Verbal de-escalation techniques for the prevention and management of workplace violence in healthcare: a systematic review
4 affiliations
- 1University Health Network
- 2Temerty Faculty of Medicine, University of Toronto
- 3Institute of Health Policy, Management and Evaluation, University of Toronto
- 4The Wilson Centre, University Health Network and University of Toronto
Abstract
Background: Workplace violence (WPV) remains a significant and escalating challenge across healthcare settings, threatening the safety, well-being, and retention of frontline healthcare professionals (HCPs). Verbal de-escalation is widely promoted as a first-line strategy to prevent or manage aggressive patient behavior. However, the scope, implementation, and effectiveness of these techniques have not been consistently synthesized.
Methods: This systematic review was conducted in accordance with PRISMA guidelines. Studies were eligible if they examined verbal de-escalation as a primary strategy for preventing or managing WPV in healthcare settings, including hospitals, emergency departments, psychiatric units, long-term care, and outpatient clinics. All study designs were considered, including empirical research and structured descriptive guidance relevant to clinical practice. Searches were conducted in Ovid MEDLINE ALL, Embase, Emcare, PsycINFO, and CINAHL from database inception, with results downloaded on August 29, 2024, and updated on January 30, 2026. Of 15,987 records identified, 9,096 were screened following duplicate removal, 446 underwent full-text review, and 36 studies met inclusion criteria. Methodological quality was appraised using the Mixed Methods Appraisal Tool (MMAT).
Results: Substantial heterogeneity was observed in how verbal de-escalation was defined, delivered, and evaluated. Intervention studies commonly assessed structured training programs delivered through didactic sessions, interactive workshops, simulation-based education, technology-enhanced learning, or clinical unit–based training. These studies frequently reported improvements in staff knowledge, confidence, and preparedness to manage aggression. Observational and descriptive studies emphasized communication behaviors used during escalated encounters and highlighted recurring strategies, such as empathetic listening, calm verbal tone, validation, and collaborative problem-solving. Outcome measures varied considerably across studies, limiting direct comparison.
Conclusions: Verbal de-escalation represents a central component of WPV prevention in healthcare, yet implementation approaches and evaluation methods remain inconsistent. The evidence suggests associations with improved clinician confidence, reduced patient agitation, and enhanced perceptions of safety. Healthcare organizations can use these findings to strengthen training curricula, integrate de-escalation within broader safety frameworks, and support sustainable workforce protection strategies.
Systematic review registration: OSF, identifier https://doi.org/10.17605/OSF.IO/S7QD9 .
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BibTeX
@article{seiyad2026verbal,
title = {{Verbal de-escalation techniques for the prevention and management of workplace violence in healthcare: a systematic review}},
author = {Hajar Seiyad and Joseph Nimako and Brendan Singh and Brendan Lyver and Stephen Villavicencio and Melanie Anderson and Robert Whiteside and John Shannon and Alize Chandler and Torie Vaughan and Marc Toppings and Rima Styra and Christian Schulz-Quach},
journal = {Frontiers in Psychiatry},
year = {2026},
month = oct,
doi = {10.3389/fpsyt.2026.1819502},
url = {https://www.frontiersin.org/articles/10.3389/fpsyt.2026.1819502/full},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Verbal de-escalation techniques for the prevention and management of workplace violence in healthcare: a systematic review
AU - Hajar Seiyad
AU - Joseph Nimako
AU - Brendan Singh
AU - Brendan Lyver
AU - Stephen Villavicencio
AU - Melanie Anderson
AU - Robert Whiteside
AU - John Shannon
AU - Alize Chandler
AU - Torie Vaughan
AU - Marc Toppings
AU - Rima Styra
AU - Christian Schulz-Quach
PY - 2026
DA - 2026/10/14
JO - Frontiers in Psychiatry
DO - 10.3389/fpsyt.2026.1819502
UR - https://www.frontiersin.org/articles/10.3389/fpsyt.2026.1819502/full
AB - Background: Workplace violence (WPV) remains a significant and escalating challenge across healthcare settings, threatening the safety, well-being, and retention of frontline healthcare professionals (HCPs). Verbal de-escalation is widely promoted as a first-line strategy to prevent or manage aggressive patient behavior. However, the scope, implementation, and effectiveness of these techniques have not been consistently synthesized. Methods: This systematic review was conducted in accordance with PRISMA guidelines. Studies were eligible if they examined verbal de-escalation as a primary strategy for preventing or managing WPV in healthcare settings, including hospitals, emergency departments, psychiatric units, long-term care, and outpatient clinics. All study designs were considered, including empirical research and structured descriptive guidance relevant to clinical practice. Searches were conducted in Ovid MEDLINE ALL, Embase, Emcare, PsycINFO, and CINAHL from database inception, with results downloaded on August 29, 2024, and updated on January 30, 2026. Of 15,987 records identified, 9,096 were screened following duplicate removal, 446 underwent full-text review, and 36 studies met inclusion criteria. Methodological quality was appraised using the Mixed Methods Appraisal Tool (MMAT). Results: Substantial heterogeneity was observed in how verbal de-escalation was defined, delivered, and evaluated. Intervention studies commonly assessed structured training programs delivered through didactic sessions, interactive workshops, simulation-based education, technology-enhanced learning, or clinical unit–based training. These studies frequently reported improvements in staff knowledge, confidence, and preparedness to manage aggression. Observational and descriptive studies emphasized communication behaviors used during escalated encounters and highlighted recurring strategies, such as empathetic listening, calm verbal tone, validation, and collaborative problem-solving. Outcome measures varied considerably across studies, limiting direct comparison. Conclusions: Verbal de-escalation represents a central component of WPV prevention in healthcare, yet implementation approaches and evaluation methods remain inconsistent. The evidence suggests associations with improved clinician confidence, reduced patient agitation, and enhanced perceptions of safety. Healthcare organizations can use these findings to strengthen training curricula, integrate de-escalation within broader safety frameworks, and support sustainable workforce protection strategies. Systematic review registration: OSF, identifier https://doi.org/10.17605/OSF.IO/S7QD9 .
SN - 1664-0640
ER -