However, there is evidence de-escalation training can help staff manage aggressive patients by boosting skills and confidence, found the study by RAND Europe.
“There is no clear indication that de-escalation training reduces the number of actual incidents”
The research, commissioned by NHS Improvement, comes amid ongoing concern about levels of violence in the health service.
The 2018 NHS Staff Survey found 14.5% of staff in England had experienced physical violence from patients, service users, relatives or members of the public in the past 12 months – increasing to more than 33% for ambulance staff and just over 20% for those working in mental health and learning disability trusts.
The study set out to explore the effectiveness of training programmes for staff – focusing on de-escalation training aimed at giving practitioners such as nurses the skills to defuse and manage difficult situations.
As part of their study the researchers looked at 19 reviews of evidence – encompassing more than 800 individual studies.
Overall, they found no clear evidence that de-escalation training had much of an impact on the level of violence and injuries sustained by staff.
“There is no clear indication from the evidence we reviewed that de-escalation training reduces the number of actual incidents of violence and aggression, nor whether it reduces the number of staff injuries,” said the report.
There was some evidence that de-escalation training may even lead to a short-term increase in reports of violent or aggressive incidents.
This could be down to increased awareness and the fact staff were more likely to report incidents, the report suggested.
However, other reasons could include staff being more likely to confront patients or that organisations were relying on the training alone to tackle problems and had not put other safety precautions in place.
One of the main benefits identified by researchers was the fact training boosted staff’s knowledge and confidence when it came to spotting and handling aggressive patients and dealing with violent incidents when they occurred.
De-escalation training has also been shown to contribute to a significant reduction in lost work days, complaints and overall expenditure, and improved staff retention.
“Managers’ commitment and engagement is key to a programme’s success”
Studies also found staff felt training was important when it came to managing violence and believed it could boost safety at the same time as promoting teamwork and peer support.
Common elements of training programmes included learning about the causes and triggers of aggression and contributing factors, communication skills and verbal and non-verbal de-escalation techniques, which might include physical restraint or the use of seclusion.
However, the researchers found little evidence to show which elements of training were particularly effective although there was some evidence that repeating or refreshing training regularly may be better than a one-off course.
One factor identified as being key to success was support from managers.
“It is well-known that one of the most important tasks of managers is to support their staff and multiple authors observed that managers’ commitment and engagement is key to a programme’s success,” said the report.
Meanwhile, much research pointed to the need for a range of measures to help prevent violence, which might include changes in policy, additional security measures, alterations to the physical environment alongside staff training.
“This comprehensive approach may help overcome the apparent inability of de-escalation training to prevent and/or reduce violent incidents while still capturing the benefits to staff knowledge and confidence,” said the report.
The researchers stressed there was a need for more robust evaluation of de-escalation training to try and identify what really works.
“Any efforts to implement de-escalation training should include evaluation measures within their design in order to inform the programme’s development,” they added.