Table 3 Summary of interventions to mitigate underreporting

Organizational Interventions

 Policy & Reporting System

[2, 6, 11,12,13, 17, 22,23,24,25,26,27,28, 30, 32, 34]

• Consider a zero-tolerance WPV policy/campaign including signage regarding behavior expectations and consequences

• Develop a clear and detailed WPV policy including definitions of WPV and formal reporting processes

• Ensure the policy includes structure/process for immediate response and follow-up

• Confirm that the reporting system is clear, effective, userfriendly, and not time-consuming

• Evaluate the reporting system routinely for effectiveness and usability maintaining oversight by stakeholders

 Education and Training

[1, 2, 6, 11,12,13, 17, 22,23,24,25, 27, 28, 30,31,32, 34]

• Educate staff about the phenomenon of WPV in healthcare and its implications. Teach that everyone has the right to freedom from harm and that violence is not “just part of the job”

• Inform about the magnitude of underreporting; how it minimizes the problem and puts nurses at risk in the future

• Educate that reporting is essential for leadership to investigate incidents and for future allocation of resources

• Ensure that institutional training is mandatory; included in the initial orientation and annual review and communicating that reporting is non-punitive and will not affect their annual job performance evaluations

• Ensure training includes detailed WPV policy and reporting system

• Provide prevention programs that teach situational awareness, risk factors, de-escalation techniques, teamwork training, therapeutic communication skills, conflict management skills, and collaborative care to decrease unmet patient needs

• Provide training to managers on conflict resolution, early recognition of problems, and coaching skills

 Staffing

[2, 13, 22, 23, 30, 32]

• Ensure the presence and availability of security officers in high-risk areas

• Maintain adequate healthcare & security staffing

 Security Measures

[13, 22, 23, 30]

• Perform risk assessments routinely to include workflow and overcrowding issues. Work to decrease wait times

• Communicate behavior expectations to patients and family

• Ensure that patients/families identified as high risk are communicated to all staff/departments

• Enforce security and visitor policies

 Collaboration

[17, 22, 24, 27]

• Collaborate with leaders in other hospitals and institutions to share data, identify solutions, and implement improvements

• Develop a WPV response team that will collaborate and review each report of WPV to provide a satisfactory response

• Ensure all leaders are engaged

 Support-Resources

[23, 24, 26]

• Provide resources for staff affected by WPV; physical, emotional, psychological, and legal

• Offer resources that help teach coping skills and decrease occupational stress

Management Interventions

 Create a Positive Unit Culture

[17, 24, 32]

• Display a caring, engaged, supportive, approachable, and nonjudgmental attitude

• Create an environment of valuing nurses’ input and a culture of preventing, recognizing, reporting, and addressing violence

• Develop and enforce an open and blame-free culture around WPV and reporting

• Maintain effective communication with staff

 Follow up

[11, 17, 22,23,24, 32]

• Investigate and address all reports of WPV promptly,

consistently, and provide appropriate feedback in a debrief after a WPV event

• Enforce WPV policies

 Collaboration

[22]

• Collaborate with interprofessional team and management

 Support

[2, 12, 13, 17, 24]

• Listen to staff and offer post-event support

• Provide time for staff to formally report WPV

• Guide staff to additional resources for assistance

• Message the intolerance of WPV

Community Interventions

Collaboration

[6, 11, 13, 24, 26, 32, 34]

• Collaborate with external stakeholders to share data, identify solutions, and implement improvements (e.g. develop campaign on WPV in healthcare, develop global program for tracking and preventing WPV)

• Promote and sponsor legislation that supports and protects healthcare workers from WPV

• Collaborate with law enforcement to enforce laws that deter assaults on healthcare workers

• Work with academia to promote early education for nursing and medical students