Whittington 1996.

Study characteristics
Methods	Controlled before and after Non‐random sample: n = 155 (47 intervention, 108 control), convenience sample (nominated to attend) from 155 nurses Study location/s London Study setting/s Two psychiatric hospitals—13 wards with the highest levels of violence across the 2 hospitals were selected for the study Withdrawals Not specified
Participants	Health worker type/s Nurses Total number, number of health worker type subpopulations and proportions (%) 155 nurses. 47 (30.3%) were attenders—chosen by ward managers. 108 (69.7%) were non‐attenders. 89% of attender group were qualified nurses compared with 71% of the control group Mean age or age range Not specified Gender Not specified. No significant sex differences between groups Workplace/s (e.g. mental health, emergency department) Mental health inpatients Work setting/s (e.g. hospital inpatient, hospital outpatient, community) Hospital inpatient Work sector/s (e.g. public, private, non‐government) Not specified Inclusion and exclusion criteria Not specified
Interventions	Face‐to‐face program One‐day education session—1 part dealing with prevention of imminent violence, and the other dealing with the possible psychological consequences of assault Description of intervention and co‐interventions (especially noting whether bundled with other organizational interventions) A 7‐hour period of training in 1 day, divided into 4 sessions Targeted knowledge, attitudes, and skills • Risk assessment and diffusion techniques • Post‐assault management, legal issues, and the nature of traumatic stressful events Comparison Non‐attenders of the sessions Content of both intervention and control conditions, and co‐interventions Intervention: risk assessment and diffusion techniques, post‐assault management, legal issues, and the nature of traumatic stressful events. Teaching methods included role‐play of potentially violent situations and relaxation techniques Control: no intervention Duration One‐day sessions (held twice a week for 3 weeks; 6 groups in total) Intensity (e.g. frequency or levels of intervention) Intervention took place in 4 sessions over 7 hours in total Number commencing 155 (47 attended the intervention; 108 were non‐attenders) Number completing 155 Adherence to protocol Not stated
Outcomes	Description of primary and secondary outcomes specified and collected During the baseline period of 28 days before training, assaults on staff in both groups were counted. Following completion of the 6 training sessions, in the 28 days post intervention, assaults on staff were counted in the same way as before for both groups Measurement instruments used and validation status (e.g. reported/not reported) Not specified Number of notified assaults on staff during a 28‐day period immediately before training and during another 28‐day period immediately after training Assaults were detected by contacting participating wards every weekday and asking all available staff about any notifiable assaults occurring in the preceding 24 to 48 hours. No validation Time points reported 28 days pre‐intervention, 28 days post‐intervention Controlling for biasing or confounding effects of co‐interventions Not specified Mention made of individual effect and willingness of certain staff to take part in any training that is offered. Post–data collection analysis showed a higher number of assaults on the attenders group pre‐intervention Overall, in the study wards, reported violence fell by 31% after training, with 58 assaults reported in the month before training and 40 in the month after training Intervention Reported assaults for attenders fell from 22 (pre‐intervention) to 19 (post‐intervention)—not statistically significant (McNemar’s test) Control Reported assaults for non‐attenders fell from 13 (pre‐intervention) to 8 (post‐intervention)—not statistically significant (McNemar’s test) Other comparisons For high‐compliance wards (≥ 50% of staff trained), reported assaults fell from 40 (pre‐intervention) to 12 (post‐intervention) For low‐compliance wards (< 50% of staff trained), reported assaults increased from 18 (pre‐intervention) to 28 (post‐intervention) This difference between wards according to compliance was statistically significant (r² = 12.9; 1 df; P < 0.05) using the Chi² test of association Time points at which primary and secondary outcomes were collected and categorization to short‐term (6 months and less), medium‐term (more than 6 months up to 12 months), and long‐term (> 12 months) follow‐up 28 days post intervention—short‐term
Notes	Funding for the study Not specified Notable conflicts of interest of study authors Not specified NOTE: intervention group worked in the same settings as control group (assault rates for participants were the main outcome measure)
Risk of bias
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	High risk	No randomization into intervention or control groups—participants were nominated by ward managers
Allocation concealment (selection bias)	High risk	Allocation was not concealed
Blinding of participants and personnel (performance bias) All outcomes	High risk	No blinding. Participants knew that they were sent to a course about coping with violent persons, and the control group worked on the wards while intervention group members were away on the course
Blinding of outcome assessment (detection bias) All outcomes	High risk	Insufficient information to permit judgment of "low risk" or "high risk"
Incomplete outcome data (attrition bias) All outcomes	Low risk	No attrition or other non‐engagement in the intervention apparent
Selective reporting (reporting bias)	Unclear risk	Insufficient information to permit judgment of "low risk" or "high risk"
Other bias	High risk	Small sample size, groups not matched, no support for external or internal validity

CNA: certified nursing assistant.

DT: delayed treatment.

IMPACS: I.mpact of Patient Aggression on Carers Scale

KMO: Kaiser‐Meyer‐Olkin test.

LTC: long‐term care.

LVN: licensed vocational nurse.

NA: nursing assistant.

POAS‐S: Perception of Aggression Scale.

RN: registered nurse.

SD: standard deviation.

VIF: violent incident form.

VST: video situation test.

WPV: workplace violent incident.