Study designs of evaluations included in the review
The 9 studies which evaluated interventions included: 6 single group pre- and post-test studies, 1 non-randomised one-comparison group design, 1 non-randomised two-comparison group design, and 1 ecological study design.
Specific interventions included in the review
Nine interventions in a health care setting were evaluated:
1. Voluntary 16-hour nurse training programme in the management of patient assaultive behaviours.
2. Identification of high-risk patients through a computerised programme, and provision of 'warning flags' and background information to hospital employees prior to patients' visits.
3. Assaulted staff action programme: crisis intervention offered to employees assaulted by patients, including one-on-one counselling, support groups and referrals to professionals.
4. CARIE abuse prevention programme: 1-day workshop for nursing assistants aimed at identifying causes of abuse, understanding caregivers' feelings, cultural and ethnic perspectives, and strategies for presenting abuse and dealing with aggressive patients.
5. Use of total quality management principles during mealtimes to reduce violent incidents.
6. Aggression control techniques: 24-hour training on how to handle aggressive patients delivered in three phases: (i) verbal intervention procedures, (ii) basic physical intervention techniques, and (iii) specialised instructions in restraint and control.
7. Five-hour employee training on how to prevent and manage patients' assaultive behaviours.
8. Critical incident stress debriefing intervention, based on the Mitchell Model, offered to employees who experienced a traumatic event within the past 6 months.
9. Control and restraint training programme: 4-day training to nursing staff teaching breakaway techniques and team approaches to restraining a violent patient; 1- to 2-day refreshers were offered after initial training.
Participants included in the review
The evaluated intervention studies mostly included staff and patients from Veterans Administration hospitals and psychiatric hospitals.
Outcomes assessed in the review
Articles were included in the review if they reported cognitive, behavioural, or injury-related outcomes relating to the intervention.
How were decisions on the relevance of primary studies made?
The abstracts of articles were scanned, and two reviewers applied the inclusion and exclusion criteria.