# The effect of de-escalation simulation training on empowerment and confidence in managing patient aggression among psychiatric nursing students: an experiential learning approach

## TL;DR

A simulation training program using standardized patients improves psychiatric nursing students' confidence and empowerment in handling patient aggression.

## Contribution

A structured de-escalation simulation with standardized patients and debriefing significantly enhances students' psychological empowerment and confidence.

## Key findings

- Students in the simulation group showed greater gains in psychological empowerment compared to controls.
- Confidence in coping with patient aggression improved significantly in the simulation group.
- High fidelity and attendance were maintained during the simulation sessions.

## Abstract

Patient aggression is a persistent challenge in mental health settings, and undergraduate preparation in de-escalation remains variable. This study evaluated whether a standardized-patient (SP) de-escalation simulation improves psychological empowerment and confidence in coping with aggression among psychiatric nursing students.

We conducted a parallel-group randomized controlled trial (pretest–posttest) with undergraduate psychiatric nursing students randomly assigned to either an SP-based de-escalation simulation program or routine curriculum control. The intervention comprised 12 sessions over 8 weeks (4 theory + 8 SP practical scenarios with structured debriefs aligned to INACSL standards). Primary outcomes were psychological empowerment and confidence in coping with patient aggression, assessed at baseline and immediately post-intervention using validated scales. Fidelity was supported through scripted scenarios, SP calibration, and facilitator adherence/debrief quality checks. Between-group differences in change scores were examined.

Compared with the control group, students in the simulation arm demonstrated significantly greater gains in both psychological empowerment and confidence in coping with aggression from pretest to posttest. Fidelity indices indicated consistent SP portrayal and facilitator adherence across sessions, and attendance was high. No adverse events were reported.

A structured de-escalation simulation using trained standardized patients significantly improves empowerment and confidence among psychiatric nursing students. The scenario maps, learning outcomes, and debriefing approach described support replication and curriculum integration in undergraduate mental health nursing. Future work should examine longer-term retention, transfer to clinical practice, and curriculum-level outcomes.

Not applicable.

The online version contains supplementary material available at 10.1186/s12912-025-03958-1.