JMIR Publications

ABSTRACT

Background:

Children with autism frequently demonstrate aggression and externalising behaviours in the acute care hospital environment. Paediatric acute care nursing staff are often not trained in managing aggression and in particular lack confidence in preventing and managing externalising behaviours in children with autism. High fidelity simulation exercises will be used in this study to provide deliberate practice for acute care paediatric nursing staff in the management of aggressive and externalising behaviours.

Objective:

The purpose of this study is to conduct a pilot and feasibility cluster randomised controlled trial (RCT) to evaluate the effectiveness of simulation-based education for staff in managing aggression and externalising behaviours of children with autism spectrum disorder (ASD) in the hospital setting.

Methods:

This study is a mixed design, with between group and within participant comparisons to explore the acceptability and feasibility of delivering a large scale cluster RCT. Trial process including recruitment, completion rates, contamination and completion of outcome measures will be assessed and reported as percentages. This study will assess the acceptability of the simulation-based training format for two scenarios involving an adolescent with autism +/- intellectual disability and aggressive and externalising behaviours and the resulting change in confidence in managing clinical aggression. Two paediatric wards of similar size and patient complexity will be selected to participate in the study and randomized to receive either simulation-based education plus web-based education materials or the web-based education materials only. Change in confidence will be assessed using pre- and post-training surveys for bedside nursing staff exposed to the training and the control group who receive who receive the web-based training materials. Knowledge retention three months post-training and continued confidence and exposure to clinical aggression will be assessed via surveys. Changes in confidence and competence will be compared statistically (Chi squared test) using before and after data, to compare the proportion of those who have high confidence at baseline between the two arms and at follow up. The simulation-based education will be recorded with trained assessors reviewing participant ability to de-escalate aggressive behaviours using a validated tool. This data will be analysed using mean values and standard deviations to understand the variation in performance of individuals who undertake the training. Data from each participating ward will be collected each shift for the duration of the study to assess number of aggressive incidents and successful de-escalation for patients with ASD. Total change in Code Grey activations will also be assessed with both data sets analysed using descriptive statistics.

Results:

This study gained ethical approval from Research Ethics and Governance, The Royal Children’s Hospital Melbourne on 1st November 2019.

Conclusions:

We hypothesize that this study is feasible to be conducted as a cluster RCT and that simulation-based training will be acceptable for acute care paediatric nurses. We anticipate the intervention ward will have increased confidence in managing clinical aggression in children with autism immediately and up to 3 months post-training. Clinical Trial: Australian New Zealand Clinical Trials Registry (ANZCTR) ACTRN12620000139976 http://www.ANZCTR.org.au/ACTRN12620000139976.aspx