De-escalation Training to Reduce Workplace Violence in Emergency Nurses:A Systematic Review

Abstract

Background:
Workplace violence against emergency nurses is highly prevalent and threatens staff safety, morale, and retention. De De-escalation training is widely promoted as a core strategy to manage aggression, but its effectiveness in reducing violence and related harms in emergency departments remains uncertain.
Methods:
A systematic search of databases identified clinical trials and cohort studies evaluating de
de-escalation or violenceviolence-prevention training for emergency nurses. Ten studies (randomised cluster trials, controlled cohorts, and pre pre-post designs) were included. Primary outcomes were workplace violence incidence and staff injuries; secondary outcomes were de de-escalation knowledge, confidence, attitudes, reporti ng behaviours, and psychological impacts. Risk of bias was assessed with design design-appropriate tools, and findings were synthesised narratively.
Results:
The 9 studies enrolled approximately 800 800-1,000 emergency nurses, with follow follow-up ranging from immediately postpost-training to 24 months. A large cluster trial reported a 52 % reduction in physical violence at 6 months (incident rate ratio 0.48; 95 % CI 0.29 0.29-0.80) and 63 % lower injury risk at 24 months (incident rate ratio 0.37; 95 % CI 0.17 0.17-0.83). A quasi quasi-exper imental study found workplace violence prevalence declined from 63.9 % to 46.2 % (18 % absolute risk reduction). Across studies, de de-escalation training consistently improved knowledge, confidence, and attitudes, but effects on incident rates were modest, h eterogeneous, and sometimes short short-lived.
Conclusions:
De -escalation training substantially enhanced emergency nurses’ competencies and perceived preparedness but only variably reduced workplace violence and injuries, with the most robust benefits observed when training was embedded in multifaceted organisational prevention programmes.