has been shown by numerous studies that nurses tend not to be very assertive. training is therefore usually offered by organizations with regard to assertiveness, and deals mainly with improving self-esteem, self-confidence and interpersonal communication. the health services advisory committee (hsac) recommends a three-dimensional foundation by which to deal with violence in the workplace. it involves "researching the problem and assessing the risk, reducing the risk and checking what has been done". in 1997, hsac provided the following guidelines as to what good training involves: theory: to understand the aggression within the workplace prevention: to assess the danger and take precautions interaction: with aggressive individuals post-incident action: to report, investigate, counsel, and follow up the incident identifying whether patients are currently at risk of violence the stamp violence assessment framework lists elements of patient behaviour that are correlated with violence, and was developed in 2005 by luck, jackson and usher. this model was later extended by the authours into an 18-point violence assessment tool.: 3 looking at the predictors in the violence assessment tool, resisting nonconsensual healthcare was found to be the best predictory of violence, followed by aggressive language and yelling.: 5 assertiveness training although many studies looking at the effectiveness of training have provided inconclusive results, a study by lin et al. positively correlated the improvement of assertiveness and self-esteem with an assertiveness training programme. the programme targets difficult interactions that we may face in day-to-day life and includes both, behavioural and cognitive techniques. the effectiveness of training is measured using the assertive scale, esteem scale, and interpersonal communication satisfaction inventory. evaluating the effectiveness of training it remains that training is not universally or consistently offered to healthcare workers. beale et al. found that the levels of training offered ranged from nothing to high-level restraint/self-defense training. a report by the national audit office (nao) in 2003 found that, within mental health trusts, a reactionary approach tends to prioritise over prevention. although criticised by many; restraint, seclusion and medication are used (wright 1999, gudjonsson et al. 2004). breakaway techniques, restraint, rapid tranquilisation or isolation tend to be recommended when violence is instigated with a failure to prevent aggression. this correlates to the level of training offered, which dominates in these areas, however lacks in situation risk assessment and customer care–methods that are vital in a preventative approach to prevent escalation of the situation, causing for reactionary measures to be brought into play. the study by beale et al. therefore provides the following advice as to good practice: training should emphasise prevention, calming and negotiation skills as opposed to confrontation training should be offered in modules, ranging initially from basic customer care and handling difficult patients to full control and restraint of patients. material relating to the causes of aggression, how to reduce risks, anticipation of violence, resolving conflict and dealing with post-incident circumstances should be provided to staff. physical breakaway skills should be taught–however an understanding as to situations in which such skills should be practiced must be appreciated. staff should be taught to control their own feelings an understanding of normal/abnormal post-trauma reactions should be reached staff should be familiar with local arrangements and policies