A regular feature of the American Journal of Critical Care, Clinical Evidence Review unveils available scientific evidence to answer questions faced in contemporary clinical practice. It is intended to support, refute, or shed light on health care practices where little evidence exists. We welcome letters regarding this feature and encourage the submission of questions for future review. W orkplace violence-any threat or act of physical violence, harassment, intimidation, or other threatening behavior 1 -is a serious problem worldwide.2 Health care workers have an increased risk of workplace violence compared with workers in private industry.3 Nurses are the most common victims, 4-6 and patients are the main perpetrators (however, visitors and employees also can precipitate workplace violence).3 In 2014, the US Bureau of Labor Statistics 7 reported that serious workplace violence is more than 3 times higher in health care settings than other workplaces, with an incidence of 16.2 per 10 000 employees. Such estimates are conservative because of gross underreporting of workplace violence in health care settings. 2,3,[8][9][10] The percentage of nurses reporting having experienced verbal threats or actual physical violence ranges from 33% to 65% (Australia), 11 to 50% (Switzerland), 12 to 76% (US). 10 A systematic review 1 of 50 international studies revealed that patients' aggression toward nurses was similar in type (verbal abuse reported 3 times as often as physical assault in any setting), location and context (nurses in emergency departments commonly report higher rates), 10 individual consequences (physical injury, short-and long-term trauma), and organizational consequences (eg, absenteeism, low morale, job dissatisfaction, increased turnover, worker's compensation, heightened security, property damage, litigation) in different countries.8 Risk factors include individual influences such as history of aggression, psychiatric disorders, substance abuse, stress/frustration/ anxiety, powerlessness, and perceptions that violence is tolerated. Environmental risk factors for workplace violence include unrestricted access, inadequate security, long wait times, overcrowding, weekends/off-shifts, and lack of aggression management training.2,3,10,13,14 As education is a critical solution to arm nurses with knowledge, skill, and confidence to prevent and respond to situations involving workplace violence, the PICO (patient population, intervention, comparator, outcome) question for this evidence synthesis is, What effect does deescalation education have on nurse outcomes of aggression management knowledge and performance and clinical outcomes (incidence and severity of violence)?
MethodThe strategy included searching the Cumulative Index to Nursing and Allied Health Literature (CINAHL) and MEDLINE. Key words included violence, hospital violence, acute care, nurses, aggression management, and deescalation education. The search was limited to research from the past 10 years.
Results
Seven original research papers15-21 were...