Young Kang, DNP, GNP

Abstract:

Background: Agitation and aggression in hospitalized older adults, especially those with dementia, delirium, or psychiatric conditions, pose serious challenges to patient care. These behaviors increase safety risks, prolong hospital stays, and contribute to workplace violence. The healthcare organization's intervention strategy for agitation and aggression is broadly applied to all hospitalized patients and lacks a structured, specific framework for older adults. Objectives: Educating Nurses on the DICE (Describe, Investigate, Create, Evaluate) approach enhanced their knowledge and self-efficacy in managing agitation and aggressive behaviors in geriatric unit patients. Methods: Nurses received structured training on the DICE approach through group or individual sessions. Pre- and post-intervention assessments using DKAT 2 (Dementia Knowledge Assessment Tool 2) and GSE 6 (General Self-Efficacy Scale 6) measured changes in dementia knowledge and self-efficacy. Agitation and aggression incidents were monitored for two months post-intervention to evaluate effectiveness. Results: Nurses demonstrated statistically significant improvements in dementia knowledge and self-efficacy, as the results showed in increased DKAT 2 scores (p < .001) and GSE 6 scores (p < .05). There were also significant positive correlations between geriatric experience and self-efficacy on GSE 6 items Q1, Q3, Q4, Q5, and Q6 (p < .05). Additionally, a 54.8% reduction in agitation and aggression incidents was observed in the geriatric unit between the eight weeks before and after the intervention, indicating significant improvement post-training. Conclusion: This quality improvement project initiative demonstrated that structured education on the DICE approach effectively improves nurses' dementia knowledge and confidence in managing agitation and aggression in older adults. Future steps include integrating this training into standard onboarding for geriatric unit staff and expanding its application to other units.

Click here to see the full manuscript.