The Active Shooter in the Pediatric Intensive Care Unit: Interprofessional Education Through Simulation

Purpose:
The purpose of this project was to simulate workplace violence and the process of de-escalation occuring in an in-patient critical care setting through interprofessional education in a psychologically safe environment.

Relevance/Significance:
Workplace violence occurs frequently in health care settings and can result from angry family members, patients, or disgruntled coworkers. Intensive Care Units are high risk areas within health care organizations and are associated with increased rates of assaults, including active shooter situations. Because of this, increased stress along with a decreased sense of personal safety among staff are associated with higher turnover rates and decreased staff satisfaction.

Strategy and Implementation:
To improve interprofessional collaboration and teamwork during a situational crisis, a simulation program involving a workplace violence scenario was developed and implemented. Because the context of the crisis was in the intensive care unit, the program was specifically developed for interprofessional participation including nurses, medical staff, and ancillary staff. Development of the program was a collaborative effort between intensive care, Security, Hospital Safety, and the Simulation Center. Using high fidelity patient simulators along with an evolving case study, participants were provided opportunities to demonstrate the following: situation recognition, effective communication use, and implement de-escalation techniques. Through debriefing sessions led by trained simulation facilitators, participants critically evaluated communication and de-escalation techniques along with individual and overall team dynamics implemented during the simulation exercise.

Evaluation:
The program is currently in progress and will be offered a total of 5 times over the course of a 10 week period of time. Outcomes of interest include positive participant feedback on the overall program, validation by participants of the benefit of using standardized communication and the value of debriefing sessions. Program outcomes will be available for dissemination at the conference.

Implications for Practice:
Nursing implications include improved recognition of potential hostile and violent situations, increased comfort with using de-escalation strategies, and improved workplace and personal safety in the pediatric critical care environment.