Workplace Violence Training and Prevention in Hospital-Based Healthcare: Implications for Nursing and the Interdisciplinary Team in the Hospital



Table 1: Review of Literature

Study and Location


Level of Evidence, Quality and Design

Training Methods

Major Findings



Heckemann, et al., 2016 (Switzerland)

To evaluate nurses’ perspectives of knowledge and skills learned from an aggressive management training course.

Level III, good quality. Descriptive qualitative interview study of seven nurses pre and post training.

8.5 hours theory then 3.5 hours practice training scenarios

Aggressive management improved nurses’ skills and knowledge, however, emotional impact unchanged.

Mitchell, et al., 2020 (Australia)

To evaluate a simulation-based program and its effectiveness to understand participants confidence managing aggressive clinical situations.

Level III, high quality. Proof of concept study for the management of clinical aggression (MOCA) utilizing the Kirkpatrick framework to assess training. 140 total participants completed pre and post-survey questionnaires.

Two-hour simulation training in addition to the management of clinical aggression training.

Improved confidence scores in staff who encountered aggressive patients during the 3-6 months post training.

Story, et al., 2020 (United States)

To evaluate the impact of workplace violence in a hospital setting and to evaluate the effectiveness of a workplace violence prevention training program in connection to nurses’ confidence and perceptions in managing violence and aggression.

Level III, high quality. Quality improvement project utilized “Confidence in Coping with Patient Aggression” (CCPA) to evaluate the effectiveness of the workplace violence prevention training program. Forty-three participants completed the required pre and post training surveys.

Single two-hour training session.

Improved skills in recognizing aggression and management of aggressive situations.




Adams, et al., 2017 (Australia)

To evaluate the effectiveness of clinical education in recognizing patients with high risk for violence and to reduce the number of violent events.

Level II, good quality. A pre and pos-training 1-5 Likert Scale questionnaire utilized to assess staff’s confidence and perceived capability to prevent and manage workplace violence. A population sample of 65 pre and 73 post-training scores were utilized in the study.

Daily education in pre-shift huddles included hypothetical situations. Four key areas were educated to staff: assessment, planning, implementation during a crisis, and post incident.

Education decreased violent incidents by 45%. However, confidence and capability score did not increase post education.

Arnetz, et al., 2017 (United States)

To evaluate the effects of randomized controlled interventions to reduce workplace violence in type II violence.

Level I, good quality. Forty-one units across seven hospitals placed into intervention and control groups. Intervention unit groups developed action plans based on data.

Intervention groups developed action plans in three categories: environmental strategies, administrative strategies, and behavioral strategies.

Intervention groups had significantly lower risks for events and injuries as compared to the control group over a six-month period of time.

de la Fuenta, et al., 2019 (United States)

To evaluate nurses’ confidence in managing aggressive patients post behavior management training

Level II, high quality. A five-hospital health system conducted pre and post-training surveys utilizing the Confidence in “Coping with Patient Aggression” (CCPA). A total of 75 participants were utilized in training, while only 31 participated in the surveys.  

4-hour in person training program Management of Aggressive Behavior (MOAB).

Significant improvement of nurses’ confidence in managing aggressive patients post training.

Jeong, et al., 2020 (South Korea)

To develop, implement and evaluate a violence prevention program for nursing students. The programs goals include improving communication self-efficacy, problem focused coping style, emotion focused coping style, and the ability to cope with violence.

Level II, high quality. Quasi-Experimental research using nonequivalent control group with a pre and post-test design of 45 students.

Two groups, control group and experimental group. Experimental group participated in eight sessions including simulation over four weeks. The control group participated in a 120 minute lecture in the first and only session.

Significant improvement in post-training scores for the experimental group in problem-focused coping style, emotion-focused coping style, and observation assessments of students ability to cope with violence.

Mixed Methods


Baig, et al., 2018 (Pakistan)

To evaluate the effectiveness of de-escalation training to prevent verbal and non-verbal violence.

Level III, good quality. Quasi-experimental study with mixed method design. Two similar hospitals participated in the study. The control and intervention group consisted of 77 participants each.  Confidence levels were measured utilizing the “Confidence in Coping with Patient Aggression Instrument” (CCPAI) scale

The intervention group were given a four-hour de-escalation training session. The training consisted of four key topics: Understanding violence and stress, escalation and de-escalation of violence, management of post-traumatic stress disorder, and patient-communication protocol.

Significantly higher CCPAI scores for the intervention group in comparison to the control group.

Coneo, et al., 2020 (Uganda)

To evaluate the effectiveness of the RESPECT training program on staff’s perceptions of causes and management of patient aggression

Level III, good quality. Mixed methods convergent design. Sample size of 90 participated in pre and post-training analysis tool and interviews. The analysis tool used was the “Management of Aggression and Violence Scale” (MAVAS)

Four-day RESPECT training course. The program is comprised of 70% prevention, 20% de-escalation, and 10% reactive strategies.

Significant effect of staff’s perception of causative factors and management of aggression post RESPECT training.

Shaw, 2015 (United States)

To understand pediatric emergency department staff’s perceptions to workplace violence risk which will help determine improvements needed to reduce risks and staff fear.

Level III, good quality. Descriptive, non-experimental design. Surveys were sent to staff in two EDs and three urgent care centers. The surveys utilized a Likert Scale and narrative response questions.

Survey centered on four topics: work-based demographics, perceptions of security fears and concerns, local police department presence, and hospital security staff presence.

Significant evidence shows staff have concerns and fear regarding personal safety at work to some degree. Researchers recommended implementing a workplace violence prevention program in all hospitals.

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