Document Type



Doctor of Nursing Practice



Date of Defense


Graduate Advisor

Susan Dean-Baar, Ph.D., RN, CENP, FAAN, Chairperson


Louise C. Miller, Ph.D., RN, Co-Chairperson


Kimberly Siemons, MSN, RN



Problem: Rising rates of violence in health care environments signal a need for health care workers, specifically frontline nurses, to be trained in effective de-escalation management skills. Since January 2017, there has been an increase in the number of patients categorized as aggressive with more violent patient events taking place at a selected midwestern hospital facility in the critical care department, particularly the intensive care and transitional care units.

Methods: Using a pre-post design, this project compared nurses’ verbal de-escalation skills using the English Modified De-escalating Aggressive Behaviour Scale (EMDABS) to determine effectiveness of de-escalation strategies in simulated scenarios prior to and following classroom training. Ten nurses met study criteria and completed pre-and post-intervention simulations as well as the classroom training.

Results: Results demonstrated all categories of the EMDABS increased to acceptable practice levels in nurses’ abilities to de-escalate patients. Additionally, there was an 11% increase in the total EMDABS score from pre to post intervention. One EMDABS category, Risky, reached statistical significance.

Implications for Practice: Use of the EMDABS tool paired with high fidelity simulations and verbal de-escalation training increases nursing staff’s verbal de-escalation skills. Ongoing integration of verbal de-escalation techniques into educational programs offered system-wide, with particular attention to nurse skill-building in the critical care units can accurately be measured by the EMDABS tool to objectively assess nurse de-escalation capabilities.