A Qualitative Evaluation of Nurses' Perceptions of De‐Escalation and Resilience Training for Workplace Violence Prevention

ABSTRACT

Significance/Background

Workplace violence is a persistent threat to nurses' safety, well‐being, and retention, particularly in acute care settings where patient acuity, time pressure, and emotionally charged interactions can heighten the risk of aggression. De‐escalation training is increasingly recommended as a workplace violence prevention strategy, while resilience‐oriented support may help nurses cope with the psychological consequences of exposure. However, less is known about how nurses experience these forms of training in routine acute care practice and what contextual factors influence their uptake and usefulness.

Aims

To explore nurses' experiences with de‐escalation training and resilience support in the context of workplace violence prevention and to identify factors influencing their perceived usefulness and sustained application in acute care settings.

Methods

A qualitative study guided by interpretive description and informed by the Consolidated Framework for Implementation Research was conducted in acute care facilities in the Al‐Ahsa region, Saudi Arabia. Purposive sampling was used to recruit 20 registered nurses from emergency, medical‐surgical, and critical care units who had participated in workplace violence‐related training within the previous 12 months. Data were collected through semi‐structured interviews and analyzed using reflexive thematic analysis.

Results/Findings

Four themes were identified: (1) training as a foundation for confidence and psychological preparedness, (2) organizational climate as a determinant of training usefulness, (3) barriers to translating training into practice, and (4) the need for system‐level integration for sustainable workplace violence prevention. Participants viewed de‐escalation training as strengthening communication and situational response skills, while resilience support was perceived as helping nurses manage stress reactions and recover after difficult incidents. However, staffing pressures, inconsistent reporting pathways, and variable leadership support limited sustained application.

Linking Evidence to Action

Effective workplace violence prevention requires more than staff education alone. Healthcare organizations should embed de‐escalation training within mandatory competency development, pair it with structured psychological support after incidents, and strengthen leadership engagement, reporting systems, and interdisciplinary coordination to promote safer acute care environments.

1. Background and Significance

Workplace violence is a major occupational and patient‐safety concern in healthcare and is commonly defined as incidents in which healthcare workers are abused, threatened, or assaulted in circumstances related to their work. It includes physical assault, verbal abuse, threats, intimidation, and other forms of psychological aggression from patients, relatives, visitors, or coworkers (Lim et al. 2022). Nurses are disproportionately exposed because of their sustained frontline contact with patients and families, particularly in high‐demand clinical environments. Recent evidence suggests that workplace violence remains highly prevalent in nursing populations and is especially concerning in acute care contexts, where patient deterioration, overcrowding, and emotionally charged situations can increase the risk of aggression (Eshah et al. 2024). In Saudi Arabia, a recent systematic review and meta‐analysis estimated a pooled prevalence of workplace violence against nurses of 61.8%, underscoring the urgency of identifying contextually relevant prevention and support strategies.

Evidence indicates that violence in clinical environments includes physical assaults, verbal abuse, threats, and psychological intimidation from patients, relatives, and sometimes colleagues (Abdelmalik et al. 2025). Workplace violence is not merely an expected occupational hazard; it is a significant workforce and patient‐safety issue with consequences for psychological well‐being, job satisfaction, quality of care, and retention. Exposure to repeated aggression has been associated with burnout, emotional exhaustion, anxiety, and turnover intention among nurses (Çakır et al. 2025). These consequences are especially important in the context of global nursing shortages, where unsafe work environments may contribute to staff withdrawal, absenteeism, and reduced workforce sustainability. Framing workplace violence in this way strengthens the rationale for interventions that address both immediate safety and longer‐term workforce outcomes (Abdelmalik et al. 2025).

Beyond prevalence, workplace violence has substantial psychological and organizational consequences. Studies consistently demonstrate associations between exposure to violence and increased levels of stress, anxiety, and burnout among nurses. For example, research examining hospital nurses found that higher exposure to workplace violence was positively associated with burnout and negatively associated with psychological resilience and sense of coherence, suggesting that violence contributes to long‐term emotional exhaustion and reduced professional engagement (He et al. 2026). Similarly, evidence indicates that violence from patients, colleagues, and supervisors is significantly linked to poorer psychological well‐being, with resilience functioning as a mediating factor that can mitigate distress (García‐Izquierdo et al. 2025). These findings underscore that workplace violence is not only a safety issue but also a determinant of workforce sustainability and retention.

Resilience has increasingly been discussed as an important protective resource in nursing, particularly in high‐stress clinical environments. Rather than functioning as a primary violence prevention strategy, resilience‐oriented interventions are more appropriately understood as supports that help nurses regulate stress responses, recover following difficult encounters, and maintain psychological well‐being after exposure to workplace adversity (Alenezi 2024; Donnellan et al. 2024). Prior evidence suggests that resilience may buffer the relationship between workplace stressors and adverse mental health outcomes, and resilience‐focused interventions have shown promise in supporting coping and emotional recovery among nurses (Gündüz et al. 2024; Trulik et al. 2025). In the context of workplace violence, resilience support may therefore complement prevention‐oriented strategies by strengthening nurses' capacity to recover after distressing events.

In contrast, de‐escalation training is more directly aligned with workplace violence prevention because it equips nurses with communication, behavioral, and situational strategies intended to reduce the likelihood or severity of aggressive escalation (Kim and Nam 2025). Previous literature suggests that de‐escalation training can improve confidence, communication skills, and perceived preparedness when responding to aggressive behavior (Baig et al. 2018; Eltrass et al. 2026). However, the extent to which these gains are sustained in routine practice appears to depend on organizational conditions such as staffing, leadership responsiveness, reporting culture, and interdisciplinary coordination. Thus, although de‐escalation is widely promoted, its day‐to‐day usefulness is shaped by the realities of the clinical environment in which it is implemented.

Despite growing evidence supporting both resilience development and de‐escalation training, implementation in routine clinical practice remains inconsistent. Research suggests that the effectiveness of violence‐prevention interventions is strongly influenced by contextual factors such as leadership support, staffing levels, safety climate, and organizational culture (Heckemann et al. 2019). Although there is emerging research on nurses' experiences with de‐escalation in clinical settings, less is known about how nurses in acute care settings experience the combined presence of prevention‐oriented training and resilience‐oriented support in real‐world workplace violence contexts. In particular, there remains a need to understand how organizational climate, workload pressures, leadership engagement, and team readiness shape the perceived usefulness and sustained application of these interventions. Addressing this gap is important because training initiatives that are effective in principle may fail to translate into meaningful practice change when contextual barriers are not considered.

Given the global priority of protecting the nursing workforce and improving healthcare quality, examining how evidence‐based training initiatives are implemented within acute care environments is essential. Understanding nurses' perspectives can inform organizational strategies that strengthen adoption, enhance psychological safety, and promote sustainable violence‐prevention practices across healthcare systems.

1.1. Aim

The aim of this study was to explore nurses' experiences with de‐escalation training and resilience support in the context of workplace violence prevention and to identify the individual, organizational, and contextual factors that influenced their perceived usefulness and sustained application in acute care settings.

2. Methods

2.1. Design

This study used a qualitative design guided by interpretive description, an approach suited to generating practice‐relevant knowledge in applied health disciplines (Lee and Thorne 2022). Interpretive description was selected because the study sought not merely to describe experience, but to develop clinically meaningful understanding of how nurses perceived and used de‐escalation training and resilience support within the realities of acute care practice. The study also adopted an implementation‐oriented perspective by examining how contextual conditions shaped the uptake and usefulness of these interventions in real‐world settings.

To support a systematic exploration of contextual influences, the study was informed by the Consolidated Framework for Implementation Research (Jorgenson et al. 2022). CFIR provided a sensitizing framework for examining how intervention characteristics, inner setting conditions, individual factors, and implementation processes influenced nurses' experiences of training and support related to workplace violence.

2.2. Setting

The study was conducted across acute care hospitals in the Al‐Ahsa region of the Eastern Province, Saudi Arabia. Data were collected from multiple high‐acuity clinical units, including emergency departments, medical‐surgical wards, and critical care units, where nurses are frequently exposed to stressful interactions, rapid clinical decision‐making, and a heightened risk of workplace aggression. Acute care settings were selected because they represent environments in which workplace violence prevention is especially relevant due to patient instability, family distress, overcrowding, and time‐sensitive care demands.

Data were collected from multiple units characterized by elevated risk of aggressive incidents, including emergency departments, medical–surgical wards, and critical care units. Including diverse clinical areas allowed exploration of contextual variations in how de‐escalation and resilience training were implemented and experienced across different practice environments.

2.3. Participants and Sampling

Participants were registered nurses employed in the selected acute care facilities who had direct patient care responsibilities and had been exposed to, or were at risk of, workplace violence in their clinical roles. Eligibility criteria included: (a) current employment in an acute care unit, (b) completion of, or participation in, workplace violence prevention, de‐escalation, or resilience training initiatives within the previous 12 months, and (c) willingness to share experiences related to the implementation and impact of such training. Nurses in purely administrative roles or those without direct patient interaction were excluded.

A purposive sampling strategy was used to recruit participants with diverse clinical backgrounds and experiences. Variation was sought in terms of years of professional experience, clinical specialty, gender, and prior exposure to workplace violence to enhance the breadth and transferability of findings. Recruitment was facilitated through collaboration with nursing administration and unit leaders, who distributed study invitations to eligible staff.

Sampling continued until information power and thematic sufficiency were achieved, defined as the point at which no substantively new insights emerged from successive interviews. Sample size was not predetermined; consistent with interpretive description and the principle of information power (Malterud et al. 2016), data collection continued iteratively until the research team determined that the data were sufficient to address the research question with depth and nuance. A final sample of 20 participants was judged adequate given the well‐defined focus of the study and the richness of the data generated. The final sample comprised nurses representing multiple acute care units, providing a rich dataset for understanding implementation processes across contexts. The final sample comprised 20 registered nurses representing emergency, medical–surgical, and critical care units.

Participants had completed workplace violence‐related training offered within their organizations during the previous 12 months. De‐escalation content generally focused on early recognition of escalating behavior, verbal and non‐verbal communication strategies, maintaining personal safety, situational awareness, and seeking team assistance when needed. Resilience‐related content focused on awareness of stress reactions, brief breathing or self‐regulation techniques, emotional reframing, and peer support following distressing encounters. While the overall aims of these training activities were similar across participating settings, delivery formats varied and included workshops, simulation‐based sessions, and structured support‐oriented sessions.

2.4. Data Collection

Data were collected through semi‐structured individual interviews, which enabled participants to provide in‐depth accounts of their experiences with workplace violence‐related training and its relevance to clinical practice. The interview guide was developed from literature on workplace violence prevention, de‐escalation, resilience in nursing, and implementation science and was further structured using CFIR domains to ensure attention to individual, intervention, and organizational influences.

Key interview areas included: experiences of workplace violence in practice; perceptions of de‐escalation training content and usefulness; perceptions of resilience‐related support or training; confidence in managing aggressive situations; leadership support and safety climate; barriers and facilitators affecting the application of training in practice; and recommendations for improving sustainability and organizational responsiveness.

Interviews were conducted in a private location within the hospital or via a secure online platform according to participant preference. Interviews lasted approximately 30 to 45 min, were audio‐recorded with consent, and were supplemented by field notes documenting contextual observations and early analytic reflections.

All interviews were conducted in the participant's preferred language, Arabic or English. Arabic interviews were translated into English for analysis, and selected transcripts underwent back‐translation to enhance linguistic accuracy and preserve meaning.

2.5. Data Analysis

Interviews were transcribed verbatim and checked for accuracy prior to analysis. Data were analyzed using reflexive thematic analysis Braun and Clarke (2022). This approach was selected because it allowed the researchers to identify patterned meanings across participants' accounts while also acknowledging the interpretive role of the research team in generating themes. Analysis was iterative and moved between detailed coding of participants' experiences and broader interpretation of how the usefulness was shaped by organizational and contextual conditions.

The analysis followed six iterative phases:

1. Familiarization with the data through repeated reading of transcripts.

2. Generation of initial codes reflecting significant statements and experiences.

3. Organization of codes into potential themes.

4. Review and refinement of themes to ensure coherence and distinctiveness.

5. Definition and naming of final themes.

6. Interpretation of findings in relation to the CFIR framework and existing evidence

Qualitative data management software (Atlas) was used to facilitate organization, coding, and retrieval of data. To enhance analytic credibility, coding decisions were discussed among members of the research team, and discrepancies were resolved through consensus.

2.6. Rigor and Trustworthiness

Several strategies were employed to ensure methodological rigor in accordance with established qualitative research standards (Guba and Lincoln 2001).

Methodological rigor was supported through strategies addressing credibility, dependability, confirmability, and transferability. Credibility was enhanced through close engagement with the data, use of verbatim quotations, and discussion of developing interpretations within the research team. Dependability was supported through maintenance of an audit trail documenting methodological and analytic decisions. Confirmability was strengthened through reflexive memo writing and attention to the researchers' assumptions and disciplinary positioning during analysis. Transferability was supported through detailed description of the study context, participant characteristics, and training environment. Reporting was guided by the Standards for Reporting Qualitative Research to enhance transparency and completeness (O'Brien et al. 2014).

2.7. Ethical Considerations

Ethical approval for this study was obtained from the Institutional Review Board (IRB) of King Faisal University, Al‐Ahsa, Saudi Arabia prior to data collection. Permission to access clinical units was also secured from relevant healthcare facility administrations.

Participation was voluntary, and written informed consent was obtained from all participants before interviews were conducted. Participants were assured that their responses would remain confidential and that no identifying information would be included in transcripts or publications. Unique codes were assigned to each participant to protect anonymity.

All audio recordings and transcripts were stored on password‐protected, encrypted devices accessible only to the research team. Participants were informed of their right to withdraw from the study at any time without penalty. The study was conducted in accordance with the ethical principles outlined in the Declaration of Helsinki.

3. Findings

3.1. Participant Characteristics

A total of 20 registered nurses participated in the study (Table 1). Participants represented a range of acute care units, including emergency departments, medical–surgical wards, and critical care settings within health facilities in the Al‐Ahsa region. The sample included nurses with varying levels of clinical experience, from early‐career practitioners to senior staff with more than 15 years of service. Both male and female nurses were represented, and participants held diverse professional roles such as staff nurse, charge nurse, and clinical educator. Participants distinguished between de‐escalation training, which they associated with managing and attempting to prevent escalation during aggressive situations, and resilience‐related support, which they associated with coping with stress reactions and recovering emotionally after difficult encounters.

TABLE 1.

Participant characteristics (N = 20).

Characteristic	Category	n	%
Gender	Female	12	60
	Male	8	40
Age (years)	23–30	6	30
	31–40	8	40
	41–50	4	20
	> 50	2	10
Years of clinical experience	< 5 years	5	25
	5–10 years	6	30
	11–15 years	5	25
	> 15 years	4	20
Current unit	Emergency Department	6	30
	Medical–Surgical	5	25
	Critical Care	5	25
	Other Acute Care Units	4	20
Professional role	Staff Nurse	13	65
	Charge Nurse	4	20
	Clinical Educator	3	15
Exposure to workplace violence (past 12 months)	Verbal Aggression	16	80
	Threatening Behavior	11	55
	Physical Aggression	6	30
Type of training received	De‐escalation Workshop	20	100
	Simulation‐Based Training	12	60
	Resilience/Stress Management Training	15	75

All participants had completed at least one form of workplace violence prevention initiative within the previous year, including structured de‐escalation workshops, simulation‐based training, or resilience‐focused sessions addressing coping and emotional regulation. Many reported repeated exposure to verbally aggressive or threatening situations in their daily practice, particularly in high‐acuity areas such as emergency and critical care units.

Participants described working in environments characterized by high patient turnover, staffing pressures, and emotionally demanding interactions with patients and families. These contextual factors were frequently referenced during interviews as shaping both the need for and the perceived usefulness of the implemented training programs.

3.2. Thematic Findings

Four interconnected themes were generated from the data, illustrating how nurses understood the value of de‐escalation training and resilience support, and how organizational context shaped their ability to apply these approaches in practice (Table 2).

TABLE 2.

Themes, subthemes, and representative participant quotations.

Theme	Subtheme	CFIR domain	Representative quotation
Training as a foundation for psychological safety and confidence	Structured communication strategies improve confidence	Characteristics of individuals	“Before the training, I felt anxious when patients became angry. Now I know how to speak in a way that reduces tension”
	Increased awareness of emotional responses	Characteristics of individuals	“The resilience sessions helped me understand my reactions and stay calmer during difficult situations”
	Need for ongoing practice and reinforcement	Implementation process	“After some time, we need refreshers because confidence decreases without practice”
Organizational climate as a determinant of training effectiveness	Leadership engagement enhances safety culture	Inner setting	“When the supervisor supports us and responds quickly, we feel safer using the skills we learned”
	Staffing pressures limit application of de‐escalation techniques	Inner Setting	“When you are responsible for many patients, you cannot always spend the time needed to calm the situation”
	Incident reporting systems influence perceived protection	Inner setting	“If incidents are reported and followed up, staff feel the hospital takes violence seriously”
Bridging knowledge to practice, barriers to consistent implementation	Unpredictable clinical environments hinder skill use	Intervention characteristics	“Sometimes the situation escalates very quickly, and communication alone is not enough”
	System‐level stressors contribute to patient aggression	Outer setting	“Patients become angry because of long waiting times or overcrowding”
	Inconsistent team preparedness reduces effectiveness	Implementation process	“If only some nurses are trained, the response becomes mixed and less effective”
Toward sustainable violence prevention, system‐level integration	Need for multidisciplinary involvement	Implementation process	“Violence is not only a nursing issue. The whole team should know how to respond together”
	Importance of psychological support after incidents	Inner setting	“After a serious incident, talking with the team helps us recover and feel supported”
	Integration into mandatory training and policy	Intervention characteristics	“These skills should be part of regular mandatory training, not just one workshop”

3.2.1. Theme 1: Training as a Foundation for Psychological Safety and Confidence

Participants consistently described de‐escalation training as enhancing their confidence and practical readiness when managing aggressive or potentially escalating situations. In parallel, resilience‐related support was described as helping them recognize stress responses, regulate emotions, and recover more effectively after distressing encounters. Together, these forms of preparation contributed to a stronger sense of psychological preparedness, although participants generally viewed them as serving different functions in practice.

Several participants emphasized that learning specific verbal and non‐verbal techniques helped them approach escalating situations more calmly. One nurse noted, “Before the training, I felt anxious when patients became angry. Now I know how to slow the situation down and speak in a way that reduces tension.”

Resilience components of the program were perceived as equally valuable. Nurses described gaining awareness of stress reactions and learning techniques such as brief breathing exercises, emotional reframing, and peer support. These strategies were seen as enabling faster recovery following distressing encounters. A participant explained, “The resilience sessions helped me understand my reactions. I don't carry the stress home the same way anymore.”

Despite these benefits, some nurses indicated that confidence gains were strongest immediately after training and gradually declined without reinforcement. Participants suggested that ongoing practice opportunities, refresher sessions, and simulation exercises were necessary to maintain competence. Overall, the training was viewed as an important foundation for improving psychological preparedness, but not sufficient as a standalone solution without sustained organizational support.

3.2.2. Theme 2: Organizational Climate as a Determinant of Training Effectiveness

The effectiveness of de‐escalation and resilience training was strongly influenced by the organizational environment in which nurses practiced. Participants repeatedly highlighted leadership engagement, staffing adequacy, and safety culture as critical factors shaping whether training translated into real‐world practice.

Nurses working in units where managers actively promoted safety protocols described greater confidence in applying de‐escalation techniques. One participant stated, “When the supervisor supports us and responds quickly, we feel safer using the skills we learned.” In contrast, in settings where incidents were perceived as routine or unavoidable, nurses reported reluctance to implement recommended strategies.

Staffing shortages were frequently cited as a major barrier. Participants explained that high workload and time pressure limited their ability to use communication‐based de‐escalation approaches, which require patience and focused attention. As one nurse noted, “When you are responsible for many patients, you cannot always spend the time needed to calm the situation.”

Safety reporting practices also influenced perceived program effectiveness. Units with clear incident reporting systems and visible follow‐up were described as more supportive environments. Conversely, when incidents were not formally addressed, nurses felt that training alone could not prevent recurrence. Overall, participants emphasized that training outcomes were contingent upon a supportive organizational climate that prioritized staff safety and reinforced evidence‐based practices.

3.2.3. Theme 3: Bridging Training to Practice: Barriers to Consistent Application

Although participants acknowledged the value of training, many described challenges translating learned strategies into consistent clinical practice. A common barrier was the unpredictability and intensity of acute care environments, where rapid patient deterioration or family distress could escalate situations beyond the scope of standard communication techniques.

Some nurses reported that aggressive behavior was occasionally linked to systemic factors such as long waiting times or resource limitations, reducing the effectiveness of individual‐level interventions. One participant remarked, “Sometimes the patient is angry because of delays or overcrowding. Even with good communication, the situation can still escalate.”

Another barrier involved variability in team preparedness. Participants indicated that inconsistent training across staff members created difficulties in coordinated responses. When only some nurses had received training, applying de‐escalation strategies was less effective. A nurse explained, “If the whole team is not trained, the response becomes mixed and the patient becomes more confused.”

Participants also noted that resilience strategies were often practiced individually rather than embedded within team culture. Without structured opportunities for reflection or peer support, coping mechanisms were inconsistently applied. Despite these challenges, nurses expressed willingness to integrate training into daily practice if supported by ongoing reinforcement, interdisciplinary collaboration, and clear protocols.

3.2.4. Theme 4: Toward Sustainable Violence Prevention, Recommendations for System‐Level Integration

Participants emphasized that the long‐term effectiveness of workplace violence prevention requires integration of training into broader organizational systems rather than isolated educational sessions. Nurses advocated for routine refresher programs, simulation‐based practice, and inclusion of de‐escalation competencies in mandatory professional development.

Many participants recommended incorporating multidisciplinary involvement, including physicians, security personnel, and administrative staff, to ensure coordinated responses to aggressive incidents. One nurse stated, “Violence is not only a nursing issue. The whole team should know how to respond together.”

Participants also highlighted the importance of visible leadership commitment, including clear policies, rapid incident review, and psychological support following traumatic events. Access to counseling services and structured debriefing sessions were viewed as essential components of resilience building. A participant commented, “After a serious incident, talking with the team helps us recover and feel supported.”

Finally, nurses suggested that organizational investment in safety infrastructure, such as alarm systems, environmental design, and adequate staffing, would enhance the impact of training initiatives. Participants viewed these measures as reinforcing the message that staff well‐being is a priority. Collectively, these recommendations underscored the need for multi‐level implementation strategies that combine education, leadership engagement, and structural support to achieve sustainable reductions in workplace violence.

3.3. Conceptual Model of the Proposed Findings

The findings informed a conceptual model in which de‐escalation training and resilience support contribute to workplace violence response through related but distinct pathways. De‐escalation training appeared to strengthen nurses' communication strategies, situational awareness, and confidence in responding to escalating behavior, thereby supporting immediate prevention and response efforts. Resilience‐related support appeared to strengthen emotional regulation, stress recognition, and psychological recovery after difficult incidents. However, the usefulness and sustainability of both pathways were strongly shaped by organizational conditions, particularly leadership engagement, staffing adequacy, reporting culture, team preparedness, and opportunities for reinforcement. The model therefore conceptualizes workplace violence response in acute care as a multi‐level process in which individual skills and recovery supports can only be sustained when reinforced by a supportive organizational environment (Figure 1).

FIGURE 1.

Conceptual model of the proposed findings.

4. Discussion

4.1. Key Findings

This qualitative study explored nurses' experiences with de‐escalation training and resilience support in the context of workplace violence in acute care settings. Four themes highlighted that nurses perceived de‐escalation training as enhancing confidence, communication, and immediate situational response, whereas resilience‐related support was understood as helping them cope with emotional strain and recover after difficult encounters. Participants also emphasized that the practical usefulness of both forms of support depended heavily on organizational climate, including leadership engagement, staffing levels, reporting systems, and wider team readiness. These findings suggest that workplace violence prevention and response cannot be achieved through education alone; rather, they require alignment between staff preparation and organizational conditions that enable sustained practice.

First, participants described training as enhancing psychological safety, communication skills, and professional confidence when managing aggressive situations. Second, the organizational climate, including leadership engagement, staffing adequacy, and safety culture, was perceived as a critical determinant of whether training translated into daily practice. Third, nurses reported persistent barriers to consistent implementation, particularly in high‐acuity environments characterized by time pressure and unpredictable patient behaviors. Finally, participants emphasized that sustainable violence prevention requires system‐level integration of training through multidisciplinary collaboration, structured reinforcement, and organizational support mechanisms. Collectively, these findings indicate that while individual competencies gained through training are essential, their impact is contingent upon supportive organizational infrastructures that enable consistent application.

4.2. Comparison With Existing Literature

These findings are consistent with emerging qualitative work showing that nurses' use of de‐escalation strategies is shaped not only by individual skill, but also by the wider clinical and organizational environment. Recent qualitative studies have similarly identified the importance of staff consistency, leadership support, and contextual pressures in determining whether de‐escalation approaches can be sustained in practice. The present study extends this line of work by showing that nurses also value resilience‐related support, not as a primary violence prevention strategy, but as an important mechanism for coping and recovery after exposure to aggression. Previous research has shown that exposure to verbal and physical aggression is linked to increased levels of burnout, anxiety, and emotional exhaustion, as well as decreased job satisfaction and retention (Zhang et al. 2025). Participants in the present study similarly described emotional strain associated with repeated exposure to aggressive encounters, reinforcing the importance of interventions that target both prevention and recovery.

Consistent with prior intervention studies, nurses in this study reported that de‐escalation training improved their confidence and preparedness when managing escalating situations. Evidence suggests that structured communication strategies and situational awareness training enhance nurses' ability to recognize early warning signs and respond in ways that reduce aggression (Babaei et al. 2025). Likewise, simulation‐based de‐escalation programs have been associated with increased self‐efficacy and perceived safety among frontline staff (Johnson et al. 2026). The present findings extend this literature by demonstrating that while confidence gains are meaningful, they may diminish over time without ongoing reinforcement, highlighting the importance of sustained implementation strategies (Matthews et al. 2024).

The role of resilience in the present study should be interpreted carefully. Participants did not describe resilience support as preventing violent incidents directly. Rather, they viewed it as helping them recognize stress reactions, regulate emotions, and recover following exposure to aggressive or threatening situations. This interpretation aligns more closely with literature positioning resilience interventions as supports for psychological well‐being following occupational stress, rather than as direct violence prevention mechanisms. Making this distinction is important conceptually because it prevents conflation of prevention‐oriented training with recovery‐oriented support (Bayram Değer et al. 2025). Participants described resilience training as facilitating emotional regulation and faster recovery following distressing encounters, which is consistent with evidence indicating that resilience‐building interventions can reduce emotional exhaustion and improve coping capacity (Mccraty and Atkinson 2012). However, as observed in the present study, resilience strategies are most effective when supported by a positive organizational climate that promotes psychological safety.

Importantly, the influence of organizational context on implementation outcomes mirrors findings from implementation science literature. Studies applying frameworks such as the Consolidated Framework for Implementation Research have demonstrated that leadership engagement, resource availability, and safety culture are key determinants of whether evidence‐based interventions are adopted and sustained in practice (Hu et al. 2025). Participants in the current study emphasized that staffing pressures, inconsistent reporting systems, and limited managerial follow‐up reduced the effectiveness of training, underscoring that individual‐level interventions alone cannot address systemic contributors to workplace violence. These findings reinforce calls for integrated, multi‐level approaches that combine education with organizational change strategies (Vasel 2025).

4.3. Implementation Implications

The findings suggest that workplace violence‐related training should be implemented as part of a broader organizational strategy rather than as a stand‐alone educational activity. First, de‐escalation training should be reinforced through ongoing simulation, refresher sessions, and team‐based practice so that communication and situational response skills remain usable under pressure. Second, resilience‐related support should be embedded within post‐incident recovery processes, such as structured debriefing, peer support, and access to psychological support services, rather than framed as a substitute for prevention. Third, implementation efforts should involve the wider interdisciplinary team, because inconsistent preparedness across staff can undermine coordinated responses during escalating situations. Finally, organizations should monitor not only training delivery but also contextual conditions, including staffing, reporting responsiveness, and leadership visibility, because these factors determine whether training can be translated into routine practice (Lin et al. 2022).

Third, resilience training should be integrated into routine professional development rather than delivered as an isolated intervention. Structured debriefing sessions, peer support programs, and access to psychological services can reinforce coping mechanisms and promote recovery following distressing incidents. Such approaches align with evidence suggesting that organizationally supported resilience initiatives are more effective than individual coping strategies alone (Evans et al. 2023).

Finally, implementation strategies should include mechanisms for monitoring fidelity and outcomes, such as incident reporting trends, staff perceptions of safety, and confidence in managing aggression. Linking training initiatives to measurable indicators can support continuous quality improvement and demonstrate organizational commitment to staff well‐being.

4.4. Organizational and Policy Relevance

The present findings reinforce that workplace violence is an organizational responsibility, not solely an individual burden borne by frontline nurses. Participants repeatedly described leadership responsiveness, staffing adequacy, and visible follow‐up after incidents as factors that shaped whether training felt meaningful and safe to apply. For this reason, policies aimed at reducing workplace violence should extend beyond educational provision and include clear reporting pathways, timely incident review, staff support after exposure, and practical reinforcement of safety procedures (Awaji et al. 2025; Muir et al. 2025). At a systems level, embedding de‐escalation competencies into mandatory staff development and organizational safety standards may help improve consistency across units. However, such policies are likely to be most effective when coupled with structural supports that address workload pressures and foster a culture in which staff feel protected and heard (Ominyi and Alabi 2025).

From a policy perspective, integrating de‐escalation competencies into mandatory training standards and accreditation requirements may promote consistent adoption across healthcare settings. Additionally, investment in environmental safety measures, including alarm systems and unit design modifications, can complement behavioral interventions (Carrillo et al. 2024). These system‐level strategies align with international recommendations advocating comprehensive approaches that address both individual preparedness and organizational risk factors.

At the workforce level, improving psychological safety and reducing the emotional burden associated with workplace violence may contribute to better retention and job satisfaction. Given ongoing global nursing shortages, organizational investment in violence prevention and well‐being initiatives represents not only an ethical imperative but also a strategic approach to sustaining a resilient healthcare workforce.

4.5. Implications for Future Research

Future research should evaluate the effectiveness of integrated, multi‐component workplace violence prevention programs using mixed‐methods or longitudinal designs to assess sustained outcomes over time. Comparative studies examining different implementation strategies across clinical contexts may help identify the most efficient approaches for scaling interventions. Additionally, incorporating objective indicators, such as incident rates and staff turnover, alongside qualitative perspectives could strengthen the evidence base linking training initiatives to workforce and patient safety outcomes.

4.6. Implications for Practice, Education, Policy

At the practice level, the findings support embedding de‐escalation training within routine competency development for nurses working in high‐acuity settings. This recommendation is justified by participants' accounts that structured communication strategies improved confidence and preparedness, but that these gains weakened without reinforcement. Regular simulation‐based refreshers, team rehearsal, and post‐incident debriefing may therefore help sustain skill use and support psychological recovery after aggressive events.

At the educational level, workplace violence content should move beyond awareness raising to include practical rehearsal of communication, situational assessment, and emotional self‐regulation. Participants' experiences suggest that experiential learning approaches, such as simulation and guided reflection, may be especially valuable because they bridge theory and real‐world response demands. Educational programs should also prepare nurse leaders to recognize how organizational climate affects staff willingness to use learned strategies in practice.

At the policy level, the findings support comprehensive workplace violence strategies that combine prevention, reporting, and staff support. This is warranted because participants described training as less effective when reporting systems were unclear, follow‐up was inconsistent, or staffing pressures limited the time needed to use de‐escalation techniques. Policies should therefore include mandatory de‐escalation preparation, structured post‐incident support, visible managerial follow‐up, and adequate staffing considerations to create conditions in which evidence‐informed approaches can be applied safely and consistently.

5. Limitations

Several limitations should be considered when interpreting the findings. First, the study was conducted within acute care facilities in a single geographic region, which may limit transferability to other healthcare contexts with different organizational structures or patient populations. Second, participation was voluntary, and nurses with strong experiences or interest in workplace violence prevention may have been more likely to participate, introducing potential self‐selection bias. Third, the study relied on self‐reported perceptions of training effectiveness rather than objective indicators such as incident rates or staff turnover, which may influence the interpretation of outcomes. Although efforts were made to include participants from diverse units and experience levels, the qualitative design and sample size were not intended to achieve statistical generalization. Finally, the cross‐sectional nature of data collection does not capture how perceptions of training effectiveness may evolve over time. Despite these limitations, rigorous analytic procedures and inclusion of varied clinical settings support the credibility and practical relevance of the findings.

6. Conclusion

This study offers qualitative insight into how nurses in acute care settings experience de‐escalation training and resilience‐related support in the context of workplace violence. Nurses perceived de‐escalation training as strengthening confidence and immediate response skills, while resilience support was valued for helping them cope with stress and recover after difficult incidents. However, the usefulness of both depended heavily on organizational conditions such as leadership engagement, staffing adequacy, reporting culture, and team preparedness. These findings suggest that safer acute care environments require not only staff training but also organizational systems that sustain prevention efforts and support recovery after exposure. Integrating prevention‐oriented training with structured post‐incident support and strong organizational follow‐through may strengthen workforce well‐being and improve the sustainability of workplace violence responses in nursing practice.

7. Linking Evidence to Action

Evidence	Action
Nurses perceived de‐escalation training as improving confidence, communication, and immediate response to escalating behavior	Embed de‐escalation training into mandatory competency development for nurses in acute care settings
Participants reported that confidence and skill use weakened over time without reinforcement	Provide regular simulation‐based refreshers, scenario rehearsal, and practice‐based reinforcement
Resilience‐related support was valued for helping nurses manage stress reactions and recover after difficult incidents	Integrate structured debriefing, peer support, and access to psychological support after workplace violence incidents
Staffing pressures, inconsistent reporting systems, and limited leadership responsiveness reduced the usefulness of training in practice	Strengthen organizational follow‐up, improve reporting pathways, and ensure leadership visibility after incidents
Inconsistent team preparedness undermined coordinated responses to aggressive situations	Expand workplace violence training to multidisciplinary teams to promote shared protocols and consistent responses
Nurses emphasized that training alone was insufficient without broader system support	Align educational interventions with staffing, safety culture, and policy‐level workplace violence prevention strategies

Funding

This work was supported by the Deanship of Scientific Research, Vice Presidency for Graduate Studies and Scientific Research, King Faisal University, Saudi Arabia (Grant: KFU262063).

Ethics Statement

Ethical approval was obtained from the Institutional Review Board of King Faisal University, Al‐Ahsa, Saudi Arabia. All procedures were conducted in accordance with the Declaration of Helsinki and relevant local regulations. Written informed consent was obtained from all participants prior to interviews and observations.

Consent

All participants provided written informed consent for the use of anonymised quotations in publications. No identifiable personal data are included in this manuscript.

Conflicts of Interest

The authors declare no conflicts of interest.

Data Availability Statement

The qualitative datasets (full transcripts, observation fieldnotes) contain potentially identifying information and are not publicly available to protect confidentiality. De‐identified excerpts, the coding framework, and the analytic memo trail are available from the corresponding author (Mostafa Shaban) on reasonable request and subject to Institutional Review Board and site permissions.