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Incorporating Relationship-Based Care Into a Nurse Education Program for Managing Disruptive Patient Behaviors

Lee, Betty MN, RN, CNS, CMSRN; Del Rosario, Kristian BSN, RN-BC; Byron-Iyamah, Cecily MSN, RN-BC, CNML

doi: 10.1097/NUR.0000000000000309
Feature Article

Purpose: In the hospitalized patient, stressors can be manifested as disruptive behaviors. Nursing staff confronted with disruptive behaviors from their patients or families may have difficulty delivering care and developing therapeutic relationships. The purpose of this project was to evaluate the effects of an education program using the concepts of relationship-based care with role-play and reflective practice on the knowledge, attitudes, and confidence of the nursing staff in managing disruptive patient behaviors.

Description: Nursing staff (N = 68) from an adult medical unit participated in an interactive education program. We compared participants’ self-responses about knowledge, attitudes, and confidence before intervention and at 3-month and 1-year postintervention. The number of disruptive incidents requiring hospital security was also measured.

Outcome: At 3-month and 1-year postintervention, staff reported higher levels of knowledge, attitudes, and confidence in managing disruptive behaviors. The number of disruptive incidents per 1000 patient days decreased from 0.78 to 0.39.

Conclusion: Effectively managing disruptive behaviors creates a safe, healthy environment for patients and nurses. Role-play and reflective practice are useful educational methods to teach skills to manage these encounters. Clinical nurse specialists can play a key role in developing innovative education programs through interprofessional collaboration.

Author Affiliations: Clinical Nurse Specialist (Ms Lee) and Assistant Unit Director/Administrative Nurse II (Ms Del Rosario), and Director, Medical Surgical Telemetry Unit (Ms Byron-Iyamah), UCLA Health, Santa Monica, California.

The authors report no conflicts of interest.

Correspondence: Betty Lee, MN, RN, CNS, CMSRN, UCLA Health, 1250 Sixteenth Street, Santa Monica, CA 90404 (

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