ABSTRACT
Aggression and violence, a healthcare problem of international proportions, creates a significant risk for nurses and results in an unsafe work environment. Education can make a difference. Nurses need a level of knowledge and confidence to effectively identify, communicate, and intervene with the patient or family member displaying behaviors associated with escalation and aggression. ACT-SMART (Attitudes and Communication Techniques for Scripps Mercy Aggression Reduction Training) provides nurses theory and specific communication skills. Program evaluation was determined by nurses' self-rated confidence and attitudes in managing aggressive situations. Evaluation was conducted with a quasi-experimental study using a pretest-posttest design with control group. In a convenience sample (N = 65), experimental group (n = 56) consisted of healthcare workers of which 12 were emergency department nurses all of whom had attended ACT-SMART. The control group (n = 9) consisted of non-emergency-department nurses, and they attended an 8-hr program unrelated to the ACT-SMARTprogram; their content was related to trauma. A demographic data form and Likert-scale questionnaire measuring the incidence of aggression, confidence in managing aggressive behavior and attitudes toward aggression in emergency department were used. Descriptive statistics, paired t test, and Bivariate Pearson's correlation procedure were employed. Results included that after attending ACT-SMART, the experimental group (n = 56; 12 from emergency department) significantly improved scores on confidence in managing aggressive situations (t= -6.416, df = 42, p = .001; and t = -3.307, df = 11, p = .007). Mean scores for the control group were 2.4 and 2.4, respectively; there was no statistical difference. Weekly exposure to verbal aggression was reported by one fourth to one third of respondents. ACT-SMART improves confidence in nurses in managing aggressive situations and may be useful for improving the overall patient care.