Recognising the warning signs of a potential physical assault and knowing what to do if it happens are useful skills for future nurses and midwifes to acquire
Citation: Stephens J (2017) Benefits of teaching students de-escalation and breakaway skills. Nursing Times; 113: 1, 58.
Author: Justin Stephens is senior lecturer at University of Greenwich.
De-escalation and breakaway techniques are an important part of the skills that should be learned by nursing and midwifery students. The National Institute for Health and Care Excellence (2015) defines breakaway techniques as “physical skills to help separate or break away from an aggressor in a safe manner [that] do not involve the use of restraint.”
Between 2013 and 2014, 68,683 physical assaults were recorded against NHS staff. This represents an increase of 8.7% on the total reported figures from 2012-13 (NHS Business Services Authority, 2014). The need to provide breakaway skills training is evident, but how should it be approached with pre-registration students?
The University of Greenwich asked 16 students in their first six weeks of joining the BSc mental health nursing programme for their opinions about such training when entering their first placement. All were excited; many had previous experience as healthcare assistants or carers.
When asked whether breakaway skills training was needed, the response was unanimously affirmative. Many students wanted to be made aware of the potential dangers in specific situations, and how to avoid them. Some of the more-experienced students who had worked as HCAs recognised the importance of building a rapport, and verbal de-escalation as a means of resolving potentially violent situations. Others said they valued the reassurance of “knowing what to do in a tight situation”.
The university developed its own in-house breakaway skills session for pre-registration nursing and midwifery students, which has now been in operation since January 2015. The session was conceived as an alternative to using external training providers, so all teaching is undertaken by nurses with extensive experience across all nursing and midwifery disciplines.
All pre-registration nursing or midwifery students receive one breakaway skills session at the beginning of their studies, with annual updates for those on the learning disabilities, mental health and child branches.
Each session lasts for three hours and comprises a combination of theory and physical breakaway skills:
- Theory – includes verbal de-escalation skills and advice on how to recognise early warning and danger signs of violence and aggression (Box 1);
- Physical – involves learning a concise set of skills to break free from wrist grabs, clothes grabs, hair pulls and strangle holds.
All skills are demonstrated before the students who are asked to practise in pairs with feedback from individual members of that session’s teaching team.
Informal feedback from students has been positive. One student said the training made her feel more confident, while another stated it had helped improve her observations skills and levels of awareness. Others commented on the need for yearly updates, as well as access to teaching materials such as video clips for reference.
Students have identified breakaway as a vital part of their preparation for practice. By incorporating existing healthcare staff in the teaching team, the University of Greenwich has created a tailored approach that is responsive to students’ needs.
NHS Business Services Authority (2014) 2013-14 Figures Released for Reported Physical Assaults against NHS Staff.
National Institute for Health and Care Excellence (2015) Violence and Aggression: Short-term Management in Mental Health, Health and Community Settings.