A Quality Improvement Project to Reduce Events of Visitor Escalation in the Intensive Care Nursery

Ann Schwoebel, Elizabeth Quigley, Annemarie Deeley, Joanne Deluca, Stephanie Hollister, Joanne Ruggiero, Sheila Gephart, Katherine Newnam

Research output: Contribution to journalArticlepeer-review

1 Scopus citations


Background: Escalating and aggressive visitor behaviors have become increasingly common in healthcare settings nationally, negatively impacting staff and patients alike. Most healthcare providers do not innately possess the specific skills to manage such behaviors. Management of escalating and aggressive behaviors presents a particularly bedeviling challenge when staff safety must be balanced with the needs of parent-neonate bonding. Purpose: In the Intensive Care Nursery (ICN), the frequency of aggressive and hostile incidents from visitors increased such that the staff felt frustrated by and uneasy about their work environment. Methods: The ICN convened an interprofessional team to strategize interventions aimed at consistently managing aggressive behavior and supporting the staff after aggressive and/or hostile visitor encounters. Findings: Following staff education and training, the unit launched a de-escalation management algorithm in July 2018 that assisted in identifying high-risk families at admission and drove consistent action and management of all visitor behaviors. In the 12 months following the intervention, the frequency of behavioral escalation decreased by 75% and staff perception of safety increased by 25%. Implications for Practice: Collaborating with staff to design consistent strategies to manage aggressive and escalating visitor behavior can improve safety and improve employee satisfaction in the ICN. Implications for Research: Additional research on the effectiveness of the algorithm in other ICNs and alternative areas of practice is needed. Furthermore, validation of a staff perception survey measuring the impact of escalating visitor behaviors on employees would be an important next step in this research. Video abstract available at https://journals.lww.com/advancesinneonatalcare/Pages/videogallery.aspx?autoPlay=false&videoId=43.

Original languageEnglish (US)
Pages (from-to)69-78
Number of pages10
JournalAdvances in Neonatal Care
Issue number1
StatePublished - Feb 1 2022


  • NICU family
  • NICU family anger
  • aggression
  • caring for parents of sick newborns
  • de-escalation
  • managing disruptive behavior
  • neonatal intensive care
  • nurse job stress

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health


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