Adolescence is a unique life stage, associated with extensive biological, cognitive, and social-emotional transitions [1]. Adolescents also begin to move from an egocentric mode of thought to a more abstract and introspective kind [2]. Unfortunately, immature cognitive development tends to make adolescents “thoughtless,“ “irritable,” and “reckless,” accompanied by increases in the risk of violent behaviors as well [1]. Emotional dysregulation and the obsessive quest for autonomy in a context of insufficient cognitive maturity render adolescents susceptible to inappropriate outbursts of anger [3,4].

The World Health Organization defines violence as the intentional use of physical force or power that may result in injury, psychological harm, developmental disruption, or death [5]. Adolescent violent behavior may manifest in various forms, including physical aggression, verbal aggression, threatening behavior, bullying perpetration, fighting, emotional violence, and other externalizing behaviors [6,7]. These behaviors are associated with serious short- and long-term consequences, including physical injury, substance misuse, academic problems, criminal involvement, impaired social functioning, and mental health disorders [8,9]. Violence among adolescents also contributes substantially to the burden experienced by families, schools, health care systems, and communities [10].

Recent evidence indicates increasing trends in peer aggression, physical violence, emotional violence, and other forms of externalizing behavior among adolescents worldwide [11]. A UNESCO (United Nations Educational, Scientific and Cultural Organization) report estimated that approximately one-third of adolescents aged 11‐15 years have experienced involvement in bullying or peer violence within school environments [12]. Over the past year, one-third of students (36%) aged 13‐15 years were involved in a physical fight with another student, and almost one in three (32%) had been physically attacked at least once [13]. A study in Indonesia, the National Survey on the Life Experiences of Children and Adolescents [14], found two in three children and adolescents have experienced violence at least once in their lives, with this figure increasing [15]. These findings highlight the urgent need for early identification, prevention, and intervention strategies targeting adolescents at risk of violent behavior, particularly within community and primary health care settings [16].

Adolescent violent behavior is influenced by multiple interacting internal and external factors. Internal factors include age, sex, impulsivity, emotional regulation, psychological conditions, coping abilities, and spirituality [17,18]. External factors include parenting style, family conflict, peer influence, school climate, exposure to community violence, and broader social environments [19,20]. Conversely, protective factors such as family connectedness, empathy, religiosity, social support, and positive school engagement may reduce the likelihood of violent behavior [21,22]. Understanding these multidimensional influences is important for health care professionals, particularly nurses, in supporting early risk identification, prevention planning, and violence management among adolescents [23].

Health care professionals, especially nurses working in primary health care and community settings, play an important role in preventing and managing adolescent violent behavior [24]. Nurses are often among the first health care providers to identify behavioral problems, aggression, emotional dysregulation, and psychosocial risks in adolescents [25]. Their roles may include early screening and risk assessment, psychoeducation, counseling, emotional regulation support, family involvement, crisis management, and referral coordination. Effective nursing interventions may contribute to reducing aggressive behavior and improving psychosocial and behavioral outcomes among adolescents [26].

Despite the important role of nurses, previous studies indicate that many nurses report insufficient preparedness, limited confidence, and inadequate competencies in managing adolescents with violent or aggressive behavior [27-29]. Limited training in adolescent mental health, violence prevention, behavioral management, and psychosocial intervention may reduce nurses’ ability to provide early detection and appropriate interventions in health care settings [30]. In Indonesia, these challenges may be more pronounced because mental health services in primary health care settings (puskesmas) still predominantly focus on severe mental disorders rather than preventive interventions targeting adolescent behavioral risks [31].

Recent studies suggest that education and training programs for health care professionals, including nurses, may improve confidence, preparedness, communication skills, risk assessment abilities, and management of violent or aggressive behaviors among adolescents [26]. Interactive approaches such as role-playing, simulation, case-based learning, and de-escalation training have been associated with improved competency development and more sustainable behavioral outcomes [32]. However, most violence prevention interventions have primarily focused on school-based or community-based youth programs, whereas evidence specifically examining nurse-targeted training for adolescent violence prevention and management remains limited [33]. Existing studies also commonly position nurses as facilitators or referral agents within broader community or school health initiatives rather than as primary targets of structured competency-based training programs [34].

Implementation of violence prevention training programs is influenced not only by individual competencies but also by institutional and systemic support, including operational guidelines, referral pathways, leadership support, protected intervention time, and intersectoral collaboration [35]. Although adolescent violence may occur across school and community environments, this scoping review specifically focuses on nurse training interventions in the Prevention of Adolescent Violence Risk-Behavior (Keterampilan Pencegahan Risiko Perilaku Kekerasan Remaja [Kepolar]) program implemented within health care and primary health care contexts.

Effective prevention and management of adolescent violent behavior require multidimensional approaches addressing individual, interpersonal, family, community, and societal factors, as described in the social ecological model [36,37]. Nursing interventions and training programs may also be informed by frameworks such as King’s Goal Attainment Theory [38] and Bronfenbrenner’s Ecological Systems Theory [39], which emphasize interactions among adolescents, health care providers, families, and surrounding environments. These theoretical perspectives may support the development of structured nurse training models for adolescent violence prevention within primary health care settings.

Current evidence related to violence prevention interventions remains methodologically heterogeneous, with many studies characterized by small sample sizes, inconsistent outcome measures, and limited reporting transparency. Existing evidence on nurse training interventions for adolescent violence prevention has also not been comprehensively mapped regarding theoretical frameworks, intervention components, implementation strategies, and reported outcomes. Therefore, a scoping review is needed to systematically identify, map, and synthesize available evidence regarding nurse training interventions for adolescent violence prevention and management within primary health care settings.

This scoping review protocol seeks to offer a more structured and methodical approach for identifying young people who behave violently and ensuring they are referred to nurse education programs so that they may benefit from interventions provided therein. Our protocol is designed to make sure that the review procedure is carried out systematically and reproducibly, thereby reducing any possible bias and increasing methodological transparency as well as scientific trustworthiness.

The purpose of this review is to create an evidence-based training model that can be used by nurses in primary health care centers (puskesmas) to prevent adolescent violent behavior. In particular, this scoping review aims to discern and map the current scientific evidence on training for nurses in adolescent violence prevention regarding theoretic frameworks, the main elements of interventions, and intervention delivery strategies and effects. Finally, risk and protective factors related to adolescent violent behavior will be discussed in this review, as well as the instruments adopted for measuring nurses’ knowledge, attitudes, skills, and self-efficacy. It will offer further evidence of training interventions’ impact on these competences.

This protocol has been registered in the Open Science Framework. The final report will be prepared in accordance with the PRISMA-ScR checklist to ensure transparency and completeness throughout all stages of the review.

This scoping review seeks to map and synthesize the existing evidence regarding nurse training programs for the prevention of adolescent violent behavior in primary health care settings.

The main research question guiding this review is “What evidence exists regarding training programs for nurses in the prevention of adolescent violent behavior in primary health care settings?”

The review will further address the following subquestions:

The eligibility criteria for this scoping review were developed using the Population-Concept-Context (PCC) framework recommended by the Joanna Briggs Institute for scoping reviews (Table 1). The population of interest includes nurses and nursing personnel involved in providing care for adolescents who exhibit violent behavior. The concept focuses on violence prevention training interventions designed to enhance nurses’ capacity in managing adolescent violent behavior. These interventions may include educational programs, de-escalation training, communication skills training, simulation-based learning, and other strategies aimed at improving nurses’ knowledge, attitudes, competencies, confidence, preparedness, self-efficacy, and experiences in managing violent behavior among adolescents (Textbox 1). Comparators, where applicable, may include usual care, routine nursing practice without specific violence prevention training, health care services without active nurse involvement in violence prevention, or pre–post comparisons evaluating the effects of training interventions. The context of this review encompasses health care settings, community services, school-based health services, and primary health care facilities, including public health centers (puskesmas).

The review will consider qualitative, quantitative, and mixed methods studies, as well as review articles and relevant gray literature published in English or Indonesian between 2000 and 2024. Editorials, commentaries, opinion papers, conference abstracts without full text, and studies not related to violence prevention training for nurses in the context of adolescent violent behavior will be excluded. Studies eligible for inclusion are those that discuss violence prevention training, intervention programs, or related educational strategies for nurses in the context of adolescent violent behavior management. Editorials, commentaries, opinion papers, conference abstracts without full text, and studies not relevant to violence prevention training for nurses managing adolescent violent behavior will be excluded from the review.

Although scoping reviews do not primarily aim to evaluate the effectiveness of interventions, the PCC framework was used to provide additional clarification regarding the focus of this review. The population of interest includes nurses or nursing personnel involved in adolescent violence prevention and management within primary health care, community health care, school-based services, or other health care settings.

The included interventions of this scoping review are training and education initiatives that enhance nurses’ competencies regarding the prevention of violence in adolescents. These may include modules on emotional regulation, conflict resolution, early detection of violence risk, and communication strategies for managing adolescents. The training can be delivered through workshops, seminars, simulation-based learning, online courses, or blended methods. Some studies may also include the use of digital communication media as part of training delivery such as mobile apps, web-based platforms, social media, educational games, or interactive tools to support nurses in health promotion, emotional management, and psychosocial education for adolescents.

The context of this review encompasses primary health care settings, community health care services, school health services, and other health care settings where nurses provide adolescent health services and are involved in violence prevention and management activities.

Because the objective of this scoping review is to map the breadth of existing evidence, outcomes will not be predefined as eligibility criteria. Instead, all reported outcomes associated with nurse training interventions for adolescent violence prevention will be charted during data extraction. These may include outcomes related to nurses (eg, knowledge, attitudes, competencies, confidence, and self-efficacy), adolescents (eg, behavioral and psychosocial outcomes), and implementation outcomes (eg, feasibility, acceptability, and sustainability).

A comprehensive literature search will be conducted to identify studies relevant to violence prevention training programs for nurses in the context of adolescent violent behavior management. Electronic databases to be searched include PubMed, Scopus, CINAHL, ProQuest, Web of Science, and ScienceDirect. Gray literature sources, including Google Scholar, institutional repositories, reports, and theses, will also be searched to identify additional relevant evidence. The search strategy is detailed in the next section.

The search strategy will be developed in accordance with the objectives and research questions of this scoping review. Searches will be conducted using a combination of controlled vocabulary terms, including MeSH and free-text keywords related to nurses, violence prevention, adolescent violent behavior, and training or educational programs. Reference lists of included studies will also be screened manually to identify additional eligible articles.

Keywords and phrases such as “violence prevention,” “aggression management,” “de-escalation training,” “nurse,” “nursing staff,” “adolescent,” “youth,” and “training program” will be combined using Boolean operators such as AND and OR. Quotation marks will be used for exact phrases where appropriate, and search strategies will be adapted according to the syntax and indexing systems of each database.

Filters and limits applied during the search process will include publication years between 2000 and 2024, articles published in English or Indonesian, and studies available in full text when accessible. The search process and study selection procedure will be presented using a PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) flow diagram.

To ensure transparency and reproducibility, the complete PubMed search strategy for one electronic database is provided in Multimedia Appendix 1 and reported according to the PRISMA-S (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Literature Search Extension) recommendations.

All retrieved records will be imported into EndNote (Clarivate; version 20) and subsequently uploaded into Rayyan (Rayyan Systems Inc; version 2024) for screening and duplicate removal. Two reviewers will independently screen titles and abstracts according to the eligibility criteria. Full-text articles of potentially relevant studies will then be assessed independently by the same reviewers. Disagreements at any stage will be resolved through discussion, and where consensus cannot be reached, a third reviewer will be consulted. The study selection process will be reported using a PRISMA-ScR flow diagram.

A standardized data charting form will be developed to systematically extract and organize relevant information from the included studies. The form will be pilot-tested on a small number of studies and refined iteratively throughout the review process to ensure consistency and relevance to the review objectives and research questions.

The extracted data will include author(s), year of publication, country of study, study design, study objectives, participant characteristics, health care or community setting, characteristics of the training or educational program, theoretical frameworks, delivery methods, duration of intervention, implementation strategies, measurement or assessment tools, and reported findings related to nurses’ competencies in adolescent violence prevention (Table 2). Information related to barriers, facilitators, implementation experiences, and recommendations for practice or future research will also be extracted where available.

Data charting will be conducted independently by two reviewers using the standardized form. Any discrepancies in the extracted data will be resolved through discussion and consensus, with consultation from a third reviewer if necessary. The extracted data will be reviewed regularly to ensure accuracy, completeness, and alignment with the objectives of the scoping review.

Data will be summarized in narrative and tabular forms to map the extent, characteristics, and distribution of the existing evidence regarding violence prevention training programs for nurses in the context of adolescent violent behavior management. Consistent with the purpose of a scoping review, the synthesis will focus on describing and mapping available evidence rather than evaluating intervention effectiveness.

Descriptive analysis (frequencies and percentages) will be conducted for quantitative data where appropriate, while qualitative findings will be synthesized using thematic analysis following the 6-phase approach proposed by Braun and Clarke [42]. The analysis will involve six iterative phases: (1) familiarization with the extracted data, (2) generation of initial codes, (3) searching for potential themes, (4) reviewing and refining themes, (5) defining and naming themes, and (6) producing the narrative synthesis. Themes will be developed inductively to map intervention characteristics, implementation strategies, barriers, facilitators, and reported outcomes related to nurse training for adolescent violence prevention. The synthesis process will also examine the characteristics of training programs, educational components, delivery methods, theoretical frameworks, assessment approaches, and reported findings related to nurses’ competencies in adolescent violence prevention.

The findings will be presented in narrative summaries, evidence tables, and thematic groupings aligned with the objectives and research questions of the review. Quality appraisal will not be performed, as it is not mandatory for scoping reviews and the primary aim of this review is to comprehensively map the existing literature.

Results will be presented according to the objectives and research questions of the review, including characteristics of training programs, educational components, delivery methods, theoretical frameworks, assessment approaches, implementation strategies, and reported findings related to nurses’ competencies in adolescent violence prevention. The synthesis will discuss the extent, nature, and limitations of the existing evidence and provide implications for nursing practice, policy, and future research.

The study selection process will be presented using a PRISMA-ScR flow diagram, while the review findings will be summarized in narrative form and supported by evidence tables and thematic groupings where appropriate.

Validity of the findings, missing evidence, and interpretation of results will be addressed through an expert consultation involving psychiatric nursing, adolescent psychology, and public health experts. Expert input will be included in the final synthesis to increase the relevance and utility of the review.

As this is a review study, we use secondary data collected from previously published studies and therefore do not need any formal ethical approval. However, all procedures will be conducted in accordance with research ethics guidelines, such as following citation rules and acknowledging intellectual property rights. If the results are later to be used as the basis for a human study, ethical approval shall be sought before collecting data.