The Effectiveness of Workplace Violence Prevention Education Training Programs on Healthcare Professionals’ Confidence: A Systematic Review and Meta‐Analysis

ABSTRACT

Aim

The purpose of the study is to examine the effectiveness of educational training programs on healthcare professionals' confidence in dealing with workplace violence.

Background

Workplace violence is a global problem with serious consequences in healthcare. While training enhances knowledge, skills, and confidence, the critical factor for translating learning into practice, remains underexplored.

Methods

A systematic review and meta‐analysis. Data were retrieved from four databases searched through September 2024.

Results

Ten studies met the inclusion criteria, and two meta‐analyses were conducted. With the control group design, a pooled analysis indicated a significant improvement in healthcare professionals’ confidence following workplace violence training. With a one‐group pre‐ and post‐design, a significant improvement was also found. Although subgroup analysis based on different confidence measurement tools was conducted, heterogeneity was not substantially reduced.

Discussion

Workplace violence training programs improve confidence, yet the evidence is constrained by heterogeneity and limited randomized trials. Confidence‐building strategies such as simulation and repeated practice may be more effective than lectures, though standardized measures and program designs are needed to strengthen comparability and guide best practices.

Conclusion

Workplace violence prevention training appears effective in enhancing healthcare professionals’ confidence. Future studies should establish optimal models, frequency, and validated instruments to ensure sustainable outcomes.

Implications for Nursing and Nursing Policy

According to the WHO Global Strategic Directions, workplace violence prevention training should be integrated into nursing education and practice. Simulation and team‐based methods enhance confidence more effectively than lectures. Institutions must adopt standardized protocols, refreshers, and debriefings, while nursing leaders and professional bodies establish unified standards. Building confidence is central to care quality and system sustainability.

1. Introduction

Workplace violence (WPV) against healthcare professionals, defined by the WHO (2021a) as incidents in which an employee is subjected to, threatened, or assaulted in the workplace, is a long‐standing and prevalent problem. A meta‐analysis by Liu et al. (2019) estimated the global 12‐month prevalence of WPV among healthcare workers at 61.9% (95% CI: 56.1%–67.6%). While the reported rates of events were highest in emergency departments and inpatient hospital settings, the United States Bureau of Labor Statistics (2023) reported that healthcare and social service workers experienced 9.8 incidents of intentional injury per 10,000 full‐time workers, compared with 2.1 incidents across all industries. Moreover, up to 88% of WPV incidents in hospital settings may go unreported, suggesting that the true prevalence is substantially higher (Arnetz et al. 2015). There is a growing body of evidence suggesting that exposure to WPV results in physical and psychological sequelae, compromises healthcare professionals’ safety and well‐being and may contribute to post‐traumatic stress disorder and burnout (Benning et al. 2024; Davids et al. 2021; Munn et al. 2024). Psychological and physical effects of WPV negatively affect nurses’ lifestyle, work, and self‐confidence (Bildik et al. 2022; Lu et al. 2020). Reported symptoms include headache, insomnia, general weakness, helplessness, fear, anger, and depression. These consequences can directly or indirectly contribute to the resignation of valuable healthcare professionals (Baby et al. 2019; David et al. 2021).

According to the World Health Organization (2021b), the Global Strategic Directions for Nursing and Midwifery (SDNM) 2021–2025 update the 2016–2020 framework, emphasize evidence‐based practices, and comprise four policy focus areas: education, jobs, leadership, and service delivery. The fourth strategic focus area, service delivery, underscores the importance of safe and supportive service environments. To achieve such an environment, workplaces should guarantee decent working conditions, enforce zero‐tolerance policies, and ensure adequate protection, training, and resources during public health emergencies or incidents of violence (World Health Organization 2021b).

The paucity of evidence surrounding the contributors to WPV is a barrier to creating educational training programs intended to reduce the incidence. While Geoffrion et al. (2020) reported, in a systematic review, that education and training programs enhance personal knowledge and attitudes, they did not address the role of confidence in managing WPV. Confidence, reflecting both practical and psychological dimensions, is often underexplored in the literature on healthcare professionals’ safety (Liao et al. 2025). Kynoch et al. (2024) reviewed the educational interventions for WPV prevention and found current programs primarily focus on enhancing knowledge and skills, such as theories of aggression (n = 18), communication (n = 16), risk assessment (n = 15), de‐escalation strategies (n = 15), and post‐incident management (n = 10). However, there has been limited attention to healthcare professionals’ confidence in handling WPV events.

Confidence enables learners to better calibrate their understanding, seek help when needed, and maximize the effectiveness of an educational intervention. The incorporation of confidence into healthcare professionals’ education helps ensure that the educational content is translated into practice (Morony et al. 2013). Confidence is regarded as one of the most powerful behavioral motivators in daily life. In clinical settings, particularly in critical care or emergency response situations, confidence plays a pivotal role in enabling healthcare professionals to respond promptly, accurately, and safely (Güllü and Kanadli 2025; Oludare and Kotronoulas 2022). A study by Sharour et al. (2022) during the COVID‐19 pandemic reported a positive correlation between confidence and the quality of nurse–patient interactions (r = 0.81, p < 0.0001). Therefore, although knowledge, skills, and attitudes are fundamental components of WPV prevention training, integrating confidence as a core construct in the design and implementation of educational programs is equally critical for enhancing action readiness in challenging clinical environments.

Previous studies have found improved confidence in dealing with violence following violence prevention training programs (Emmerling et al. 2024; Tölli et al. 2017). While the literature has discussed the importance of training healthcare professionals to manage WPV, there is a lack of in‐depth exploration of how confidence influences their ability to effectively handle violent situations (Geoffrion et al. 2020; Kynoch et al. 2024). Therefore, a systematic review was conducted to evaluate the effectiveness of educational training programs in improving healthcare professionals’ confidence in dealing with WPV among healthcare professionals.

2. Methods

2.1. Design

A systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses (PRISMA) guidelines (Page et al. 2021) and registered on PROSPERO (CRD42251083585).

2.2. Search Strategy

A comprehensive systematic literature search was conducted in four databases: PubMed, Embase, the Cochrane Library, and the Cumulative Index to Nursing and Allied Health Literature (CINAHL), covering all records from their inception to September 2024, with no language restrictions. A hand search of reference lists from included articles was also completed. Two independent reviewers (YC and YC) screened the titles and abstracts of articles to assess eligibility for inclusion in the review, with a third reviewer (MT) consulted in cases of disagreement. The same two reviewers (YC and YC) conducted full‐text screening, and discrepancies were resolved through discussion or consultation with the third reviewer. Keywords included “healthcare professional,” “training program,” “education program,” “intervention,” “workplace violence,” “aggression*,” and “confidence.” Search strategies were developed using a combination of free‐text terms, a controlled vocabulary, and keyword synonyms, including Medical Subject Headings (Mesh), Embase subject headings (Emtree), and CINAHL subject headings, applied via Boolean operators. Gray literature and the reference lists of included articles were also searched. (See Figure 1 and Supporting Information Table S3 for details.)

FIGURE 1.

PRISMA 2020 flow diagram.

2.3. Inclusion and Exclusion Criteria

Included articles were conducted in a healthcare setting if the confidence of healthcare professionals evaluated an intervention related to WPV. WPV was defined as verbal or physical violence or aggression from patients or families directed at healthcare professionals. Healthcare professionals were defined as doctors, physician assistants, nurses, midwives, or allied health professionals.

2.4. Quality Appraisal

Study quality was appraised using the JBI Critical Appraisal Checklist for Quasi‐Experimental Studies¹⁵ and Mixed Method Appraisal Tool (MMAT). Two reviewers (YC and YC) appraised article quality independently, with disagreements resolved through discussion with a third reviewer (MT).

2.5. Data Extraction

Two reviewers (YC and YC) extracted study information independently using a standardized data extraction form, and disagreements were resolved by a third reviewer (MT). Information included author, year of publication, country, setting, participant characteristics, sample size, research design, intervention (program name, structure, content, and timing), comparison, measurement, follow‐up period, and outcome (confidence) (Supporting Information Table 1).

2.6. Data Synthesis and Statistical Analysis

Heterogeneity across studies was evaluated using Cochran's χ² test (Cochran's Q), Tau² (τ²) values, and I² values. Standardized mean difference (SMD) and 95% CI were calculated as the difference using the pooled standard deviation (SD) for continuous outcomes. For studies with a single‐group pretest–posttest design, effect sizes were converted to Cohen's d to represent the SMD before and after the intervention. All conversions and analyses were conducted in R (version 4.4) using the metafor and dmetar packages. The random‐effects model used RevMan5 software to evaluate the effect of preventative education training programs in dealing with WPV. The contents of the intervention program were summarized. Subgroup analyses were conducted based on the confidence measurement instruments.

3. Results

The initial search identified 175 articles for screening. After removing ten duplicates, 165 articles remained for title and abstract screening. Title and abstract screening resulted in the assessment of 42 full‐text papers. A review of reference lists identified ten additional studies for further assessment. Finally, ten studies met the eligibility criteria for synthesis (Figure 1).

3.1. Study Characteristics

Ten studies were published from 2007 to 2023. Sample sizes across the included studies ranged from 9 to 392, with a total of 1210 participants. Three studies were conducted in Australia (Adams et al. 2017; Middleby‐Clements and Grenyer 2007; Young et al. 2022) and two each in Pakistan (Baig et al. 2018; Khan et al. 2021), Taiwan (Chang et al. 2022; Ming et al. 2019), and the United States (Armstrong 2017; Jones et al. 2023). One study was conducted in Egypt (Hamza and Abd Elrahman 2020). One study utilized a quasi‐experimental (pre–post), mixed‐methods design (Khan et al. 2021). Six of nine studies used a one‐group, pre–post design (Adams et al. 2017; Armstrong 2017; Hamza and Abd Elrahman 2020; Jones et al. 2023; Middleby‐Clements &Grenyer 2007; Young et al. 2022), and three studies used an interventional design (nonequivalent control group design) (Baig et al. 2018; Chang et al. 2022; Ming et al. 2019).

Five studies used the Confidence in Coping with Patient Aggression Instrument (CCPA) (Baig et al. 2018; Jones et al. 2023; Khan et al. 2021; Middleby‐Clements &Grenyer 2007; Ming et al. 2019). One study used a self‐efficacy scale, and four studies applied investigator‐developed scales (Adams et al. 2017; Armstrong 2017; Chang et al. 2022; Hamza and Abd Elrahman 2020; Young et al. 2022). Nine studies provided evidence that healthcare professionals’ confidence following the preventative educational training program improved (Armstrong 2017; Baig et al. 2018; Chang et al. 2022; Hamza and Abd Elrahman 2020; Khan et al. 2021; Middleby‐Clements and Grenyer 2007; Ming et al. 2019; Jones et al. 2023; Young et al. 2022); however, one study reported no change in confidence (Adams et al. 2017) (Supporting Information Table 1).

3.2. Risk of Bias

One study was appraised with the MMAT (Khan et al. 2021) with a moderate risk of bias. Nine studies were evaluated using the JBI Critical Appraisal Tool (Tufunaru et al., 2024) with scores ranging from 6 to 9, low to moderate risk bias (Supporting Information Tables S1 and S2).

3.3. Intervention Programs

Synthesis of the ten studies identified various education training programs aimed at enhancing healthcare professionals’ confidence in managing WPV. Participants included a wide range of healthcare workers, such as nurses, doctors, paramedics, support staff, such as psychiatry, allied health, and security, administration, medical students, and nursing assistants. Each program adopted a multifaceted approach, incorporating elements such as risk assessment, planning, communication techniques, and de‐escalation strategies. Instructional methods varied and included lectures (n = 2), video‐based learning (n = 2), and experiential components (n = 9), such as group role‐plays and scenario‐based exercises (n = 7) focusing on communication and de‐escalation skills. Training durations ranged from 30 to 130 minutes per session, delivered as either single‐session workshops (n = 4) or multi‐session programs (n = 6), with frequencies spanning daily sessions over 35 days, two‐day intensives, weekly formats, and periodic training every three to six months. Most studies highlighted the importance of repeated practice to reinforce learning and skill retention.

Although the training content and delivery methods varied, three strategies were identified across the range of interventions: awareness and risk assessment (Adams et al. 2017; Armstrong 2017; Baig et al. 2018; Chang et al. 2022; Hamza and Abd Elrahman 2020; Jones et al. 2023; Ming et al. 2019; Young et al. 2022), communication and de‐escalation (Baig et al. 2018; Chang et al. 2022; Hamza and Abd Elrahman 2020; Jones et al. 2023; Khan et al. 2021; Young et al. 2022), and post‐incident management with institutional policy development (Adams et al. 2017; Middleby‐Clements and Grenyer 2007; Young et al. 2022). The first component focused on the early identification of behavioral cues, environmental triggers, and the motivations behind aggressive behavior. The second centered on strengthening verbal and nonverbal de‐escalation skills through interactive and scenario‐based methods. The third involved post‐incident strategies, including structured debriefings and the implementation of institutional protocols such as zero‐tolerance policies and emergency response procedures such as “Code Black.”

Confidence‐building was a foundational element integrated throughout all components of the programs. Interventions that embedded repeated practice, team‐based feedback, and realistic simulations were found to be more effective in enhancing participants’ psychological readiness and perceived competence. The systematic review indicates that confidence‐enhancing strategies should be intentionally incorporated, prior to or alongside communication and de‐escalation training, to strengthen healthcare professionals’ engagement, motivation, and real‐world application of acquired skills.

3.4. Meta‐Analysis of Confidence

Two meta‐analyses were conducted with or without a control group. Four studies that adopted a nonequivalent control group design were incorporated into the primary meta‐analysis. Six studies employed a single‐group pretest–posttest design. While these lacked control groups, they were synthesized using the method proposed by Baldwin et al. (2023), with effect sizes converted to Cohen's d and analyzed using a random‐effects model.

The meta‐analysis conducted using data from four studies that included control groups (Chang et al. 2022; Baig et al. 2018; Khan et al. 2021; Ming et al. 2019) provided the requisite data with a sample size of 821 healthcare professionals ranging in age from 27 to 34 years. The results showed that implementing a WPV preventative education program significantly increased participants’ confidence (SMD = 0.85, 95% CI = 0.51–1.19). However, considerable heterogeneity was noted (Cochran's Q = 16.21, p = 0.001, I² = 81.5%, Tau² = 0.092) (Figure 2). To explore potential sources of heterogeneity, a subgroup analysis was performed based on the type of confidence measurement instrument used, including an investigator‐developed scale. The analysis showed that studies using the CCPA scale exhibited substantial heterogeneity (I² = 79.2%, SMD = 0.62, 95% CI = 0.15–1.10, τ² = 0.0932, p = 0.0283). The overall test for subgroup differences was not significant (χ² = 3.17, p = 0.2050) (Figure 4) (Table 1).

FIGURE 2.

Confidence in control group design.

FIGURE 4.

Confidence in control groups design subgroup by instrument.

TABLE 1.

Data extraction.

First author (publication year), country	Study design	Setting	Sample size and characteristics	Comparison group	Intervention	Instrument	Results
Middleby‐Clements and Grenyer 2007 Australia	Quasi‐experimental study (one group, pre–post study)	NSW Health Service	n = 117 Age: mean age of 38–41 years Gender: 68% female Experience: unspecific	Yes	Content: (1)Two aggression minimization training programs (2)Modules 1 and 2 of the state‐wide programs (3)New zero‐tolerance policy information for dealing with aggression and violence Model: Not provided Frequency: 2 days Implementation: 6 months	Confidence in Coping with Patient Aggression Instrument (CCPA) 10‐Item self‐report questionnaire 10‐Point Likert scale Cronbach's α: 0.92; Internal consistency: 0.92	Confidence: Pre vs. Post: 62.62 vs. 69.89, df = 1, F = 16.48, p = 0.00
Adams et al. 2017 Australia	Quasi‐experimental study (one group, pre–post study)	Two medical wards	Sample size: n = 28 pre and 31 post Age: All more than 30 years Gender: 78.8% were female (RN) Experience: approximately five years	Yes	Content: four key areas (assessment, planning, implementation [.crisis], post‐incident) Model: not provide Frequency: one hour every day for 35 days	Self‐administered questionnaire Three Likert scale questions Investigator developed, Cronbach's α: 0.93; test–retest reliability: r = 0.986; have content validity and face validity One group compared before and after the intervention	Confidence: F (1, 55): 0.239 p: 0.627 (95% CI: −0.073‐0.119)
Armstrong 2017 United States	Quasi‐experimental study (one group, pre–post study)	Medical–surgical unit	n = 9 Age: Mean age of 38 Gender: All female Experience: 3.65 years.	N/A	Content: Includes the Plan–Do–Study–Act cycle to guide each step in the process Model: Modify CREW program (culture of civility, respect, and engagement in the workplace). Based on the model for improvement (MFI) Frequency: Every week for 4 weeks, 20–30 minutes Implementation: 8 weeks	Confidence Scale A 100‐point scale Uses 10‐point increments, ranging from no confidence (0 points) to high certainty in the ability to respond (100). Investigator developed, developed by Mallette et al. (2011), but does not provide the reliability and validity One group compared before and after the intervention	Confidence: Item 1: Means ± SD: −14.444 ± 15.09 t = −2.871; p = 0.021 Item 2: Means ± SD: −0.23.333 ± 15.00 t = −4.667; p = 0.002 Item 3: Means ± SD: −0.24.44 ± 16.667 t = −4.400; p = 0.002 Overall: ΔMean: 20.41 Pooled SD (total): 19.08
Baig et al. 2018 Pakistan	Quasi‐experimental study (intervention study)	Emergency, gynecology and obstetrics, medicine and allied and surgery	n = 77 in each group (intervention group and control group) Age: 27.34 ± 6.17 years and 29.86 ± 8.55 (intervention group and control group) Gender: 64.8% female Experience: <1 year were 45.7%−54.9%	Yes	Content: (1) Understanding violence and stress (2) Escalation and de‐escalation of violence (includes techniques of de‐escalation of aggressive behavior using verbal and nonverbal techniques) (3) Management of post‐traumatic stress disorder (4) Patient‐communication protocol Model: De‐escalation training Frequency: Four months Implementation: Not provided	Confidence in Coping with Patient Aggression Instrument (CCPA) A 10‐item self‐report questionnaire A 10‐point Likert scale	Confidence: (Means ± SD: 27.49 ± 3.53) as compared with control (means ± SD: 23.92 ± 4.52) p < 0.001
Ming et al. 2019 Taiwan	Quasi‐experimental study (intervention study)	Medical center Wards, emergency and intensive care units	n = 392 clinical nurses (200 intervention group; 192 control group) Age: Mean age of 34.0 ± 9.0 years. Gender: 100% female Experience: 10.8 ± 8.6 years	Yes	Content: (1)Lecture: an overview for 60 minutes (2)Video for 10 minutes (3)Communication skills for 30 minutes (4)Demonstration and handling and escape skills for 30 minutes. (5)Group role‐play and scenario simulation exercises for 50 minutes. Model: Not provided Frequency: Continue for 3 months. Implementation: Divided into 4 groups, each group each time for 3 hours	Confidence in Coping with Patient Aggression (CCPA) 17 items(revised version by self‐designed questionnaires) Cronbach's α: 0.92; CVI = 1.0 Scores high mean certainty in the ability to respond confidence. Likert 5‐point scoring Compare experimental and control groups	Self‐confidence: p < 0.001 (Means ± SD: 59.78 ± 8.06) as compared with control (means ± SD: 68.84 ± 8.78) After GEE analysis (B = 8.054, Wald χ2 = 115.520, p < 0.001)
Hamza and Abd Elrahman 2020 Egypt	Quasi‐experimental study (one group, pre–post study)	Psychiatric wards	n = 45 Age: 30.18 ± 9.1 years Gender: female for 46.7%; male for 53.3% Experience:9.6 ± 8.8 years	N/A	Content: 3 strategies (1)Preventive strategies: Awareness and understanding, self‐awareness, and assertiveness training (2)Anticipatory strategies: warning signs, violence assessment, de‐escalation strategies, communication strategies, and behavioral actions (3)Containment strategies: escaping (from holds and grabs, seclusion), restraints, reporting and recording Model: Not provided Frequency: One‐time course Implementation: Once	Confidence in Managing Service user Aggression A 7‐item rating scale Revised version by self‐designed questionnaires; does not provide the reliability and validity	Confidence Item 1: Means ± SD: 1.4 ± 1.5t = 6.24** Item 2: Means ± SD: 0.3 ± 1.4 t = 1.26 Item 3: Means ± SD: 1.5 ± 1.4 t = 7.26** Item 4: Means ± SD: 1.1 ± 1.5 t = 4.93** Item 5: Means ± SD: 1.2 ± 1.5 t = 5.42** Item 6: Means ± SD: 0.8 ± 1.0 5.36** Item 7: Means ± SD: 0.3 ± 1.6 1.37 **p < 0.0001 Overall: ΔMean: 0.943 Pooled SD (total): 1.427
Khan et al. 2021 Pakistan	Mixed‐method design (intervention study)	Emergency department of two tertiary care hospitals	n = 100 in each group (intervention group and control group) Age: Mean age of 33.52 ± 9.5 years; 31.62 ± 8.4 years (intervention group and control group) Gender: Male for 70; 73% (intervention group and control group) Experience: mean work experience of 4.16 ± 4.73; 3.32 ± 3.71 years (intervention group and control group)	Yes	Content: (1)De‐escalating violence (2)Ground realities, improvement in communication skills and future recommendations (3)Control hospital's coping mechanisms and the need for formal training regarding de‐escalation of violence. Model: Not provided Frequency: One‐time course Implementation: Focus group/once	Confidence in Coping with Patient Aggression (CCPA) 10 items Cronbach's α: 0.81 Internal consistency	Confidence: p = 0.006 (Means ± SD: 28.32 ± 3.21) as compared with control (Means ± SD: 26.78 ± 4.57)
Young et al. 2022 Australia	Quasi‐experimental study (one group, pre–post study)	Psychiatric wards	n = 122 Age: Mean age of 37 ± 11.3 years Gender: Female for 70% (n = 85); male for 30% (n = 37) Experience: Unspecific	N/A	Content: (1)Scope of practice based on simulation scenario. (2)Collaborative partnership, verbal de‐escalation, and situational awareness. (3)Crisis resource management methodology. (4)Team training method. (5)Scenario: Real‐life deidentified clinical incidents and Code Black (personal threat) incidents. Model: Role play of the experiential learning framework Frequency: One‐time course Implementation: group/once for 8–10 persons	Self‐efficacy Likert scale 10 items 0 (no confidence) to 100 (very confident). Cronbach α: 0.926, and provides evidence of construct validity Two domains: Leadership/management Communication/teamwork	Confidence: Two domains: Leadership/management t = 8.2; df = 119; p < 0.000; (95% CI: 13.3, 21.7) Communication/team‐ work t = 8.0; df = 119; p < 0.000; (95% CI: 11.1, 18.4). Overall: ΔMean: 16.125 pooled SD (total): 22.951
Chang et al. 2022 Taiwan	Experimental study (cluster‐randomized assigned, intervention study)	Emergency department	n = 75 clinical nurses (39 intervention group; 36 control group) Age: Mean age of 33.74 ± 6.48 years; 29.14 ± 4.86 (intervention group and control group) Gender: 97.44% female; 83.33% female (intervention group and control group) Experience: 7.24 ± 4.68 years; 4.29 ± 3.32 years (intervention group and control group)	N/A	Content (three parts combined 12 components): (1)Awareness: Such as identification of patients/visitors at high risk of violent behavior, the motivations of perpetrators, the causal factors, triggers, and cues. (2)Intervention focused on interaction, management, prevention, and post‐incident action (danger assessment, communication skills, problem‐solving, conflict management, and anger management) (3)Confidence techniques (4)Use video, lecturers, proactive questioning, role‐plays, scenario examples based on actual WPV, in various communication exercises, discussions, and debriefing.
					2.Model: Workplace Violence Prevention and Management Training Program (WPV‐PMTP) has three types of outcomes: cognitive, skill‐based, and affective 3.Frequency: 12‐session course 4.Implementation: Each session lasted at least 1 hour.	Confidence in Managing Aggressive Behavior 8 items A 4‐point scale, ranged from 1 (not) to 4 (extremely) Cronbach's α was 0.83 and provides evidence of content validity	Confidence: Confidence in their ability to manage a patient's/relative's violent behavior (p < 0.001). Group and time interaction: significant increase in confidence in managing violence (B = 4.58, p < 0.001, 95% CI: 2.71, 6.45; marginal R 2 = 0.58) (Means ± SD: 27.41 ± 2.56) as compared with control (means ± SD: 24.67 ± 2.31)
Jones et al. 2023 United States	Quasi‐experimental study (one group, pre–post study)	Neuroscience department Emergency department Neonatal intensive care unit Cardiac telemetry and intermediate care	n = 28 Age: Most participants were aged between 35 and 44 years (35.7%) Gender: Female for 53.6% (n = 15); male for 46.4% (n = 13) Experience: Most participants had 0–1 year of work experience (42.9%)	N/A	Content (three parts combined 12 components): (1)Awareness: empathize with patients’ perspectives. To consider the types of events (e.g., not feeling heard, disrupted sleep, family member's illness) (2)Emotional triggers (e.g., stress, frustration, anxiety, anger) (3)Used traditional models of teaching, the project team structured training around presenting materials (e.g., PowerPoint presentation and videos) (4)Used verbal and nonverbal de‐escalation techniques in role‐playing scenarios, a teaching method recommended. (5)Real‐time feedback was followed by a question‐and‐answer Model: PDSA blueprint, evidence‐based de‐escalation training Frequency: Not provided Implementation: 1 hour.	Confidence Coping with Patient Aggression Instrument (CCPA) 10 items Internal consistency: Cronbach's α: 0.92	Confidence: (1) Items 1, 7, and 8 were significant (p < 0.01) (ratings of safety, comfort, and confidence) (2) Pre‐ or post‐training, scored a higher mean. Overall: ΔMean: 0.21 pooled SD (total): 0.177

A separate meta‐analysis was conducted for the remaining six studies that used a single‐group, pretest–posttest design (Jones et al. 2023; Young et al. 2022; Hamza and Abd Elrahman 2020; Adams et al. 2017; Armstrong 2017; Middleby‐Clements and Grenyer 2007). The studies provided data from 234 participants, with reported mean ages ranging from 26 to 39 years. Although these studies lacked a control group, they were synthesized using the method proposed by Baldwin et al. (2023), with effect sizes converted to Cohen's d and analyzed using a random‐effects model. The results indicated a significant improvement in participants’ confidence following the intervention (Cohen's d = 0.71, 95% CI = 0.35–1.07), with moderate heterogeneity (Cochran's Q = 14.20, p = 0.0141, I² = 64.8%, Tau² = 0.0707) (Figure 3). A subgroup analysis was conducted for the six studies that adopted a single‐group pretest–posttest design, using the type of confidence measurement instrument as the classification criterion. Studies that employed the CCPA scale demonstrated a larger effect size, with moderate heterogeneity that was lower than the overall estimate (Cohen's d = 0.91, I² = 61.5%, 95% CI = ‐1.73–3.56, τ² = 0.0574, p = 0.1068). In contrast, studies using investigator‐developed tools reported a smaller effect size, with higher heterogeneity exceeding the overall estimate (Cohen's d = 0.54, I² = 70%, 95% CI = −0.56–1.64, τ² = 0.1246, p = 0.0357). Although the test for subgroup differences did not reach significance (χ² = 1.30, p = 0.52) (Figure 5), these findings suggest that variation in measurement tools may be one of the potential contributors to differences in effect size estimates and study heterogeneity.

FIGURE 3.

Confidence in single‐group pretest–posttest design.

FIGURE 5.

Confidence in single‐group pretest–posttest design subgroup by instrument.

4. Discussion

A review of ten studies published between 2007 and 2023 examined the ability of WPV prevention training for healthcare professionals across various countries and professional roles to impact confidence. The study designs comprised four quasi‐experiments with control groups and six single‐group pretest–posttest designs, using six different instruments to assess confidence. Notably, only five studies used the CCPA scale, which has demonstrated good validity and reliability in evaluating healthcare professionals’ confidence (Thackrey 1987). Overall, nine studies reported improvements in confidence following the intervention. These findings align with earlier work by Tölli et al. (2017), which showed that training interventions were more effective in enhancing confidence than in improving knowledge or attitudes. Consistent with Liao et al. (2025), our results also suggest that simulation‐based and repeated training may further strengthen confidence and psychological resilience in high‐risk situations. Confidence is considered a broad and consciously accessible belief system and has been identified as the strongest predictor of achievement outcomes (Morony et al. 2013). Confidence may improve the ability of healthcare professionals to speak out and intervene appropriately when faced with WPV (Fathy Abd Elmoteleb Ali Hamza and Abd Elhamed Abd Elrahman 2020). Taken together, the evidence highlights the practical effectiveness of confidence‐building strategies embedded within WPV prevention programs. The results indicated that, compared with improving attitudes or knowledge, training significantly enhanced nurses’ confidence.

The quality of the studies was good, though only four studies included control groups. The lack of randomized control trials reduces the strength of the body of evidence. The curriculum and content of the educational training programs identified in this systematic review demonstrated marked heterogeneity in the confidence measurement instrument, intervention content, frequency, and duration. Some studies used validated instruments (e.g., CCPA), while others relied on researcher‐developed measures with limited psychometric information. This variation in measurement tools may have reduced the comparability of outcomes across studies and contributed to heterogeneity. The various interventions likely contributed to heterogeneity, making any recommendation difficult. The persistence of moderate to high heterogeneity indicates that additional factors contribute to the observed variation across studies. Factors may include differences in intervention content, training frequency and duration, instructional approaches, curriculum structure, and sample characteristics. Future research should prioritize the use of standardized, psychometrically validated instruments and investigate potential moderating variables to obtain a more comprehensive understanding of the sources of heterogeneity in intervention effectiveness.

Therefore, although knowledge, skills, and attitudes are fundamental components of WPV prevention training, incorporating “confidence” as a core construct in the design and implementation of educational programs is equally critical to enhancing action readiness in challenging clinical environments.

4.1. Implications for Nursing and Nursing Policy

According to the World Health Organization (2021b), the SDNM 2026–2030 outline four key pillars—education, employment, leadership, and service delivery—that can guide nursing policy responses. Based on the findings of this systematic review and meta‐analysis, we propose the following recommendations for stakeholders. “Education,” WPV prevention should be integrated across the entire nursing continuum. Simulation‐based training, scenario‐based learning, and team drills are more effective than traditional didactic approaches in fostering confidence and real‐time response. Regarding workforce considerations, or “jobs,” institutions must implement standardized WPV training protocols that are tailored to clinical realities. Modular formats, regular refreshers, and post‐incident debriefings can strengthen psychological readiness, while embedding these practices into hospital accreditation processes helps ensure sustainability and institutional accountability. “Leadership and service delivery” also play pivotal roles. Nursing leaders must prioritize WPV prevention within organizational policy and culture by advocating for resources, staff empowerment, and ongoing institutional support. Simultaneously, national nursing associations and regulatory bodies should collaborate to establish unified training standards that define core content, recommend validated confidence measures, and offer benchmarks for evaluating effectiveness. These strategies reflect the WHO framework and provide a comprehensive policy road map. Ultimately, our review highlights that building confidence is critical to service delivery in WPV contexts. At the same time, embedding WPV prevention training into broader strategies across education, employment, and leadership may further strengthen the sustainability and system‐level impact of such programs, though this requires confirmation in future research.

4.2. Limitations

A comprehensive search included quasi‐experimental designs with methodological quality. However, limitations include the lack of control groups in many studies, limiting the strength of the evidence. Study heterogeneity reduced the precision and statistical power of the meta‐analysis. Although subgroup analyses were conducted to enhance the robustness of the findings, the results must be interpreted with caution. Considerable variation in the content of the preventative education programs limited the interpretability and comparability of the findings. Moreover, due to the small number of studies with the same design, it was not possible to formally assess publication bias, which further constitutes a limitation of this review. High‐quality controlled trials are recommended to validate these results.

5. Conclusion

WPV preventive education training programs can increase healthcare professionals' confidence in managing patient behaviors in healthcare workplace settings. Although the effectiveness of these programs varies across different study designs and definitive conclusions remain limited, the findings contribute to consolidating existing evidence and strengthening the empirical foundation for the role of such programs in supporting professional competence. While an increase in confidence does not directly indicate an improvement in performance or ability, confidence may reflect a heightened sense of preparedness and willingness to respond to violent incidents. Establishing a standardized training protocol that incorporates core components and integrating it into hospital‐level education planning may help ensure a consistent level of readiness among healthcare professionals in the face of WPV. Although some studies suggest that training should be provided every 3 to 6 months to reinforce and sustain acquired knowledge and skills, the optimal frequency and timing of training sessions require further investigation. Future research is needed to explore the most effective implementation models for educational training programs to affect worker confidence in fostering a safe, supportive, and empowering work environment.

Author Contributions

Study conception and design: Yi‐Fei Chung and Susan Jane Fetzer. Data collection, data analys and interpretation: Yi‐Fei Chung, Yu‐Chun Chang, and Meng‐Hsuan Tsai. Drafting of the article: Yi‐Fei Chung. Critical revision of the article: Yu‐Chun Chang, Susan Jane Fetzer, Lindsay Tessmer, and Jui‐Ying Feng.

Supporting information

Supporting Information File 1: inr70107‐sup‐0001‐tableS1.pdf.

Supporting Information File 2: inr70107‐sup‐0001‐tableS2.pdf.

Supporting Information File 3: inr70107‐sup‐0001‐tableS3.pdf.

Chung, Y.‐F. , Chang Y.‐C., Fetzer S. J., Tessmer L., Tsai M.‐H., and Feng J.‐Y.. 2025. “The Effectiveness of Workplace Violence Prevention Education Training Programs on Healthcare Professionals’ Confidence: A Systematic Review and Meta‐Analysis.” International Nursing Review 72, no. 4: e70107. 10.1111/inr.70107

Data Availability Statement

Access to the primary data underpinning the study's findings can be facilitated by referring to the search strategy outlined in Supporting Information. Any data that may not be accessible are due to specific constraints or limitations, which will be clearly explained.