The effect of implementing the workplace violence management training program on knowledge, attitude, and self-confidence regarding adaptation to patient violence among undergraduate nursing students

Abstract

Background

Violence management training is necessary for nursing students who are in the most contact with the patient and his/her companion. The aim of this study was to investigate the effect of implementing the workplace violence management training program (WVMTP) on knowledge, attitude, and adaptation to patient violence among undergraduate nursing students.

Methods

This semi-experimental study was conducted on 42 nursing students. Sampling was performed using the convenience sampling method and the samples were randomly assigned to the intervention (IG) and control groups (CG). The data collection tools included the Knowledge and Attitude toward Patient Violence Questionnaire, and the Self-Confidence in Adaptation to Patient Violence Questionnaire. The IG received training in the form of question/answer, lecture, and role-play, using slides and showing movies for 6 hours.

Results

No statistically significant difference was found in the mean knowledge score of students in the IG and CG two weeks after the intervention. The Wilcoxon test results indicated no statistically significant difference in comparing the mean self-confidence score in adaptation to patient violence in the IG and CG two weeks after the intervention, but a statistically significant difference was observed in the IG before and after the training (p = 0.40).

Conclusion

Although the WVMTP for nursing students was able to increase student knowledge, attitude, and self-confidence in the short term, considering the instability of this learning within the next two weeks and the importance of violence management skills, this skill is recommended to be included in the curriculum and educational credits with continuous training.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12909-026-08898-1.

Introduction

The occupation of nursing has traditionally been recognized as a high-risk profession due to the inherent characteristics of the job, such as direct patient care and less-than-ideal clinical settings [1]. A global concern has been the increasing frequency of violence against nurses and nursing students in the workplace [2, 3]. “Any act or threat of physical violence, harassment, intimidation, or other threatening disruptive behavior” that takes place in the workplace is classified as workplace violence (OSHA, ND). According to recent evaluations, it is most often described as being committed by patients, and to a lesser amount, by their families and visitors [4, 5]. Verbal aggression against nurses in psychiatric facilities ranges from 7.8% to 89.4%, while physical violence against them is reported to occur in between 2.3% and 88.4% of cases [6].

Patients in a hospital setting commonly display a range of factors that increase their risk of violence, such as substance abuse, stress, pain, cognitive impairment, and altered mental status [7]. Although the evidence presented suggests that nursing personnel encounter workplace violence [8], there is a scarcity of research on the experiences of pre-registration nursing students in this regard. Nevertheless, there exist numerous justifications for investigating the experiences of students. The rate of attrition in training incurs significant costs in terms of both economic and other resources [9]. Additionally, workplace violence serves as a contributing factor for some students. Students are susceptible to workplace violence and may be at a higher risk due to their lack of experience [10].

Studies carried out in Turkey [11, 12], Iran [13, 14], and other Middle Eastern nations have revealed that nursing students face higher physical and verbal abuse, with patients and their companions mostly imposing this aggression on them [14, 15].

In addition, these studies found that the experience of violence at work can lead to psychological complications such as anxiety, depression, diminished self-esteem, irritability, feelings of distress and fear, as well as damage to the student’s physical health. Experiencing workplace violence can also reduce nursing student commitment, dismiss student values and professional identities, and, in some cases, lead them to abandon nursery care [16].

To prevent the detrimental aspects of experiencing violence in the workplace, developing anger management and empowerment programs is necessary and essential for the treatment staff [17, 18]. In this fact, anger management skills are essential for nursing students, as in clinical situations, various conflicts are common. Therefore, nursing education should be revised in a way that helps students improve their ability to control anger [12].

Students are not immune to workplace violence and may be more vulnerable due to their inexperience [19]. Research has focused more on clinical violence directed at nurses than nursing students, but related studies have found variation in the types, causes, and outcomes of clinical violence [19–21]. One review study conducted about workplace violence prevention programs has suggested that programs should be conducted using new teaching methods and with a control group [22]. The purpose of this study was to determine the impact of the Workplace Violence Management Training Program (WVMTP) on Knowledge, Attitude, and self-confidence regarding adaptation to Patient Violence among Undergraduate Nursing Students.

Method

Study design and participants

The present research was a semi-experimental study conducted from March to October 2021 in the Faculty of Nursing and Midwifery, Mashhad University of Medical Sciences. The research population consisted of nursing students. The inclusion criteria included the willingness to participate in the research, no history of mental disorders, and no history of taking neuropsychiatric drugs. The calculated sample size for each group was 22 and by considering 10% withdraw 25 samples at each group was assigned.

As the required sample size estimation could not be directly derived from the Solorzano Martinez (2017) study [23], a post-hoc calculation was performed to estimate the overall effect size of intervention from this study. So, the parameters used were a statistical power of 90%, a one-tailed α level of 0.050, and an estimated large effect size (Δ = 1). The sample size (n) for each group was determined using the standard formula:

The result of this calculation indicated a necessary sample of 20 per group. Consequently, anticipating a 20% participant withdrawal, the final assigned sample size was set at 25 participants per group.

For sampling, the researcher first went to the research setting, selected the eligible students; the first 25 participants on the list were assigned to the intervention group, and the next 25 were assigned to the control group. The research sample encompassed 50 nursing students studying in the 6th semester who were willing to participate in the study and were randomly divided into two intervention (N = 25) and control (N = 25) groups. Two people from the intervention group and 1 person from the control group were excluded from the study because of absence at the time of completing the questionnaires. Moreover, after data collection, 1 person from the intervention group and 4 people from the control group were excluded from the study because of not completing the questionnaires correctly, and finally, 20 people remained in the control group and 22 people in the intervention group.

Data collection and measurements

Data collection tools included a demographic questionnaire, the Knowledge and Skill Questionnaire, the Violence Experience Questionaire, the Attitude toward Patient Violence Questionnaire, and the Self-Confidence in Adaptation to Patient Violence Questionnaire. The demographic questionnaire contained 6 questions (age, gender, grade point average (GPA), marital status, extent of interest in the field of nursing, and intention to change the field). The Knowledge and Violence Experience Questionnaire contained 5 questions related to knowledge and Skill and 15 questions related to violence experience which is extracted from Jonas-Dwyer et al.’ study (2017), Scoring of the knowledge section in this questionnaire is based on a Likert scale, where ‘Strongly agree’ receives a score of 4 and ‘Strongly disagree’ receives a score of 1. The maximum possible score is 20 and the minimum possible score is 4. To evaluate the patient violence experience section, a 15-item questionnaire was used before the intervention. Following the intervention, 5 items (questions 4, 7, 8, 9, and 20) were added to this section. The scoring for this section will be based on the calculation of frequency percentages [24]. The Attitude toward Patient Violence Questionnaire contained 20 questions which extracted from Collins (1994) [25] and Beech (2001) [26]. This 20-item instrument uses a Likert scale, with responses ranging from a minimum score of 1 (‘strongly disagree’) to a maximum score of 4 (‘strongly agree’). The total scores for this questionnaire range from a minimum of 26 to a maximum of 74.

The Self-Confidence in Adaptation to Patient Violence Questionnaire designed by Thackery (1987) consisted of 10 questions [27], This items scored on a scale from 1 to 11. A score of 1 represents the worst possible state, while a score of 11 indicates the best possible state. The total scores for this questionnaire range from a minimum of 10 to a maximum of 110. The validity was confirmed by the qualitative content validity confirmation method by experts and content validity confirmation method and content validity index (CVI) calculation and reliability was confirmed by calculating internal consistency and Cronbach’s alpha coefficient. The Cronbach’s alpha coefficient was calculated as 0.78 for the Knowledge and Violence Experience Questionnaire, 0.65 for the Attitude toward Patient Violence Questionnaire, and 0.95 for the Self-Confidence in Adaptation to Patient Violence Questionnaire.

The inter-rater reliability was calculated as an ICC of 0.85 for the Knowledge and Violence Experience Questionnaire, ICC of 0.85 for the Attitude toward Patient Violence Questionnaire, and ICC of 0.85 for the Self-Confidence in Adaptation to Patient Violence Questionnaire. The test-retest reliability was calculated as the correlation was (r = 0.82) for the Knowledge and Violence Experience Questionnaire, for the Attitude toward Patient Violence Questionnaire(r = 0.82), and for the Self-Confidence in Adaptation to Patient Violence Questionnaire(r = 0.82).

After obtaining permission from the Ethics Committee of Mashhad University of Medical Sciences and the Dean of the Faculty of Nursing and Midwifery and coordinating with the Faculty’s Graduate Education Unit, the researcher determined a class to bring all the research participants together. The researcher first introduced herself to the students and selected the eligible individuals based on the research course-taking checklist from among the students meeting the inclusion criteria using the convenience sampling method. After providing a group oral explanation (about 5 min) about the research purpose and method, written informed consent was obtained from the selected individuals. Having assigned the participants to the intervention and control groups, the researcher held a 6-hour WVMTP for the intervention group. This intervention was carried out by a co-author with a background in facilitating violence management workshops for nursing staff [28] for two sessions. The training material was prepared based on the topics outlined in Table 1, using content from journals and authoritative nursing textbooks such as “Workplace Violence in Healthcare Toolkit: a Guide to Establishing a Prevention & Training Program” and “Leadership Roles and Management Functions in Nursing”.

Table 1.

Details of workplace violence management training program

Session	Topic	Learning Objectives	Teaching Method	Participant Activities	Duration
First session	Workplace Violence	Define workplace violence.	Lecture	Share potential experiences.	30 minutes
		Explain types of violence.	Lecture	Share opinions.	30 minutes
		Understand the causes of violence in the healthcare system.	Lecture	Share opinions.	30 minutes
		Learn methods for preventing workplace violence.	Lecture	Share experiences.	30 minutes
		Understand self-awareness, tolerance, and appropriate responses to workplace violence.	Lecture	Share experiences.	30 minutes
		Practically demonstrate the dos and don’ts of verbal and non-verbal communication.	Video presentation	Practical exercises by participants.	60 minutes
Second Session	Methods of Managing Workplace Violence	Identify risk factors (environmental, staff, and organizational factors).	Lecture	Share experiences	20 minutes
		Understand risk prediction, management, and danger assessment.	Lecture	Share experiences and knowledge.	20 minutes
		Know the dos and don’ts of verbal and non-verbal communication.	Lecture	Participate in discussions.	20 minutes
		Display video scenarios of difficult and dangerous care situations.	Film presentation	Practical exercises.	30 minutes
		Practically demonstrate legal and acceptable isolation techniques.	Film presentation	Practical exercises.	30 minutes
		Role-play how to deal with patient violence.	Role-play	Practical exercises.	30 minutes

The first session was held for 3.5 h on the topic of workplace violence aiming to familiarize nursing students with workplace violence via lectures and playing videos. The second session was held for 2.5 h on the topic of workplace violence management methods aiming to familiarize nursing students with workplace violence management skills via lectures, playin videos, and role-play (Table 1). Data collection was carried out three times before the intervention, immediately after the intervention, and two weeks after the intervention.

Data analysis

We analyzed the data using SPSS software version 20. The Kolmogorov-Smirnov test was used to assess the normality of the data. Due to the non-normality of the data, non-parametric tests (the Mann-Whitney U test, Fisher’s exact test, and Wilcoxon test) were used to analyze the data. A significance level of p > 0.05 was considered.

Ethical considerations

In the study, the ethics committee of Mashhad University of Medical Sciences approved the ethical considerations (Ref No: IR.MUMS.NURSE.REC.1402.022).

Results

The mean age of the participants in the intervention group and in the control group was 22.05 ± 0.75 and 21.95 ± 1.96 years, respectively. The results demonstrated that the two groups were homogeneous regarding gender (p = 0.834), marital status (p = 0.187), and intention to change the field (p = 0.379) (Table 2). In terms of GPA, students had a mean score of 17.37 ± 1.00 in the intervention group and 17.11 ± 1.04 in the control group. A Pearson’s chi-square test revealed that there was no statistically significant difference between the two groups regarding their level of interest in their field of study (p = 0.299).

Table 2.

Distribution and comparison of demographic variables in the two intervention and control groups

Variable		The Intervention Group	The Control Group	Statistical Test
		N (%)	N (%)
Gender	Female	9 (45%)	13 (59.1%)	p*=0.834 F**=0.273
	Male	11 (55%)	9 (40.9%)
Marital status	Married	1 (5%)	5 (22.7%)	p = 0.187 F = 0.115
	Single	19 (95%)	17 (77.3%)
Intention to change the field	Yes	7 (35%)	5 (22.7%)	p = 0.379 F = 0.296
	No	13 (65%)	17 (77.3%)

^*Asymp. Sig. (2-sided)

^**Fisher’s exact test

The results of Fisher’s exact test indicated no statistically significant differences between the two groups in terms of exposure to violence, the form of violence encountered, students’ feelings and thoughts, history of violent victimization, and the type of action taken in response to violence. However, the test revealed a statistically significant difference between the intervention and control groups regarding exposure to violence perpetrated by patient caregivers (P = 0.011) (Table 3).

Table 3.

Assessment of homogeneity in baseline variables between groups

Variable		Group		Statistical Test
		Intervention N (%)	Control N (%)
Exposure to violence	yes	15 (0.75%)	14 (63.6%)	P = 0.426 F = 0.323
	no	7 (0.25%)	8 (36.4%)
Aggressive Individuals	patient	7 (35%)	4 (18.2%)	P = 0.216 F = 0.188
	Family Caregiver	10 (50%)	3 (13.6%)	P = 0.011 F = 0.013
	Clinical Supervisor	4 (20%)	5 (22.7)	P = 1.00 F = 0.565
	Nurse in Charge	4 (20%)	8 (36.4%)	P = 0.241 F = 0.204
	Nurses	7 (35%)	8 (36.4%)	P = 0.927 F = 0.591
	Other Healthcare Professionals	3 (15%)	3 (13.6%)	P = 1.000 F = 0.620
	Administrative Staff	1 (5%)	0 (0%)	P = 0.476 F = 0.476
Type of Violence Experienced	Verbal violence	20 (100%)	17 (77.3%)	P = 0.049 F = 0.031
	Physical Violence	1 (5%)	2 (9.1%)	P = 1.000 F = 0.537
	Intimidation	5 (25%)	4 (18.2%)	P = 0.714 F = 0.435
	Direct Threat	0 (0%)	1 (4.5%)	P = 1.000 F = 0.524
	Indirect Threat	1 (5%)	1 (4.5%)	P = 1.000 F = 0.732
Students’ Feelings and Thoughts	Feeling embarrassed	4 (20%)	3 (13.6%)	P = 0.691 F = 0.444
	Feeling hurt	3 (15%)	2 (9.1%)	P = 0.656 F = 0.453
	Feeling shocked	8 (40%)	4 (18.2%)	P = 0.118 F = 0.111
	Feeling angry	11 (55%)	11 (50%)	P = 0.746 F = 0.494
	Feeling disrespected	7 (35%)	4 (18.2%)	P = 0.216 F = 0.188
	Feeling anxious	7 (35%)	11 (50%)	P = 0.327 F = 0.252
	Feeling frustrated	4 (20%)	4 (18.2%)	P = 1.000 F = 0.594
	Feeling powerless	4 (20%)	2 (9.1%)	P = 0.400 F = 0.286
	Feeling exhausted	2 (10%)	2 (9.1%)	P = 1.000 F = 0.659
	This incident did not concern me	6 (30%)	3 (13.6%)	P = 0.269 F = 0.181
	Feeling Victimized	6 (30%)	9 (40.9%)	P = 0.461 F = 0.340
	Feeling of fear	6 (30%)	2 (9.1%)	P = 0.123 F = 0.091
	Feeling of guilt	1 (5%)	1 (4.5%)	P = 1.000 F = 0.732
	I felt sympathy for the aggressor	9 (45%)	12 (54.5%)	P = 0.537 F = 0.379
	I triggered the incident.	0 (0%)	0 (0%)	-
	other	0 (0%)	0 (0%)	-

According to the Wilcoxon statistical test result, the mean knowledge score of students in the intervention group had a significant increase immediately after the intervention (p = 0.011), but it was not significant two weeks after the intervention. Also, a significant increase was observed in the mean score of self-confidence in adaptation to patient violence in the intervention group immediately after the intervention (p < 0.0001) and two weeks later (p = 0.058). Moreover, the Wilcoxon statistical test result indicated that the mean score of attitude toward patient violence immediately after the intervention and two weeks later had no significant difference compared to before the intervention (Table 4).

Table 4.

Comparison of the scores before the intervention, immediately after the intervention, and two weeks after the intervention according to the two intervention and control groups

Variable	Measurement Time	Group							Mann-Whitney U	Friedman
		Intervention				Control
		n			Mean ± Standard Deviation	n		Mean ± Standard Deviation
Knowledge and Skill	Before the intervention	20			19.20 ± 1.93	22		19.50 ± 1.79	p = 0.868 z= -0.166	Chi-squre = 5.94 p = 0.051 df = 2
	After the intervention	20			20.85 ± 2.27	0		-	-
	two weeks after the intervention	20			19.55 ± 1.87	22		18.86 ± 2.37	p = 0.263 z= -1.119
The Wilcoxon test result for immediately after the intervention - before the intervention		P = 0.011 z= -2.59				-
The Wilcoxon test result for two weeks after the intervention - before the intervention		P = 0.449 Z= -0.757				P = 0.243 Z= -1.169
The Wilcoxon test result for two weeks after the intervention - immediately after the intervention		P = 0.022 Z= -2.28				-
Self-confidence in adaptation to patient violence	Before the intervention	20	54.85 ± 16.59			22	50.54 ± 24.45		p = 0.420 z = 0.806	Chi-squre = 16.71 p = 0.0001 df = 2
	After the intervention	20	70.75 ± 13.19			0	-		-
	two weeks after the intervention	20	62.85 ± 19.90			22	54.61 ± 17.85		p = 0.220 z= -1.226
The Wilcoxon test result for immediately after the intervention - before the intervention		p = 0.000 z= -3.18				-
The Wilcoxon test result for two weeks after the intervention - before the intervention		p = 0.040 z= -2.055				p = 0.154 z= -1.42
The Wilcoxon test result for two weeks after the intervention - immediately after the intervention		P = 0.058 z= -1.89				-
Attitude toward patient violence	Before the intervention	20		71.20 ± 4.04		22		70.27 ± 5.84	p = 0.677 z= -0.417	Chi-squre = 1.78 p = 0.409 df = 2
	After the intervention	20		72.50 ± 3.66		0		-	-
	two weeks after the intervention	20		73.65 ± 4.92		22		71.27 ± 11.09	p = 0.433 z= -0.784
The Wilcoxon test result for immediately after the intervention - before the intervention		p = 0.248 z= -1.155				-
The Wilcoxon test result for two weeks after the intervention - before the intervention		p = 0.337 z= -0.059				p = 0.021 z = − 2.301
The Wilcoxon test result for two weeks after the intervention - immediately after the intervention		p = 0.631 z= -0.480				-

Discussion

This semi-experimental study was conducted aiming to determine the impact of the Workplace Violence Management Training Program (WVMTP) on Knowledge, Attitude, and self-confidence regarding adaptation to Patient Violence among Undergraduate Nursing Students. The results indicated the increased knowledge of nursing students in the intervention group about violence during the study, but the mean knowledge score in the intervention and control groups was not significantly different. In this regard, Martins (2017) concluded in his pilot study that the implementation of a simulated training program could give rise to a significant increase in the knowledge of students about violence [29]. In this study, the sample size was 15 nursing students and the simulation-based educational intervention was held in one day. Although this study was similar to our study in terms of sample size and number of sessions, the results were different. Concerning the effectiveness of this intervention compared to the current study, it can be pointed out that simulation is one of the educational methods used for training under conditions similar to real life. In this method, training is presented without the existence of real-life risks, which is one of the best educational methods to promote knowledge and skills [30]; however, a large part of the training presented in this research was carried out by the lecture method. One of the reasons for the non-significance of the knowledge score difference between the workshop and control groups can be attributed to the program implementation method and the use of traditional training methods. The results of another study by Brann and Hartley (2016) demonstrated that the National Institute for Occupational Safety and Health (NIOSH) workplace violence prevention program culminated in a sustainable increase in the knowledge of nursing students during the intervention and after the follow-up stage [31]. The intervention evaluated in this study included the implementation of the NIOSH violence prevention program online for nursing students. This online training course consisted of 13 sections in 20-minute modules [31] and a large part of this program was conducted through case studies and the application of student knowledge under conditions similar to real life. The same problem can be the reason for the different effectiveness of the intervention implemented in this study on the knowledge of students. Thus, it can be suggested that using a combination of educational methods that can both promote the knowledge of students and challenge the learned knowledge in practice can culminate in sustainable learning. In similar studies conducted on similar populations, it has also been specified that violence prevention training interventions can result in promoting participants’ knowledge. For example, Glass et al. (2017) concluded in their study that implementing a computer-based violence prevention training intervention led to promoting home care workers’ knowledge. In this study, two groups of “computer-based training intervention” and “computer-based training along with peer facilitation” received violence prevention training. In computer-based training, the training was conducted during two modules. In this study, the participants’ knowledge about violence prevention methods improved in both groups [32]. Overall, based on the results of the current study and other similar studies, it can be concluded that presenting violence prevention training culminates in promoting participants’ knowledge about violence prevention methods. Based on the research results, it can be concluded that the use of a combination of educational methods with a focus on interactive methods, such as simulation, role-play, and the use of scenarios and similar methods that can induce indirect experiences for learners, is more influential in promoting knowledge. Furthermore, considering that the students participating in the current research were taking a management course and they had received numerous materials in the management class, this issue can be another reason for the presence of a significant relationship in the level of knowledge in the two intervention and control groups.

In addition, the study results indicated that the attitudes of the students increased during the intervention but no significant difference was observed in the control group. However, similar studies on students denote the effectiveness of violence prevention training on the attitudes of the students. For example, in Brown et al.’s (2018) study conducted using the simulation method for workplace violence prevention training, students showed their better preparedness to encounter violent situations. Moreover, the evaluators of the student performance in the scenarios approved the improvement of students’ ability to respond to violent situations [33]. Simulation-based training can directly affect individuals’ attitudes and reinforce interprofessional collaboration. In line with the above research, another research by Liu et al. (2022) indicated that the use of a combination of behavioral economics and simulation-based training culminated in promoting the attitudes of the medical students toward violence prevention. In this research, the simulation group received about 5 h of training regarding violence prevention through the simulation method, and the other group received 3 h of training regarding workplace violence training behavioral economics and workplace violence simulation training [34].

The study results also demonstrated the increased self-confidence to deal with violence in the students in the intervention group, with no significant difference from the control group. Similar to the current study, the results of Jeong and Lee’s (2020) study investigating the effectiveness of the clinical violence prevention training program for nursing students indicated that this training program gave rise to promoting problem-oriented and emotion-oriented coping styles, and the ability of the students to deal with violence also increased. In this study, the training program was conducted using simulation, in such a way that two researchers and a special speaker held the sessions, and three professional performers were used as patients in the simulation. The preliminary program was implemented compactly for two days. Simulation of a violent situation encompassed verbal harassment and physical violence by a patient with acute pancreatitis referring to the emergency room with complaints of upper abdominal pain [21].

The results of Liu et al.’s (2022) study also indicated that the use of a combination of behavioral economics and simulation-based training led to promoting self-efficacy regarding violence prevention among medical students. Self-efficacy is an individual’s confidence person has in himself/herself to do something [34]. In similar studies investigating violence prevention training programs for nurses, such as Hemati-Esmaeili et al. (2018), reveal that After workplace violence prevention program implementation, verbal violence and mobbing/bullying against nurses significantly decreased, as well as their fear of violence and concerns. Also, In the nurses’ view, violent incidents can be prevented and managed [28]. The results of Ostram and Mayerlo’s (2008) study investigating the effectiveness of a violence management training program also indicated that the training program consisted of three 4-hour sessions. According to the results of this study, training results in stable changes in individuals’ knowledge and behavior; in addition, violence management training is effective in improving individuals’ insight toward violence and their ability to adapt to unfavorable working conditions [35]. Moreover, in a semi-experimental study conducted by Lamont and Brunero (2018) to determine the effectiveness of the violence prevention program for nurses, it was shown that implementing the violence prevention program could culminate in promoting nurses’ confidence in violence adaptation. In this study, 11 workshops were held, which had 3 objectives: (1) Formulating violence risk assessment programs and their management, (2) using stress-relieving techniques during aggression intensification, and (3) using detachment when responding to a violent person [36]. Overall, research results demonstrate that the use of methods such as simulation, role-play, and training methods being able to remind reality so that students can practice violence prevention skills frequently can culminate in promoting knowledge, attitude, self-efficacy, and confidence in the ability to cope with violent occurrences among students.

Conclusion

Although providing violence management training among nursing students could have favorable short-term educational impacts regarding knowledge, attitude, and confidence in adaptation in the intervention group, the impacts of this intervention were not significant compared to the control group during two weeks. This study highlights the necessity of implementing more comprehensive, long-term, and continuous WVMTP within nursing internship settings to achieve sustainable outcomes. Future research should prioritize longitudinal studies with larger sample sizes to further investigate the long-term impact and scalability of such comprehensive programs.

Limitations

This study has several limitations that should be considered when interpreting the results. First, the project was conducted as a Master’s thesis within a single academic semester at a nursing school, Due to these constraints, it was not feasible to design the study with a longer follow-up period. Consequently, a convenience sampling method was used from a single center, and blinding of participants and facilitators was not possible. These methodological limitations may affect the generalizability of our findings.

Implication to practice

The results of this study can be instrumental in designing programs to enhance the physical, mental, and psychological well-being, as well as the knowledge and attitudes, of nursing students. This can be achieved by preparing them to effectively and rationally handle potential violent incidents in clinical settings. Given that workplace violence is a growing and serious concern for healthcare systems, it is incumbent upon university administrators and officials to develop preventative programs for students.

Considering the documented statistics on violent incidents against students in clinical settings, the results of this research can serve as a valuable resource for future investigators. Furthermore, these findings can provide a foundation for further studies on the impact of implementing workplace violence prevention programs.

Abbreviations

WVMTP

Workplace Violence Management Training Program

IG

Intervention Group

CG

Control Groups

GPA

Grade Point Average

CVI

Content Validity Index

NIOSH

National Institute for Occupational Safety and Health

Authors’ contributions

Concept formation (F.HN, M.N & S.V). perform research and data gathering (M.N &F.HN). Analyzed an interpreted data (Z.P, A.S and M.R). Writing draft of the manuscript (M.N, Z.P & M.R), F.HN, A.S & S.V read and approved the final manuscript.

Funding

This research receives a grant from Mashhad University of Medical Science with grant number 4011328.

Data availability

All data generated or analyzed during this study are included in this published article.

Declarations

Ethics approval and consent to participate

This study was approved by the Ethics Committee of Mashhad University of Medical Science (IR.MUMS.NURSE.REC.1402.022). Throughout the research, the University of Medical Sciences Research Vice-Chancellor approved all ethical principles of this project. A written permission was obtained from the university’s ethics committee, an introduction letter from the School of Nursing and Midwifery to the educators participating in the study, and written informed consent was obtained from the participants. We coded all questionnaires to ensure the participants’ privacy; we also assured them they could withdraw at any time if they did not wish to participate.

Consent for publication

Not applicable.

Competing interests

The authors declare no competing interests.