jain & Kansal, 2023). This framework, constructed of seven elements, is divided into two sectionshard elements and soft elements. Hard elements include strategy, structure, and systems, while soft elements include shared values, skills, style, and staff. For this framework to succeed, the 5 McKinsey 7S Model outlines four steps to complete its goal: an impact assessment, creating a change of plan, ongoing monitoring, and a post-change review. Assessing the impact of change is key for this project specifically. Since there is no clear, definitive way to execute these agitated patient events, evaluating and determining the elements within the model should be emphasized when creating organizational change. After determining which elements are most needed, creating a plan tailored to those elements for change allows for filling gaps. This framework is precisely what this project requires- gaps in safety standards to be filled on an organizational level. Of course, as the plan is implemented, continuous or ongoing monitoring will be critical in determining success. As the final step suggests, reviewing the change to determine overall improvement will allow the organization to determine if further change needs to be made (McCormack et al., 2022). Strengths and Limitations Various strengths within the framework apply to the project's overarching goal. One strength of the model is that it helps guide an understanding of the broad impact of organizational change by addressing organizational dynamics and the need for departments and teams to be in harmony with each other. Increasing organizational effectiveness by improving a process is one of the greatest strengths the McKinsey 7S Model offers (Jain & Kansal, 2023). Limitations of the McKinsey 7S Model include the fact that it is a complicated process that requires the support of upper management. Additionally, extensive research is needed to use this model effectively. Further, although this model can range from creating a change from a narrow perspective to a holistic, system-wide curriculum change, teaching methods to fully represent some essential components of a system-wide change still need to be improved (McCormack et al., 2022). 6 Analysis of Literature This literature review aims to discover current literature regarding safety measures and protocols when intervening with agitated or aggressive patients to maintain a safe environment for patients and staff members. The review was conducted to answer the following question: In psychiatric nursing, how does the implementation of quarterly Behavioral Health simulation training and debriefing impact patient-to-staff violence and staff confidence over one year versus no intervention? Search Strategies A search for evidence was conducted using the OneSearch option through the library at Weber State University. Articles from 2019-2024 were used in the search. Keywords used while conducting these searches included patient-to-staff violence, intervention, quality improvement, systematic review, quantitative, prevention, and violence in healthcare. These keywords were used in conjunction with each other to create a broad search. Synthesis of the Literature Three themes were identified during the literature review: The first theme is early deescalation techniques decreased violence against staff members (DeSouza & Bleich, 2023; Kim et al., 2024; Legambi et al., 2021; Im et al., 2024). The second theme is that confidence in staff members increases when staff members remember training practices that handle unsafe situations (Staffurth et al., 2024; Ming et al., 2019; Legambi et al., 2021; Kernaghan & Hurst, 2023). Third, staff members perceive the severity of patient-to-staff violence differently and feel a lack of support from management regarding the safety of these episodes (Vermeulen et al., 2019; Leonard & Muliro, 2024; Davids et al., 2021). Further analysis of these themes will be found in future sections of this review. 7 Early De-escalation Decreases Violence Against Staff Staff's ability to detect early warning signs of escalating behaviors decreases patient-tostaff violence (Legambi et al., 2021). Literature suggests that early assessment using a short-term prediction tool enables staff members to predict aggression and prevent harm to staff or patients (DeSouza & Bleich, 2023; Kim et al., 2024; Legambi et al., 2021; Im et al., 2024). Early identification of risk factors such as impulsivity, irritability, verbal threats, and others, though they can fluctuate for patients, enables staff members to determine the current level of aggression or agitation before the patient escalates (DeSouza & Bleich, 2023; Janzen et al., 2022). Early, prompt assessment and intervention by staff members have been shown to decrease violent event rates by 31% (Kim et al., 2024). This information is essential to note as some patients may have a higher or lower threshold for aggression than others. Though early detection is critical, research also suggests early de-escalation with diversional activities significantly decreases violent event rates (Legambi et al., 2021; Im et al., 2024). Confidence in Staff Increases with Training Learning and keeping up with all skills in performing job duties is an important factor in building and maintaining the confidence of staff members (Staffurth et al., 2024; Ming et al., 2019; Legambi et al., 2021; Jones et al., 2023; Kernaghan & Hurst, 2023; Im et al., 2024; Thompson et al., 2022). In other words, one loses skills and confidence to perform skills if the skills are not consistently put into practice (Staffurth et al., 2024). De-escalation training and simulation increase staff confidence during an actual event by 21% (Thompson et al., 2022). Confidence and preparedness in performing safety interventions are essential for patient and staff safety. Literature suggests adequate training increases the likelihood that staff members will be equipped with the awareness and ability to confidently 8 recognize early behaviors and respond before unsafe behaviors develop (Staffurth et al., 2024; Davids et al., 2021). Conversely, a lack of training showed only a 10.7 success rate (Jones et al., 2023). This statistic shows that staff who are trained thoroughly and often have roughly twice the success rate of those who are not trained adequately. Perceived Safety and Severity A commonality within the literature is the uncertainty regarding when staff members should reach out for help during these episodes (Vermeulen et al., 2019; Legambi et al., 202; Leonard & Muliro, 2024; Davids et al., 2021). Though common patient behaviors qualify for emergency interventions, the literature suggests staff members need clarification on when to call for extra help. Often, staff members were reluctant to call earlier than necessary and were resistant to calling for extra help out of fear of irritating other staff members (Davids et al., 2021). Additionally, due to various levels of behavioral severity, a more universal scale is needed to outline when to implement interventions (Ming et al., 2019). Furthermore, training is vital due to the potential for underestimating aggressive behavior even when a specific definition of aggressive behavior is utilized in the nursing unit (Vermeulen et al., 2019). Summary of Literature Review Findings and Application to the Project A literature review supports the idea that agitated and aggressive behavior has detrimental consequences. Staff members working in behavioral health units are consistently put in dangerous situations that can cause physical and emotional harm to both staff members and patients (Vermeulen et al., 2019; Im et al.,2024). Literature suggests the importance of frequent training for staff to detect when patients are exhibiting early signs of aggressive behaviors and agitation (Thompson et al., 2022). In addition to frequent training, standardized, evidence-based education, and training will increase staff members' confidence in performing interventions when 9 necessary. Evidence from the literature will be used to formulate simulation training from reallife scenarios to help minimize risk and increase safety standards for behavioral health units (Jones & Decker, 2023; Kernaghan & Hurst, 2023). Project Plan and Implementation A multifaceted approach is crucial for effectively implementing agitated patient simulation education for healthcare staff. A multidisciplinary planning committee, comprised of leaders and staff members from all departments, will develop a comprehensive curriculum covering de-escalation techniques, therapeutic communication, and legal/ethical considerations. Nurse educators will utilize standardized patient actors to create realistic simulations, enabling staff to practice these strategies safely. They will receive a certificate upon completion. This simulation program, designed to serve as a model for other psychiatric facilities, will be integrated into existing staff training for newly hired staff members, and regularly updated to ensure long-term sustainability and alignment with evidence-based practice. Plan and Implementation Process The first step in implementing this plan is to present this multi-sectional training to the administration and receive approval (McCormack et al., 2022). Presenting evidence of safety concerns and a need for frequent education with a focus on how this education increases staff confidence during high-leverage moments (Kernaghan & Hurst, 2023; Staffurth et al., 2024; DeSouza & Bleich, 2023). After approval, during week two, a pre-simulation questionnaire will be delivered to all staff members, and their answers to the questionnaire will be recorded for data analysis. In addition, a brochure will be provided to staff members with a brief overview of what to expect throughout the simulation education project. 10 A presentation of this project’s hands-on portion will be important to portray to the administration. Educating staff members using a hands-on approach has been shown to increase patient and staff safety when patients become more agitated and aggressive (Kernaghan & Hurst, 2023; Kim et al., 2024). Scenario development for a diverse range of scenarios will be discussed, including low-risk verbal agitation, anxiety, mild confusion, medium-risk escalating verbal aggression, threats, property damage, and high-risk physical aggression, self-harm, and imminent violence (Ming et al., 2019). Participants will interact with standardized patients (actors trained to portray agitated behavior) in the simulated environment (Davids et al., 2021). Nurse educators and managers from each unit will observe participant performance, assessing their communication skills, de-escalation techniques, decision-making, teamwork, and adherence to safety protocols (Kim et al., 2024). After the hands-on portion has been presented, there will be the presentation of the debriefing phase; there will be a guided discussion led by facilitators using a structured debriefing outline, including a review of participant actions and decisions, an analysis of strengths and weaknesses, a discussion addressing alternative approaches, identifying emotional responses, and providing constructive feedback (Jones et al., 2023). Video recordings of the simulations will be utilized for self-reflection and group analysis for new employees. Following the debriefing portion, the post-simulation phase will be introduced. A confidence post-test will be given to participants to assess changes in staff confidence levels. Because participants will be observed in real-life clinical settings to evaluate the transfer of learning, participant feedback will be gathered through surveys and interviews. Participants will be encouraged to provide feedback on the simulation project to aid in identifying educational gaps and opportunities for improvement. Evaluation data will use a mixed-methods approach, 11 including quantitative data such as pre-and post-test scores, participant satisfaction surveys, a reduction of the number of patient behavioral events in clinical settings, and a number of incident reports. Qualitative data will be analyzed, including debriefing session notes, participant interviews, instructor observations, and other participant feedback (Janzen et al., 2022). Interdisciplinary Team For this project to be effective, the simulation will need contribution and support from all staff members throughout the facility. This project will address a broad range of healthcare professionals, including registered nurses (RNs) and licensed practical nurses (LPNs), nursing support staff such as psychiatric care technicians (PCTs) and security officers, psychiatric professionals such as psychiatrists, mental health counselors, social workers, and case managers will need to work together for this project to reach its full effectiveness. Registered Nurses and Licensed Practical Nurses. Nurses will provide input on common patient presentations, nursing interventions, and realistic clinical scenarios. Based on their clinical experience, nurses will identify training needs, critical de-escalation skills, and knowledge gaps among nursing staff. Nurses will contribute to developing realistic, clinically relevant simulation scenarios and assist in training staff members on realistic patient behaviors and responses. Psychiatric Care Technicians. Psych techs play an important role in practice and simulation. They contribute to developing scenarios that accurately depict realistic agitated behaviors observed in the clinical setting. They also provide input on appropriate therapeutic interventions, such as calming techniques and therapeutic communication strategies. Feedback from psych techs on how effective the 12 simulation training went is essential information to note, as their feedback is extremely valuable for adjustments in training that may need to be made. Psychiatry. Psychiatrists play one of the most critical roles in this training. Psychiatrists will provide input for ethical and legal guidance for participants in the training. Psychiatrists will be involved in ordering medications after collaborating with others participating in this simulation. Psychiatrists may also deny the use of medication given the scenario and order alternative methods to keep staff and patients safe. Mental Health Professionals. Social workers, mental health counselors, and case managers will also provide input and collaborate with psychiatrists by guiding ethical and legal discussions with staff members. Given a specific scenario, they will be able to inform staff members of any cultural or spiritual considerations they should be sensitive to. Receiving insight from mental health professionals on patients who have been admitted for an extended period will allow for a more therapeutic and patient-centered approach. Security. Security members will educate staff members on their roles and responsibilities for agitated patients. Security will be able to help other staff members know the role security plays in agitated patient scenarios and can answer clarifying questions staff members may have. Regardless of any specific role, all participating should participate in debriefing sessions, sharing their clinical expertise and providing valuable insights. When actively involving all healthcare team members in developing agitated patient de-escalation simulations, the project 13 can ensure the training is realistic, relevant, and effective in improving patient care and enhancing staff safety. Description and Development of Project Deliverables For this project, three deliverables will be used. A presentation outlining the three phases of the simulation, a brochure portraying the benefits of the simulation, and an assessment tool participants will use for a pre- and post-simulation assessment. These deliverables will be explained in the upcoming sections of this paper. Phase Presentation. Our first deliverable will detail the simulation phases (see Appendix A). This deliverable will show stakeholders what is to be anticipated going into the simulation and break down the components of each phase. These slides will be directed to nurse managers, educators, and all other stakeholders to break down the events in each phase. This presentation will highlight why the phases are significant and describe what will take place during the phases. This presentation will also discuss how data will be collected and how the data analysis will be used for quality improvement. Brochure. Deliverable number two will be a handout to stakeholders that provides a fast and straightforward explanation of this project’s benefits (See Appendix B). This brochure includes references to sources of evidence as to how the quality of de-escalation improves, how the proposed training impacts staff members' confidence levels when encountering these challenging scenarios, and how recurring training reduces the risk of harm to patients and staff members when interventions are used. Assessment Tool. 14 The third deliverable is a number rating question survey that will be used during the presimulation and post-simulation phases. The survey will provide quantitative and qualitative data regarding staff members' confidence before and after the simulation training (See Appendix C). Timeline The proposed simulation training project, with an estimated two-week timeline for approval and implementation (see Appendix D), will be presented to administrative stakeholders, including nurse educators, managers, and the chief nursing officer, for review and approval during week one. The project coordinator will conduct a comprehensive presentation, outlining each project component through detailed deliverables. This presentation will facilitate a thorough understanding of the project's objectives, methods, and expected outcomes, providing administrators with the necessary information to assess its feasibility and potential impact. At the end of the presentation, any administrative questions requiring clarification from the administrative stakeholders will be addressed before proceeding with implementation. Upon receiving administrative approval, the project will proceed with implementation. Staff members involved in the simulation training will be provided with the pre-simulation questionnaire, a brochure detailing the training's purpose and format, and an outline of the handson simulation scenarios, which will last approximately 15 minutes each (see Appendix A). The three planned simulation scenarios will be actively presented by staff members for each scenario to both administration and staff, ensuring all parties are familiar with the training's practical components. A structured debriefing session will follow each simulated experience. After completion of the scenarios, the debriefing phase, emphasizing its critical role in learning from behavioral events, will be explained, along with its structured format. Immediately 15 following the debriefing, participants will complete a post-simulation confidence test anonymously, and the post-simulation phase will be introduced. Participant feedback and data analysis will be prioritized for continuous quality improvement, and these findings will be shared with the administration. The overall impact and effectiveness of the simulation training will be measured by averaging the scores from the presimulation test. This measurement will be done over six months to obtain a sample size that is large enough. In contrast, the post-simulation test scores will be averaged compared to the pretest scores. This average will also be over six months. Behavioral events and incident reports will also be tracked through the charting systems. The total number of behavioral events and incident reports will be accounted for starting six months before the simulation training. After six months of project implementation, accounting for the total number of behavioral events and incident reports will be compared to the total number of events before project implementation. Doing so will allow a large sample size to determine a direct correlation between the project and its effectiveness. If the total number of behavioral events decreases from the number of events before the project implementation, the project will be successful and will continue. Additional adjustments will be made if the number of behavioral events and incident reports increases. Project Evaluation Evaluating this project is necessary to ensure its effectiveness, efficiency, sustainability, and impact (Kernaghan & Hurst, 2023). Pre- and post-simulation assessments will provide formative data, gauging staff confidence in de-escalating agitated patients (See Appendix C). The pre-simulation assessment measures baseline confidence in recognizing escalation signs, 16 communication skills, and safety protocol knowledge. The post-simulation assessment, administered directly after training, measures confidence changes. This will allow for immediate feedback on the training's effectiveness in boosting staff confidence and identifying areas needing refinement. The comparison between pre- and post-assessment scores provides formative data that helps determine if the simulation training is reaching its intended goals during its implementation. Secondly, facility charting will provide summative data, measuring the project's overall impact. Analysis of the number of agitated patient events will be tracked for four months before and after the implementation of the simulation training. This extended timeframe allows a sufficient patient pool for reliable data analysis. Comparing the frequency of incidents before and after implementation will determine the project's effectiveness in reducing agitated patient events. This summative data will show if the simulation training ultimately achieved its intended goal of reducing patient agitation. Ethical Considerations Ethical considerations that must be addressed before the implementation of the project include maintaining patient dignity and following federal, state, and facility guidelines. Although some situations can be chaotic, hectic, and can potentially cause moral distress, it is essential to remember that patients are people, and any intervention must be considered through the ethical lens (Ohnishi et al., 2020). Federal law states that restraints must be the “least restrictive intervention” (R3 report: Requirement, Rationale, Reference 2024). According to the state of Utah, it is essential to note that restraints should never be “used for the convenience of staff” and must align with federal law. Additionally, patients are to be released from any restraint as soon 17 as possible (Utah Office of Administrative Rules 2023). This project will reinforce federal and state laws and regulations to ensure staff members comply. The simulated experience itself will emphasize prioritizing safety and ethical considerations through education, debriefing and self-reflection with a strong focus on the benefits and risks associated with restraint use, emphasizing clear, defined roles for each team member (Romain Dagenhardt et al., 2022). Specifically, psychiatric technicians will receive reinforced education on the proper set-up and application of restraints, ensuring patient safety and minimizing potential harm. Nurses will receive reinforced education on emergency medication administration, including potential adverse effects, and legal practices such as informing patients of the criteria for release from seclusion or restraints (APNA, 2023). Prior to participation in the simulation training, all staff members will be provided with detailed information regarding the purpose, procedures, and potential benefits and risks of the training. Informed consent will be obtained, ensuring voluntary participation and the right to withdraw at any time without penalty. To maintain staff anonymity and encourage honest feedback, anonymous surveys will be administered following the training to evaluate its effectiveness and identify areas for improvement. Data collected from these surveys will be aggregated and reported in an unidentifiable manner. Staff safety is a top priority during all training activities and patient interactions. The simulation environment will be designed to minimize physical risks, and staff will be trained in de-escalation techniques to prevent the need for restraint whenever possible. Ethical considerations, including patient autonomy, dignity, and the least restrictive interventions will be emphasized throughout the training. The program will adhere to current ethical guidelines and legal standards related to restraint use. 18 The implementation of agitated patient training will include simulation scenarios replicating real-life patient encounters, a didactic session covering relevant legal, ethical, and clinical information, practical skills training in restraint application and medication administration, and debriefing sessions to facilitate reflection and learning. This comprehensive approach aims to equip staff with adequate knowledge and skills necessary to manage agitated patients effectively while upholding ethical principles and ensuring the safety of both patients and staff. Discussion A comprehensive agitated patient simulation education is essential for maintaining patient and staff safety during these events (Davids et al., 2021; Im et al., 2024; Janzen et al., 2022; Jones et al., 2023; Kernaghan & Hurst, 2023). Additionally, educating staff members on de-escalating agitated patients has effectively reduced the number of agitated patient events (Thompson et al., 2022; Ming et al., 2019; Jones et al., 2023; Legambi et al., 2021). This MSN project will be implemented in the education department of a local mental health institute and will include roughly 150 staff members. This project aims to increase staff confidence in de-escalation, knowledge of early warning signs of escalating patients, and the ability to collaborate and communicate effectively with staff members before and during handson scenarios. Ultimately, this project aims to reduce the number of agitated patient events, increase and maintain safety for staff and patients and increase the confidence levels of staff members during agitated patient events. Evidence-based Solutions for Dissemination A poster presentation will highlight key findings, such as the quantifiable impact on staff confidence post-simulation and the reduction in agitated patient events. The poster will be 19 presented to members of the Annie Taylor Dee School of Nursing leaders. The poster will display the pre- and post-simulation assessment data and the facility charting results using graphs and charts. This format allows for interactive discussions and networking with other healthcare professionals. This format allows for interactive discussions and networking with other healthcare professionals. A presentation of this project can be disseminated to local and national healthcare conventions. It should explain the project methods, literature review, simulation design, and how the McKinsey 7S framework was applied. Emphasizing the project's impact on patient and staff safety, challenges, and quality improvement would allow for in-depth discussion and provide an opportunity to answer various questions. Finally, the project findings will be disseminated through publication in a scholarly journal. The literature review, simulation education design, data, data analysis, implementation, and project implications will be detailed within the article. As a result of submitting a peerreviewed journal article, the findings of this project will allow for a broader range of access to audiences related to mental health, research, education, and nursing. Significance to Advance Nursing Practice An agitated patient simulation education project offers a variety of benefits to the nursing profession such as enhancing competency and promoting safer patient care in challenging behavioral health situations. Predominantly, this project addresses the critical need for nurses and other staff members to confidently and effectively manage escalating patient behaviors, an important skill vital to maintaining patient and staff safety. Simulation training provides a safe, controlled environment for staff members to practice de-escalation techniques, communication strategies, and safe intervention protocols, which will translate to improve real-world responses 20 (Cant et al., 2020). This directly benefits the nursing profession by reducing workplace violence, a significant issue in healthcare settings. This project aims to bridge the gap between theoretical knowledge and practical application, focusing on managing a vulnerable patient population. Implementing frequent simulation training helps staff members develop enhanced situational awareness and clinical judgment, thus leading to more timely and appropriate interventions (Dawood et al., 2024). This approach can prevent staff and patient harm and reduce the need for more restrictive interventions, promoting a more therapeutic environment. Moreover, this project fosters a culture of preparedness, teamwork, and empowers staff members to address complex situations confidently. Implications Reducing or eliminating obstacles for an agitated patient simulation education project requires a multifaceted approach. Barriers will often include staff resistance to training and schedule conflicts. To address these, securing administrative support is a priority. Highlighting the potential reduction in workplace violence and improved patient outcomes can portray the importance of this project to staff members. Scheduling flexibility will be crucial; offering various training sessions at various times can accommodate the morning, swing, and night shift schedules. Addressing staff resistance will need to involve clear communication about the project's purpose and benefits. Clear communication about the project's purpose and benefits will be necessary to address staff resistance. Emphasizing the simulation's role in enhancing staff personal safety and improving patient care can foster full staff participation. Incorporating feedback from all staff members during the simulation design and implementation phases can 21 also promote personal and professional growth and engagement. Additionally, demonstrating the project's alignment with professional standards and regulatory requirements can strengthen its legitimacy. Implementing this simulation training project significantly supports psychiatric nursing knowledge and the profession. First, it will enhance nurses' clinical skills in managing agitated patients, leading to improved patient safety and reduced workplace violence. Because of the hands-on experience in educating de-escalation techniques and safe intervention protocols, the simulation training helps to bridge the gap between theoretical knowledge and practical application (DeSouza & Bleich, 2023). Secondly, this project promotes evidence-based practice by integrating current research and best practices into the training curriculum. This ensures that nurses and staff members have the most up-to-date knowledge and skills. Further, this project fosters a culture of continuous learning and professional development, encouraging nurses and staff members to engage in ongoing education and skill development. This ultimately contributes to a more competent, confident, and safer nursing workforce, increasing the capability of providing high-quality patient-centered care to those with behavioral health needs. By improving patient outcomes and reducing harm, the project reinforces the value of nursing and enhances its professional standing. Recommendations After examining the benefits of this project, recommendations for improving the agitated patient simulation education project, gathered from faculty, content experts, and peers, center on enhancing how realistic the simulations are and expanding its scope. A consistent suggestion is to incorporate diverse patient scenarios, including variations in age and cultural backgrounds. 22 This ensures that the training applies to a broader range of clinical situations unique to different units in the facility. Staff members emphasized the importance of debriefing sessions following simulations while suggesting structured debriefing frameworks to maximize learning. Other staff members recommended involving interprofessional collaboration in the simulations and involving other healthcare professionals, such as security personnel or social workers, to reflect real-world responses to agitated patients. Though already incorporated into this project, involving the interprofessional staff members in de-escalation and violence prevention were explicitly suggested. Moving forward, the next steps include conducting a pilot study to evaluate of the project's effectiveness in a real-world clinical setting. This involves collecting data on staff confidence, patient safety outcomes, and the frequency of agitated patient events. Based on the pilot study’s results, the simulation training would be fine-tuned for improvement. Conclusions In conclusion, this project addresses the need for enhanced safety protocols in behavioral health settings by creating and implementing an agitated patient simulation education program. A literature review highlighted significant gaps in staff confidence and standardized training, revealing that early de-escalation techniques, consistent and frequent training, and clear communication are necessary for reducing patient-to-staff violence. Research indicated that staff confidence significantly increases with regular simulation training, leading to improved patient outcomes and reduced workplace violence. The McKinsey 7S framework provided a structured approach to organizational change, emphasizing the importance of aligning strategy, structure, systems, shared values, skills, style, and staff. 23 The project's implementation, involving a multidisciplinary team and realistic simulation scenarios, aimed to equip staff with the necessary skills to recognize early warning signs of patient escalation and implement timely interventions. Key findings demonstrated that frequent, standardized simulation training significantly improves staff confidence, reduces agitated patient events, and enhances patient and staff safety (Cant et al., 2020; Jones et al, 2023). The project's evaluation, utilizing both formative and summative data, confirmed its effectiveness. Ethical considerations, including patient dignity and adherence to legal guidelines, were integrated throughout the training. This project's significant outcomes include a straightforward, implementable simulation training program that can be disseminated through poster presentations, podium presentations, and journal publications. By enhancing nursing competency and promoting evidence-based practice, this project advances nursing practice and fosters a culture of preparedness and teamwork. Ultimately, this initiative contributes to a safer and more therapeutic environment for both patients and staff, reinforcing the value of continuous education and skill development in behavioral health settings. 24 References APNA. (2023, March 13). Apna standards of practice: Seclusion and restraint. APNA Standards of Practice: Seclusion and Restraint. https://www.apna.org/standards-of-practiceseclusion-and-restraint/ Brugnolli, A., Canzan, F., Mortari, L., Saiani, L., Ambrosi, E., & Debiasi, M. (2020). The effectiveness of educational training or multicomponent programs to prevent the use of physical restraints in nursing home settings: A systematic review and meta-analysis of experimental studies. International Journal of Environmental Research and Public Health, 17(18), 6738. https://doi.org/10.3390/ijerph17186738 Cant, R. P., Cooper, S. J., & Lam, L. L. (2020). Hospital nurses' simulation-based education regarding patient safety: A scoping review. Clinical Simulation in Nursing, 44, 1934. https://doi.org/10.1016/j.ecns.2019.11.006 Davids, J., Murphy, M., Moore, N., Wand, T., & Brown, M. (2021). Exploring staff experiences: A case for redesigning the response to aggression and violence in the emergency department. International Emergency Nursing, 57, 101017. https://doi.org/10.1016/j.ienj.2021.101017 Dawood, E., Alshutwi, S. S., Alshareif, S., & Shereda, H. A. (2024). 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De-escalation training as part of a workplace violence prevention program. The Journal of Nursing Administration, 52(4), 222-227. https://doi.org/10.1097/NNA.0000000000001135 Vermeulen, J. M., Doedens, P., Boyette, L. N. J., Spek, B., Latour, C. H. M., & Haan, L. (2019). “But I did not touch nobody!”—Patients' and nurses' perspectives and recommendations after aggression on psychiatric wards—A qualitative study. Journal of Advanced Nursing, 75(11), 2845-2854. https://doi.org/10.1111/jan.14107 28 Appendix A Our project’s purpose will be presented to stakeholders such as nurse managers, nurse educators, and even the chief nursing officer. 29 Appendix B Handout of the simulation purpose. 30 Appendix C Pre- and post- simulation assessment. 31 Appendix D Timeline of project