--- title: "VR de-escalation training evidence: what 50 studies measured" description: "41 of 50 VR and simulation de-escalation studies stopped at reaction or learning. What the research measured, where it stops, and what buyers should ask." canonical: https://peopletechrevolution.com/insights/vr-de-escalation-training-evidence --- [Insights](https://peopletechrevolution.com/insights) # 41 of 50 studies stop in the training room: what VR de-escalation research has and has not measured Of 50 VR and simulation studies published 2015 to 2026 (Europe PMC, PubMed), 41 of 50 stopped at reaction or learning. By [Kim Loza](https://linkedin.com/in/kimberlyloza), Head of Product at People Tech Revolution Published 25 September 2026 · Last updated 28 September 2026 · Version 2.0 [Connect with Kim on LinkedIn ↗](https://linkedin.com/in/kimberlyloza) Cite this research 41 of 50 studies stopped at reaction or learning PTR evidence table, 2015 to 2026 13 of 14 VR studies measured on the day alone PTR evidence table, 2015 to 2026 6.4 times growth in training papers, 2015 to 2025 PubMed, read 26 September 2026 RR 1.14 long-term aggression, trained against untrained Cochrane review, 2020 A man waits at a triage counter. A support worker talks with a young man. A night worker at a crisis desk. The answer ## What has VR de-escalation research measured? Mostly the training room: of 50 studies we coded, 41 of 50 measured reaction or learning, and 8 of 50 reached incident or restraint data. Highest outcome level measured, 50 studies, 2015 to 2026 Level 1, reaction 6 of 50 Level 2, learning 35 of 50 Level 3, behaviour at work 1 of 50 Level 4, results 8 of 50 See the data (studies) Measure Studies Level 1, reaction 6 of 50 Level 2, learning 35 of 50 Level 3, behaviour at work 1 of 50 Level 4, results 8 of 50 Studies by the highest Kirkpatrick level measured, published 2015 to 2026, coded by PTR. Source: [Europe PMC](https://www.ebi.ac.uk/europepmc/webservices/rest/search); [PubMed](https://pubmed.ncbi.nlm.nih.gov/); [Kirkpatrick Partners levels](https://www.kirkpatrickpartners.com/the-kirkpatrick-model/). ### Learning is where most studies stop Level 2 is confidence, knowledge, attitudes and skill inside a simulation, so 82% of studies never looked past the session. The behaviour result was self-reported, and every Level 4 result came from an uncontrolled package or a feasibility trial on 3 wards. So what for you: ask a provider which level its evidence reached before reading its percentages. A learner faces the camera in coaching. ### VR studies stop earlier than simulation studies 13 of 14 VR studies stopped at reaction or learning, against 28 of 36 studies with actors, standardised patients or role play. Just 13 of 50 studies had a comparison group. A ward round seen through the headset. ### How the table was built Coded from [Europe PMC](https://www.ebi.ac.uk/europepmc/webservices/rest/search) and [PubMed](https://pubmed.ncbi.nlm.nih.gov/): staff training with VR, 360 video, actors or role play. The problem ## Why does the evidence matter to health employers? The violence the training is bought for has risen: US health care recorded 6.4 cases per 10,000 full-time workers (2011) and 11.9 (2023 and 2024). US health care violence injuries with days away from work, 2011 to 2024 Annual rate Annualised 2-year average See the data (per 10,000 full-time workers) 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021-22 2023-24 Annual rate 6.4 7.0 7.8 8.2 8.0 8.4 9.1 10.4 9.7 10.3 Annualised 2-year average 9.8 11.9 Per 10,000 full-time workers, 2011 to 2024; the last 2 points are annualised 2-year averages, with a new event code from 2023. Source: [BLS fact sheet, 2018](https://www.bls.gov/iif/factsheets/workplace-violence-healthcare-2018.htm); [BLS Table R8, 2019 to 2023-24](https://www.bls.gov/iif/nonfatal-injuries-and-illnesses-tables.htm). ### Health care violence rates have climbed for over a decade The annual rate for private health care and social assistance went from 6.4 (2011) to 10.3 (2020). The 2-year average for 2023 and 2024 was 11.9, against 2.6 across private industry, under a revised event code. So what for you: training is bought against this rate, so its evidence has to reach incidents. A community nurse greets an older woman. ### Psychiatric hospitals sit far above the average In 2023 and 2024, psychiatric and substance abuse hospitals recorded 138.8 such cases per 10,000 full-time workers ([BLS Table R8](https://www.bls.gov/iif/nonfatal-injuries-and-illnesses-tables.htm)). A relative gestures beside a facilitator. ### Accreditation now asks for de-escalation training Since 1 January 2022, [Joint Commission hospital requirements](https://www.jointcommission.org/-/media/tjc/documents/standards/r3-reports/wpvp-r3-30_revised_06302021.pdf) expect de-escalation training at hire, yearly and on program changes; home care followed on 1 January 2025 ([R3 Report Issue 45, the home care report](https://digitalassets.jointcommission.org/api/public/content/68a29e1ff3304fb892a5b9257e7097ad?v=76b54581)). Attention ## Is research on this training growing? Fast: PubMed records on de-escalation and workplace violence training rose 6.4 times from 2015 to 2025, while PubMed as a whole grew 1.5 times. PubMed records per year, de-escalation and workplace violence training, 2015 to 2025 De-escalation or workplace violence training VR and aggression or de-escalation training See the data (records per year) 2015 2016 2017 2018 2019 2020 2021 2022 2023 2024 2025 De-escalation or workplace violence training 37 42 38 55 63 107 102 139 121 135 237 VR and aggression or de-escalation training 1 0 0 2 1 5 8 8 5 5 12 Records per year, 2015 to 2025; 2026 is partial and not shown. Source: [PubMed counts via NCBI E-utilities, read 26 September 2026](https://pubmed.ncbi.nlm.nih.gov/). ### Attention has grown faster than the evidence base The count reached 237 records (2025), up from 37 (2015), while all of PubMed moved from 1,258,176 to 1,881,905. VR aggression or de-escalation training papers were 12 of 812 VR health education papers in 2025. So what for you: expect more pilots each year, and judge each by its design rather than its date. A participant talks it through afterwards. ### What the counts measure Attention, not quality: title and abstract matches, with an indexing lag. Across reviews ## Do published reviews find the same gap? They do: [Tang 2026](https://doi.org/10.3389/fmed.2026.1657986) found no VR study testing organisational impact, and [Kyaw 2019](https://doi.org/10.2196/12959) none reporting behaviour change. Studies that measured incidents, patients or the organisation, by review Tang 2026, VR de-escalation 0 of 15 Kyaw 2019, VR in health education 0 of 31 Dafny 2025, nurses on placement 1 of 13 Mitchell 2024, simulation 4 of 25 PTR table, 2015 to 2026 8 of 50 Geoffrion 2020, Cochrane, controlled designs 5 of 9 See the data (studies with outcome data) Measure Studies with outcome data Tang 2026, VR de-escalation 0 of 15 Kyaw 2019, VR in health education 0 of 31 Dafny 2025, nurses on placement 1 of 13 Mitchell 2024, simulation 4 of 25 PTR table, 2015 to 2026 8 of 50 Geoffrion 2020, Cochrane, controlled designs 5 of 9 Studies with outcome data over studies included, reviews published 2019 to 2026. Source: [Tang 2026](https://doi.org/10.3389/fmed.2026.1657986); [Kyaw 2019](https://doi.org/10.2196/12959); [Dafny 2025](https://doi.org/10.1111/jan.16357); [Mitchell 2024](https://doi.org/10.1016/j.ijnurstu.2024.104842); [Geoffrion 2020](https://doi.org/10.1002/14651858.CD011860.pub2). ### Outcome data are the exception in every review VR reviews found none. The Cochrane review found 5 of 9 controlled studies counting aggression, and its long-term estimate crossed no effect. So what for you: treat an incident claim from a VR pilot as new evidence and ask for its design. A clinician at a hospital bedside. ### The review’s behaviour ratings were therapy studies [Tang and colleagues](https://doi.org/10.3389/fmed.2026.1657986) rated 3 studies at Level 3. All 3 treated aggressive patients; every staff training study stopped at Level 1 or 2. A charge nurse briefs the ward. ### Simulation reviews carry high risk of bias Of 25 simulation studies with 2,790 participants, 24 of 25 were at high or serious risk of bias and 4 of 25 collected patient outcomes ([Mitchell 2024](https://doi.org/10.1016/j.ijnurstu.2024.104842)). A nurse crouches beside a patient at night. A facilitator adjusts a seated learner’s headset. An interviewer seen through the headset. Confidence ## Does higher confidence mean better de-escalation? Not reliably: confidence rises in almost every study, yet in 4 of 6 studies measuring self-report and observed skill together, the measures disagreed. Standardised effects reported for confidence, knowledge and skill Different outcomes and designs; read each bar alone. Confidence, controlled studies (Chung 2025) 0.85 Confidence, uncontrolled studies (Chung 2025) 0.71 Confidence after a 20-minute VR session (Johnson 2026) 0.70 Knowledge (Geoffrion 2020) 0.86 Skills (Geoffrion 2020) 0.21 See the data (standardised effect) Measure Standardised effect Confidence, controlled studies (Chung 2025) 0.85 Confidence, uncontrolled studies (Chung 2025) 0.71 Confidence after a 20-minute VR session (Johnson 2026) 0.70 Knowledge (Geoffrion 2020) 0.86 Skills (Geoffrion 2020) 0.21 Standardised mean difference or Cohen’s d, published 2020 to 2026. Source: [Chung 2025](https://doi.org/10.1111/inr.70107); [Johnson 2026](https://doi.org/10.1016/j.teln.2025.12.025); [Geoffrion 2020](https://doi.org/10.1002/14651858.CD011860.pub2). ### Confidence and knowledge move; skill barely does Pooled confidence sits at 0.85 in controlled studies and knowledge at 0.86. The Cochrane skill estimate was 0.21, with an interval that includes no effect. So what for you: put an observed skill measure beside every confidence survey. A trainee at eye level with a client. ### Where confidence and skill parted In a [cluster randomised trial](https://doi.org/10.1007/s40596-016-0559-2) of 26 psychiatry residents, simulated performance rose (d = 1.6) while confidence matched control. In [a paediatric trial](https://doi.org/10.1016/j.acap.2018.10.005) and [a medical school OSCE](https://doi.org/10.1007/s11606-024-08975-5), observed skill did not differ while self-ratings rose. A clinician sits knee to knee with a client. ### The largest VR cohort measured confidence [Johnson and colleagues](https://doi.org/10.1016/j.teln.2025.12.025) ran a 20-minute VR session with 223 participants in Australian nursing programs. Confidence rose (d = 0.70), 93% called VR suitable and 89% wanted more, with no comparison group or later check. A man waits on the footpath. ### Newer VR studies share the design In Taiwan, 54 nurses rated confidence at 60.04 before 360 video VR and 71.93 after, measured on the day ([Lin 2026](https://doi.org/10.1111/jan.70563)). Incidents ## Do assaults fall after de-escalation training? Controlled studies have not shown it: the [Cochrane review](https://doi.org/10.1002/14651858.CD011860.pub2) (1,688 participants) put the long-term risk ratio at 1.14, an interval spanning no effect. A community nurse alone in a carpark. ### Earlier and later reviews agree [Heckemann 2015](https://doi.org/10.1016/j.nedt.2014.08.003) found no change in patient aggression and [Brenig 2023](https://doi.org/10.1186/s12888-023-04714-y) no relevant impact on forensic ward incidents; in [Okubo 2022](https://doi.org/10.1590/1518-8345.5923.3638), 4 of 11 controlled studies reported less violence and the pooled estimate was null. A clinician gives a young man room. ### Service gains came with wider packages A psychiatric emergency program recorded 35% fewer restraints and 52% fewer injuries over 5 months after simulation than before, with no control group, alongside teamwork and crisis prevention programs ([Bowllan 2025](https://doi.org/10.1177/10783903241308529)). A supervisor beside a quiet driver. ### Assaults rose again once the program stopped In an emergency medicine residency, 28% of residents reported assault before its program, 11.3% a year after, and 30.6% 5 years later, once in-person training had stopped ([Roppolo 2025](https://doi.org/10.1002/aet2.11064)). Longest follow-up in each study, 50 studies Immediate, end of session 35 of 50 Under 3 months 2 of 50 3 to 6 months 7 of 50 Over 6 months 1 of 50 Not reported 5 of 50 See the data (studies) Measure Studies Immediate, end of session 35 of 50 Under 3 months 2 of 50 3 to 6 months 7 of 50 Over 6 months 1 of 50 Not reported 5 of 50 Studies by their longest follow-up, published 2015 to 2026, coded by PTR. Source: [Europe PMC](https://www.ebi.ac.uk/europepmc/webservices/rest/search); [PubMed](https://pubmed.ncbi.nlm.nih.gov/). ### Almost nothing is measured after the session 35 of 50 studies measured on the day and not again, and 1 of 50 looked beyond 6 months. A reading taken at the session overstates what lasts. So what for you: build a later check into the pilot plan before the pilot starts. Head to head ## Can VR stand in for live role play? In the short term, perhaps: 22 police officers in VR and 20 in live action each beat 21 controls by similar margins ([Lavoie 2023](https://doi.org/10.1093/police/paad069)). A facilitator and colleague rehearse feedback. ### The comparison is thin 1 of 14 VR studies compared VR with live practice. Officers were allocated by scheduling availability, outliers were removed, and follow-up was short. A caseworker across from a distressed client. ### The ward trial lost its sample An [NHS feasibility trial](https://doi.org/10.5498/wjp.v14.i10.1521) allocated wards to VR training (34 staff) or usual care (22 staff). Restrictive practice fell with fluctuation on wards that started higher, and 8 and 5 remained at the 6-month follow-up. A practitioner raises a hand to begin. ### Usability shapes the result Western Sydney clinicians (28 participants, [Moore 2022](https://doi.org/10.2196/38669)) found talking with a virtual agent feasible but flagged motion sickness and privacy; a [US pilot](https://doi.org/10.2196/70817) with 13 providers scored usability 63.30 out of 100. Demand ## Are buyers looking for this training? Increasingly: worldwide searches for de-escalation training rose 5.8 times from 2022 to 2025, and for workplace violence training 5.1 times (Google Trends). A facilitator briefs participants in a workshop. ### State obligations are widening US states with laws to prevent health care workplace violence went from 11 before 2015 to 27 by June 2024 ([Lombardi 2026](https://doi.org/10.1093/haschl/qxag022)). An officer directs an older man inside. ### The federal rule is not scheduled The OSHA rule on workplace violence in health care sits among [long-term actions](https://www.reginfo.gov/public/do/eAgendaViewRule?pubId=202510&RIN=1218-AD08), with no proposal date. A clinician sits with a young woman outside. A practitioner reviews feedback with a coach. A team leader talks through an escalation. Evidence table ## Which studies does this rest on? Design, sample, measure and result for each source. Evidence table: reviews and primary studies Study Design Sample What was measured Result Tang et al. (2026), [Frontiers in Medicine](https://doi.org/10.3389/fmed.2026.1657986) Review, VR 15 studies Kirkpatrick level None tested organisational impact Geoffrion et al. (2020), [Cochrane Database of Systematic Reviews](https://doi.org/10.1002/14651858.CD011860.pub2) Review, controlled designs 9 studies, 1,688 participants Aggression, knowledge, skills RR 1.14; knowledge 0.86; skills 0.21 Mitchell et al. (2024), [International Journal of Nursing Studies](https://doi.org/10.1016/j.ijnurstu.2024.104842) Review, simulation 25 studies, 2,790 participants Learning, performance 24 of 25 high or serious bias risk Chung et al. (2025), [International Nursing Review](https://doi.org/10.1111/inr.70107) Meta-analysis 10 studies Confidence SMD 0.85; d 0.71 Kyaw et al. (2019), [Journal of Medical Internet Research](https://doi.org/10.2196/12959) Meta-analysis, VR education 31 trials Knowledge, skills Skills SMD 1.12; no behaviour outcomes Jameyfield et al. (2026), [Academic Medicine](https://doi.org/10.1093/acamed/wvag026) Review, verbal de-escalation 56 studies Evidence strength 12 of 56 strong, all blended Okubo et al. (2022), [Revista Latino-Americana de Enfermagem](https://doi.org/10.1590/1518-8345.5923.3638) Meta-analysis 11 studies Violence 4 of 11 positive; pooled null Johnson et al. (2026), [Teaching and Learning in Nursing](https://doi.org/10.1016/j.teln.2025.12.025) Uncontrolled, VR 223 enrolled, 221 analysed Confidence d = 0.70 Lavoie et al. (2023), [Policing](https://doi.org/10.1093/police/paad069) Non-randomised, 3 arms 63 officers Scored de-escalation VR and live comparable Phiri et al. (2024), [World Journal of Psychiatry](https://doi.org/10.5498/wjp.v14.i10.1521) Feasibility, wards allocated 34 staff, 22 staff Restrictive practice Fell, with fluctuation Vestal et al. (2017), [Academic Psychiatry](https://doi.org/10.1007/s40596-016-0559-2) Cluster randomised trial 26 residents Performance, confidence d = 1.6; confidence same Bowllan et al. (2025), [J Am Psychiatr Nurses Assoc](https://doi.org/10.1177/10783903241308529) Before and after service data Emergency program staff Restraints, injuries 35% and 52% fewer; no control Roppolo et al. (2025), [AEM Education and Training](https://doi.org/10.1002/aet2.11064) Repeated survey Residents Reported assault 28%, 11.3%, 30.6% For buyers ## What should a buyer do with this? Use the evidence to set the questions, the measures and the promise. - Ask for the level, comparator and follow-up. 41 of 50 studies stopped at reaction or learning; 13 of 14 VR studies measured on the day. - Pair every confidence survey with an observed measure. In 4 of 6 studies that measured self-report and observed skill, the measures disagreed. - Frame fewer incidents as a system goal. The Cochrane risk ratio was 1.14; the 35% fall in restraints came with a wider package. - Test VR against live practice before replacing it. 1 of 14 VR studies made that comparison, in policing, over the short term. - Blend teaching with practice. 12 of 56 verbal de-escalation studies rated strong, and all combined teaching with role play or simulation. A coach watches a hand movement test. A practitioner rehearses beside a facilitator. A colleague waits for a reply. Board paper lines, ready to paste into a business case Of 50 VR and simulation de-escalation studies from 2015 to 2026, 41 of 50 measured reaction or learning, and every study reporting incidents (8 of 50) used an uncontrolled or feasibility design (PTR evidence table, 2026). A Cochrane review of education to prevent aggression toward health workers reported a long-term risk ratio of 1.14, an interval that includes no effect (Geoffrion and colleagues, 2020). Confidence gains are large, a pooled standardised mean difference of 0.85 in controlled studies (Chung and colleagues, 2025), so evaluations need observed skill and incident baselines too. A coach and learner arrange markers. A team leader gives a colleague feedback. A nurse talks with a visitor. ## Limits and method What the data cannot show, and how each figure was read. - The table is a structured scan rather than a systematic review: 1 reviewer, 2 databases, English language, no risk of bias scoring. Review counts are the cross-check. - Levels are PTR’s coding against the [Kirkpatrick Partners definitions](https://www.kirkpatrickpartners.com/the-kirkpatrick-model/), except the Tang ratings. - The pooled figures differ in outcome, instrument and design, and the Chung pools are heterogeneous. - Before and after service data cannot separate training from staffing, policy, reporting habits or chance. - Populations are mixed, and the head to head test is in policing. - PubMed counts match title and abstract words (violence, aggression or de-escalation terms with training terms; VR adds virtual reality); 2026 is partial. - BLS rates are private industry cases with days away from work (Table R8); 2021-22 and 2023-24 are annualised, with a new event code from 2023. - Google Trends values are relative interest, not volume; Australia sat below the reporting threshold until 2026. - Null pilot results are less often published, so the table can overstate positive results. - Every source was read on 26 September 2026. ## Where PTR fits PTR builds VR and AI practice for these moments, and designs pilots that reach past the training room with an observed skill measure, a comparator and a later check. See [VR de-escalation training](https://peopletechrevolution.com/training/vr-de-escalation-training), [de-escalation training programs](https://peopletechrevolution.com/training/de-escalation), [AI roleplay practice](https://peopletechrevolution.com/ai/ai-roleplay-practice) and [training for safety and wellbeing leads](https://peopletechrevolution.com/training/for-safety-and-wellbeing-leads). PTR built the VR program in a [Mayo Clinic randomised study](https://peopletechrevolution.com/work/research-evidence/vr-nursing-leaders-mayo-clinic) that followed nursing leaders for up to 8 months; it measured empathy, not de-escalation. - [Evaluating a de-escalation pilot](https://peopletechrevolution.com/insights/evaluate-de-escalation-training-pilot) - [Designing a scenario and its debrief](https://peopletechrevolution.com/insights/design-de-escalation-scenario-debrief) - [Does VR training work?](https://peopletechrevolution.com/learn/does-vr-training-work) - [Workplace violence claims data](https://peopletechrevolution.com/insights/workplace-violence-claims-data) ## Cite this research Free to quote and cite with a link to this page. Name the version you read, so readers can see what has changed since. APA 7 Loza, K. (2026, September 27). 41 of 50 studies stop in the training room: what VR de-escalation research has and has not measured (Version 2.0). People Tech Revolution. https://peopletechrevolution.com/insights/vr-de-escalation-training-evidence Copy citation Data: PTR evidence table of 50 studies coded from Europe PMC and PubMed, 2015 to 2026; reviews by Tang, Geoffrion, Mitchell, Chung and Kyaw; PubMed E-utilities counts; BLS Table R8; Google Trends; Joint Commission R3 Reports. Read 26 September 2026. ### Version history Version Date What changed Version 2.0 27 September 2026 Rebuilt on a 50-study evidence table, 30 reviews, PubMed counts and BLS incidence data: key numbers, 6 charts, an evidence table, decisions and limits. Version 1.0 25 September 2026 First published. ## Sources Each study and dataset at its publisher. ### [Tang et al. (2026). The utilization of virtual reality in the training of de-escalation of aggression for both providers and users of public and healthcare services from the new millennium to the COVID-19 era: a systematic review. Frontiers in Medicine](https://doi.org/10.3389/fmed.2026.1657986) Frontiers in Medicine, 2026 The VR review and its Kirkpatrick ratings. ### [Geoffrion et al. (2020). Education and training for preventing and minimizing workplace aggression directed toward healthcare workers. Cochrane Database of Systematic Reviews](https://doi.org/10.1002/14651858.CD011860.pub2) Cochrane, 2020 Aggression, knowledge and skill estimates. ### [Mitchell et al. (2024). Simulation-based education for teaching aggression management skills to healthcare providers in acute healthcare settings: A systematic review. International Journal of Nursing Studies](https://doi.org/10.1016/j.ijnurstu.2024.104842) International Journal of Nursing Studies, 2024 Risk of bias and outcome data. ### [Chung et al. (2025). The Effectiveness of Workplace Violence Prevention Education Training Programs on Healthcare Professionals’ Confidence: A Systematic Review and Meta-Analysis. International Nursing Review](https://doi.org/10.1111/inr.70107) International Nursing Review, 2025 Pooled confidence effects. ### [Kyaw et al. (2019). Virtual Reality for Health Professions Education: Systematic Review and Meta-Analysis by the Digital Health Education Collaboration. Journal of Medical Internet Research](https://doi.org/10.2196/12959) Journal of Medical Internet Research, 2019 VR education outcomes. ### [Jameyfield et al. (2026). Best practices for teaching verbal de-escalation in health professions education: a systematic review. Academic Medicine](https://doi.org/10.1093/acamed/wvag026) Academic Medicine, 2026 What strong interventions share. ### [Johnson et al. (2026). The effectiveness of virtual reality aggression and violence de-escalation training for nursing and midwifery students: A quasi-experimental study. Teaching and Learning in Nursing](https://doi.org/10.1016/j.teln.2025.12.025) Teaching and Learning in Nursing, 2026; [open access copy, Victoria University Research Repository](https://vuir.vu.edu.au/49954/) The largest VR cohort. ### [Lavoie et al. (2023). Training police to de-escalate mental health crisis situations: Comparing virtual reality and live-action scenario-based approaches. Policing: A Journal of Policy and Practice](https://doi.org/10.1093/police/paad069) Policing, 2023 VR against live action. ### [Phiri et al. (2024). Tree: Reducing the use of restrictive practices on psychiatric wards through virtual reality immersive technology training. World Journal of Psychiatry](https://doi.org/10.5498/wjp.v14.i10.1521) World Journal of Psychiatry, 2024 The VR ward trial. ### [Vestal et al. (2017). Simulation-Based Training for Residents in the Management of Acute Agitation: A Cluster Randomized Controlled Trial. Academic Psychiatry](https://doi.org/10.1007/s40596-016-0559-2) Academic Psychiatry, 2017 Performance against confidence. ### [Bowllan et al. (2025). Implementation and Evaluation of a High-Fidelity, Interprofessional Simulation Project Using Standardized Patients to Address Aggression in a Psychiatric Emergency Department. Journal of the American Psychiatric Nurses Association](https://doi.org/10.1177/10783903241308529) Journal of the American Psychiatric Nurses Association, 2025 Restraints and injuries. ### [Roppolo et al. (2025). Reducing physical assaults on residents through implementation of project BETA: Best practices in the evaluation and treatment of agitation. AEM Education and Training](https://doi.org/10.1002/aet2.11064) AEM Education and Training, 2025 Assaults over 5 years. ### [U.S. Bureau of Labor Statistics (2026). Survey of Occupational Injuries and Illnesses, case and demographic characteristics, Table R8. BLS](https://www.bls.gov/iif/nonfatal-injuries-and-illnesses-tables.htm) U.S. Bureau of Labor Statistics Violence rates, 2019 to 2023-24. ### [U.S. Bureau of Labor Statistics (2020). Workplace Violence in Healthcare, 2018. BLS fact sheet](https://www.bls.gov/iif/factsheets/workplace-violence-healthcare-2018.htm) U.S. Bureau of Labor Statistics Violence rates, 2011 to 2018. ### [National Center for Biotechnology Information (2026). PubMed. National Library of Medicine](https://pubmed.ncbi.nlm.nih.gov/) NCBI, E-utilities search counts Records per year. ### [The Joint Commission (2021). R3 Report Issue 30: Workplace Violence Prevention Standards. The Joint Commission](https://www.jointcommission.org/-/media/tjc/documents/standards/r3-reports/wpvp-r3-30_revised_06302021.pdf) The Joint Commission, 2021 Hospital training requirements. ### [Kirkpatrick Partners (2026). The Kirkpatrick Model. Kirkpatrick Partners](https://www.kirkpatrickpartners.com/the-kirkpatrick-model/) Kirkpatrick Partners The level definitions.