BackgroundTheme game-based learning has the potential to enrich student learning experiences, leading to improved learning outcomes. Yet, there remains a research gap regarding its application in addressing psychiatric violence, leaving uncertainties about the comparative advantages of theme game-based learning over situational simulation learning strategies. ObjectivesThe goal was to measure the effect of integrating theme game-based learning into psychiatric violence risk assessment and response training on nursing student psychiatric violence-related knowledge, skills, and self-confidence. DesignThis study was a randomized controlled, pre-test, and post-test trial. SettingThe study was conducted at a medical university in Guangzhou, Guangdong, China. ParticipantsThere were 103 third-year nursing undergraduates (intervention group = 51, control group = 52) in the study. MethodsAn Objective Structured Clinical Exam and the Workplace Violence Management Ability Assessment Questionnaire for Intern Nursing Students were used to assess student skills. The knowledge test and the Confidence in Coping with Patient Aggression Instrument were used to measure student knowledge and self-confidence level before and after intervention. ResultsNursing students in the theme game-based group demonstrated significantly superior skills and confidence in violence risk assessment and response compared with students in the situational simulation group (p < 0.001, p = 0.039, p = 0.006, respectively). However, there was no significant difference in knowledge of violence risk assessment and response between the two groups (p = 0.510). ConclusionTheme game-based learning in psychiatric violence risk assessment and response training appeared effective in enhancing the violence management abilities of nursing students.