Articles Vol. 67 No. 8 28/08/2026

COMMUNICATION SKILLS FOR MANAGING ANGRY PATIENTS IN NURSING PRACTICE: AN EVIDENCE-INFORMED METHODOLOGICAL NARRATIVE REVIEW

Vu Hong Van1,2, Pham Thi Thu Phuong1,2, Nguyen Thi Thu Thuy1,2, Le Hung Truong1,2, Nguyen Ngoc Quyen1,2
1 Department of General Outpatient Examination – 108 Military Central Hospital
2 Khoa Khám bệnh đa khoa - Bệnh viện Trung ương Quân đội 108
DOI: 10.52163/yhc.v67i8.6322
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Keywords
Communication; Nurse-Patient Relations; Aggression; Workplace Violence; Professional Competence.
Abstract

Background:  Angry/agitated patients are common in clinical practice and may lead to conflict and workplace violence.

Objectives:  To synthesize evidence on patient anger, communication strategies, and de-escalation training in nursing.

Methods:  An evidence-informed methodological narrative review was conducted in PubMed, Scopus, Web of Science, and CINAHL for studies published from January 2010 to 1 March 2026.

Results:  De-escalation includes active listening, empathy, voice control, non-verbal communication, emotional self-regulation, and problem-solving. Training may improve short-term knowledge, attitudes, and confidence, whereas evidence for reducing actual violence remains inconsistent.

Conclusions:  Communication skills are essential but must be combined with simulation, feedback, and organizational support

References
[1]
World Health Organization (WHO). Preventing Violence Against Health Workers. Published 2022. https://www.who.int/activities/preventing-violence-against-health-workers Google Scholar
[2]
Price O, Baker J. Key components of de-escalation techniques: a thematic synthesis. Int J Ment Health Nurs. 2012;21(4):310-319. doi:10.1111/j.1447-0349.2011.00793.x Google Scholar
[3]
Baby M, Gale C, Swain N. Communication skills training in the management of patient aggression and violence in healthcare. Aggress Violent Behav. 2018;39:67-82. doi:10.1016/j.avb.2018.02.004 Google Scholar
[4]
Price O, Baker J, Bee P, Lovell K. Learning and performance outcomes of mental health staff training in de-escalation techniques for the management of violence and aggression. Br J Psychiatry. 2015;206(6):447-455. doi:10.1192/bjp.bp.114.144576 Google Scholar
[5]
Hallett N, Dickens GL. De-escalation of aggressive behaviour in healthcare settings: Concept analysis. Int J Nurs Stud. 2017;75:10-20. doi:10.1016/j.ijnurstu.2017.07.003 Google Scholar
[6]
Codier E, Codier DD. Could Emotional Intelligence Make Patients Safer? Am J Nurs. 2017;117(7):58-62. doi:10.1097/01.NAJ.0000520946.39224.db Google Scholar
[7]
Green BN, Johnson CD, Adams A. Writing narrative literature reviews for peer-reviewed journals: secrets of the trade. J Chiropr Med. 2006;5(3):101-117. doi:10.1016/S0899-3467(07)60142-6 Google Scholar
[8]
Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ. 2021;372:n71. doi:10.1136/bmj.n71 Google Scholar
[9]
Higgins JPT, Thomas J, Chandler J, Cumpston M, Li T, Page MJ, Welch VA, editors. Cochrane Handbook for Systematic Reviews of Interventions. 2nd ed. Chichester: John Wiley & Sons; 2019. doi:10.1002/9781119536604 Google Scholar
[10]
Geoffrion S, Hills DJ, Ross HM, Pich J, Hill AT, Dalsbø TK, Riahi S, Martínez-Jarreta B, Guay S. Education and training for preventing and minimizing workplace aggression directed toward healthcare workers. Cochrane Database Syst Rev. 2020;(9):CD011860. doi:10.1002/14651858.CD011860.pub2 Google Scholar
[11]
Somani R, Muntaner C, Hillan E, Velonis AJ, Smith P. A Systematic Review: Effectiveness of Interventions to De-escalate Workplace Violence against Nurses in Healthcare Settings. Saf Health Work. 2021;12(3):289-295. doi:10.1016/j.shaw.2021.04.004 Google Scholar
[12]
Čelofiga A, Kores Plesnicar B, Koprivsek J, Moskon M, Benkovic D, Gregoric Kumperscak H. Effectiveness of De-Escalation in Reducing Aggression and Coercion in Acute Psychiatric Units. A Cluster Randomized Study. Front Psychiatry. 2022;13:856153. doi:10.3389/fpsyt.2022.856153 Google Scholar
[13]
Caruso R, Antenora F, Riba M, Belvederi Murri M, Biancosino B, Zerbinati L, et al. Aggressive Behavior and Psychiatric Inpatients: a Narrative Review of the Literature with a Focus on the European Experience. Curr Psychiatry Rep. 2021;23(5):29. doi:10.1007/s11920-021-01233-z Google Scholar
[14]
Renwick L, Stewart D, Richardson M, Lavelle M, Hardy C, James K, et al. Aggression on inpatient units: Clinical characteristics and consequences. Int J Ment Health Nurs. 2016;25. doi:10.1111/inm.12191 Google Scholar
[15]
Lavelle M, Stewart D, James K, Richardson M, Renwick L, Brennan G, et al. Predictors of effective de-escalation in acute inpatient psychiatric settings. J Clin Nurs. 2016;25(15-16):2180-2188. doi:10.1111/jocn.13239 Google Scholar
[16]
Richmond JS, Berlin JS, Fishkind AB, Holloman GH Jr, Zeller SL, Wilson MP, Rifai MA, Ng AT. Verbal De-escalation of the Agitated Patient: Consensus Statement of the American Association for Emergency Psychiatry Project BETA De-escalation Workgroup. West J Emerg Med. 2012;13(1):17-25. doi:10.5811/westjem.2011.9.6864 Google Scholar
[17]
National Institute for Health and Care Excellence (NICE). Violence and aggression: short-term management in mental health, health and community settings. NICE guideline NG10. Published 28 May 2015; last reviewed 11 July 2024. https://www.nice.org.uk/guidance/ng10 Google Scholar