Why nurses do not report patient aggression: A review and appraisal of the literature

Abstract

Aim To establish the current state of the science about why nurses do or do not report being the victim of patient aggression, a form of type II workplace violence. This aim includes identifying and analysing current gaps in the literature. Background It is increasingly more common for patients to instigate aggressive acts towards nurses, leading to significant consequences. Nursing victims often do not report acts of patient aggression to others, making it difficult for health care leaders and researchers to address this challenge. Evaluation The review process involved searching five databases, using the PRISMA framework to reduce 355 records to 65 sources for review and synthesis. Key Issues The findings of this review highlight key takeaways about why nursing victims do not report episodes of patient aggression, which include their fears, attitudes and abilities related to reporting; and their perspective of the patient aggression event. Workplace environments are central to most of these factors, emphasizing the importance of nursing and other health care leaders to put systems in place that promote nurse reporting behaviours. Conclusions Patient aggression is a widespread problem with severe consequences. Review findings can inform future research while having practical relevance for health care leaders. Implications for Nursing Management Health care leaders need to consider how workplace structures, practices, and cultures can encourage or stifle nurse reporting behaviours. By understanding nurse reporting behaviours, processes can be developed to promote nursing victim reporting and deter patient aggression.

Identifying Type II workplace violence from clinical notes using natural language processing

“…Nurses often do not report Type II workplace violence because their ability to report patient aggression is limited by reporting systems in the workplace and/or they do not know or understand the reporting process. In addition, they are too busy to report, or the systems that are in place do not support reporting incidents (Christensen & Wilson, 2022). Considering violence is grossly underreported among home healthcare nurses (Byon, Lee, et al, 2020), the ability to detect otherwise unreported violence incidents in clinical notes using natural language processing provides excellent opportunities for case detection and violence prevention.…”

Violence against nurses by patients and visitors in the emergency department: A concept analysis

“…Tackling this issue also requires clear documentation to support investigation and action in specific events but also to understand the scope of the problem. However, there is a lack of documentation of violent events in health care generally, due to underreporting (Aljohani et al, 2021 ; Christensen & Wilson, 2022 ; Huang et al, 2022 ; Stene et al, 2015 ). Barriers to reporting might arise from existent discrepancies between what health care organizations encourage nurses to report and what nurses actually report, perhaps due to nurses' conflicting obligations and ethical concerns about doing no harm to the patient (Buterakos et al, 2020 ).…”

“…Besides, there are also divergent views on the perception of harm. If no nurse is harmed during the patient‐related violence, an event might not meet an individual's threshold for workplace violence, which requires reporting (Christensen & Wilson, 2022 ; Huang et al, 2022 ). However, some might argue that the potential for harm exists, regardless of whether actual harm occurred, which should therefore necessitate reporting (Copeland & Henry, 2017 ).…”

Managing workplace violence against health care workers: education alone is not enough

“…Staff may under-report for several reasons, including fear of reprisal, perception of the incident, embarrassment, or as a reflection of the culture of the organization. 10 Feeling psychologically safe to report such incidents requires leadership and organizational support to develop a safety culture. It is imperative to cultivate an understanding of the underlying causes of under-reporting and formulate precise and credible mechanisms tailored for this purpose.…”

“…Under-reporting may lead to misrepresentation of the extent and severity of the issue, and also affects the ability of organizations to develop preventive strategies, as not all issues surrounding the incident may be reported. Staff may under-report for several reasons, including fear of reprisal, perception of the incident, embarrassment, or as a reflection of the culture of the organization 10 . Feeling psychologically safe to report such incidents requires leadership and organizational support to develop a safety culture.…”