Table 1 Study findings
References | Study type | Country / type of unit / Location | Participants | Intervention | Outcome measures | Results |
|---|---|---|---|---|---|---|
Isaak et al 2017 [38] | Before and after comparison without control group | Four forensic departments of a maximum security unit 132 beds Israel | 112 employees (multiprofessional staff) n = 112 Return of questionnaires: 112 pre, 85 post training | Multiprofessional staff training including several de-escalation training elements (“Return home safely”); 3-day workshop | Number of aggressive or violent incidents Number of employees injured due to patient violence Occupational safety climate measured with the Safety Questionnaire (Mearns et al. 2003) | Significant decrease in number of aggressive incidents towards staff: 55 incidents in 2006 (pre intervention) vs 26 in 2008 and 13 in 2013 (post intervention) Significant decrease in number of employees injured: 36 in 2007 (pre) vs 24 in 2008/ and 12 in 2009 (post) |
Isaak et al. 2018 [39] | Before and after comparison without control group | Four forensic departments of a maximum security unit in a mental health center 132 beds Israel | Multiprofessional staff n = 112 | Multiprofessional staff training (“Return home safely”); annual refresher sessions | Number of aggressive or violent incidents Number of employees injured due to patient violence (Number of absenteeism days) | Number of aggressive incidents towards staff remains low: 55 incidents in 2006 (pre intervention) vs 18 in 2009/ 8 in 2010/ 6 in 2015/ 16 in 2016/ 13 in 2017 (post intervention) |
Nesset et al. 2009 [40] | Before and after comparison without control group | Forensic psychiatric hospital 16 beds Norway | Nursing staff: n = 49 (rating 1); n = 48 (rating 2); n = 50 (rating 3) Patients: n = 10 (rating 1) n = 8 (rating 2) n = 8 (rating 3) | 3-weeks nursing staff training program including several de-escalation training elements and lectures on milieu therapy | Self-report questionnaire WAS-R (revised Ward Atmosphere Rating Scale) to measure patients’ and staff’s experience of the treatment environment (Experience of involvement, support, practical orientation, angry and aggressive behavior, order and organization, staff control) | Significant decrease in WAS- subscale “Angry and aggressive behavior” (patients and staff) |
Davies et al. 2016 [38] | Before and after comparison without control group | Medium secure forensic mental health service United Kingdom | 79 staff members | Staff training in positive behavioral support (PBS) | Confidence in Coping with Patient Aggression Instrument (adapted version) Challenging Behaviour Attributions Scale Causal Dimension Scale II | Significant increase in staff’s confidence in their ability to manage challenging patient behavior following PBS-training |
Martin and Daffern 2006 [41] | One group- posttest only-study | Secure forensic psychiatric clinic 100 beds Australia | 69 clinicians | 2-day workshop and refresher sessions of a staff aggression management/de-escalation training program (M4) | Adaptation of the Confidence in Coping With Patient Aggression Instrument (Thackrey 1987) | Increase in staff confidence in dealing with aggressive patients following training |