***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Conflict and containment on acute inpatient psychiatric wards pose a threat to patient and staff safety , and it is desirable to minimize the frequency of these events . Research has indicated that certain staff attitudes and behaviours might serve to accomplish this , namely , positive appreciation , emotional regulation and effective structure . A previous test of an intervention based on these principles , on two wards , showed a good outcome . In this study , we tested the same intervention on three further wards . Two ' City nurses ' were employed to work with three acute wards , assisting with the implementation of changes according to the working model of conflict and containment generation . Evaluation was via before- and -after measures , with parallel data collected from five control wards . While simple before- and -after analysis of the two experimental wards showed significant reductions in conflict and containment , when a comparison with controls was conducted , with control for patient occupancy and clustering of results by ward , no effect of the intervention was found . The results were therefore ambiguous , and neither confirm nor contradict the efficacy of the intervention . A further intervention study may need to be conducted with a larger sample size to achieve adequate statistical power Patient aggression is a problem in many health care setting s , and nursing students are among the most vulnerable to experiencing such aggression . Training courses have been suggested to help nurses better manage patient aggression . Such courses can lead to changes in attitudes toward and perceptions of , as well as greater confidence in managing , aggression . In this quasi-experimental study , we investigated the effect of a training course on nursing students '  attitudes toward , perceptions of , and confidence in managing patient aggression .  Students in the intervention group demonstrated enhanced confidence but no change in attitude after the training course , while students in the control group remained stable on all measures . The short time frame of the study , the training course itself , and the instruments used for monitoring attitudes toward aggression are possible reasons for these results . We tentatively conclude that it is possible to enhance nursing students ' perceived confidence in managing patient aggression without changing their fundamental views of it Violence prevention and management is an important part of inpatient psychiatric nursing and specific staff training is regarded essential . The training should be based on primary , secondary and tertiary prevention . In Stockholm , Sweden , the Bergen model is a staff-training programme that combines this preventive approach with the theoretical nursing framework of the City model that includes three staff factors : positive appreciation of patients , emotional regulation and effective structure . We evaluated this combination of the Bergen and City models on the violence prevention and management climate in psychiatric inpatient wards . A 13-item question naire was developed and distributed to patients and staff in 41 wards before the staff was trained and subsequently to 19 of these wards after training . Data analyses included factor analysis , Fisher 's exact test and Mann-Whitney U-test . The result showed that the staff on trained wards had a more positive perception of four of the items and the patients of one item . These items reflected causes of patient aggression , ward rules , the staff 's emotional regulation and early interventions . The findings suggest that a focus on three levels of prevention within a theoretical nursing framework may promote a more positive violence prevention and management climate on wards Systematic risk assessment and training courses have been suggested as interventions to deal with patient violence in psychiatric institutions . A dual centre prospect i ve feasibility study was conducted on two Swiss psychiatric admission wards to test the hypothesis that such interventions will reduce the frequency and severity of violent events and coercion . A systematic aggression risk assessment , in combination with a st and ardized training course in aggression management was administered and the frequency and severity of aggressive incidents and the frequency of coercive measures were registered . The incidence rates of aggressive incidents and attacks showed no significant reduction from the baseline through risk prediction and staff training , but the drop in coercive measures was highly significant . A ' ward effect ' was detected with one ward showing a decline in attacks with unchanged incidence rates of coercion and the other ward showing the opposite . The severity of the incidents remained unchanged whilst the subjective severity declined after the training course . We conclude that a systematic risk assessment and a training course may assist in reducing the incidence rate of coercive measures on psychiatric acute admission wards . Further testing of the interventions is necessary to measure the effect of the training alone and to counteract ' ward effects ' OBJECTIVE This study examined whether staff members ' use of interventions for preventing patients ' aggression  reduced the number of incidents of aggression on a closed acute admissions ward of a psychiatric hospital in the Netherl and s. METHODS The number and severity of incidents of aggression on three closed wards were measured using the Dutch version of the Staff Observation Aggression Scale ( SOAS ) . Measurements were made for three months before and after staff implemented interventions for preventing aggression on one of the wards . Interventions included a protocol for talking to patients who exhibited aggressive behavior , discussing treatment goals with the patient shortly after admission , explaining why the ward 's door was locked and the exit rules , providing a schedule of staff meetings to explain staff members ' absence from the ward , and clarifying the procedure for making an appointment with the psychiatrists . RESULTS The frequency of aggressive incidents was reduced on all three wards , with no significant difference between the ward where the interventions were implemented and the two control wards . A marginally significant difference in the severity of aggressive incidents was found between experimental and control wards after the introduction of the preventive measures , with incidents in the experimental ward tending to be less severe . CONCLUSIONS This study failed to find a robust effect of specific intervention measures on aggressive incidents . However , it did find evidence suggesting that st and ardized reporting by staff of aggressive incidents on closed psychiatric wards may in itself result in straightforward reduction of violent incidents Nurses ' attitudes towards patient aggression may influence their behaviour towards patients . Thus , their enhanced capacity to cope with aggressive patients may nurture more positive attitudes and alleviate adverse feelings emanating from patient aggression . This cluster r and omised controlled trial conducted on six psychiatric wards tested the hypotheses that a 5 day training course in aggression management would positively influence the following outcome measures : Nurses ' perception and tolerance towards patient aggression and result ant adverse feelings . A repeated measures design was employed to monitor change . No effect was found . The short time frame between the training course and the follow up measurement or non-responsiveness of the measurement instruments may explain this finding BACKGROUND The nursing profession has one of the highest assault risks . Managing patient aggression is therefore a challenge for nurses , especially for nursing students . This longitudinal pre-post-test study set out to test the outcome of a training course tailored to the special needs of nursing students on their confidence in coping with patient aggression . METHODS Sixty-three nursing students in four groups attended three-day training courses design ed specially  to meet their needs .  Thackrey 's confidence in coping with patient aggression scale  was used before the training , immediately after the training , and after two weeks in practical placement . Question naires about perceived changes were completed two weeks into practical placements and were analyzed by qualitative content analysis . RESULTS A significant enhancement of students ' self-reported confidence in dealing with patient aggression was found . The overall mean score changed significantly from 2.5 in the pre-test to 3.6 after the training . No significant decrease in the score was found after two weeks in the practical placement . Regarding managing aggression almost half of the students became aware of perceived changes in daily practice . CONCLUSION The three-day training course is able to support nursing students ' self reported capacities to manage patient aggression 
    Output:
    
The strongest impact of training appears to be on de-escalation-related knowledge , confidence to manage aggression and deescalation performance ( although limited to artificial training scenarios ) .
No strong conclusions could be drawn about the impact of training on assaults , injuries , containment and organisational outcomes owing to the low quality of evidence and conflicting results .
It is assumed that de-escalation techniques training will improve  staff 's  ability to de-escalate violent and aggressive behaviour and improve safety in practice .
There is currently limited evidence that this training has these effects