Verbal de-escalation techniques for the prevention and management of workplace violence in healthcare: a systematic review

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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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