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Intervenciones organizativas para prevenir y minimizar la agresión dirigida a los trabajadores sanitarios de parte de los pacientes y los defensores de los pacientes

Appendices

Appendix 1. MEDLINE search strategy

Abbreviations used in this document

mp

mp=title, abstract, original title, name of substance word, subject heading word, keyword heading word, protocol supplementary concept word, rare disease supplementary concept word, unique identifier

Database: Ovid MEDLINE(R) In‐Process & Other Non‐Indexed Citations and Ovid MEDLINE(R) <1996 to May 25 2019>
Search Strategy: (results in brackets)

Search no.

Keyword

1

Workplace Violence/

2

Violence/pc

3

violen*.mp.

4

aggress*.mp.

5

angry.mp.

6

hostil*.mp.

7

"inappropriate behavio?r".mp.

8

bullying.mp.

9

pester*.mp.

10

Bullying/

11

Aggression/

12

Hostility/

13

inappropriate behavio?r.mp.

14

(mob or mobs or mobbing).mp.

15

Agonistic Behavior/

16

harass*.mp.

17

disrupt*.mp.

18

incivility.mp.

19

abus*.mp.

20

assault*.mp.

21

Violence/

22

1 or 2 or 3 or 4 or 5 or 6 or 7 or 8 or 9 or 10 or 11 or 12 or 13 or 14 or 15 or 16 or 17 or 18 or 19 or 20 or 21

23

Health Occupations/ or Allied Health Occupations/

24

health personnel.mp. or Health Personnel/

25

personnel, hospital.mp. or Personnel, Hospital/

26

health care worker.mp.

27

health care workers.mp.

28

health care personnel.mp.

29

health‐personnel.mp.

30

health provider.mp.

31

health providers.mp.

32

health care provider.mp.

33

health care providers.mp.

34

health staff.mp.

35

health care staff.mp.

36

healthcare staff.mp.

37

health professional.mp.

38

health care professional.mp.

39

healthcare professional.mp.

40

health worker.mp.

41

medical staff.mp.

42

medical personnel.mp.

43

medical professional.mp.

44

medical worker.mp.

45

medical provider.mp.

46

military‐medical personnel.mp.

47

Physicians/ or physicians.mp.

48

Physician.mp.

49

doctor.mp.

50

practitioner.mp.

51

clinician.mp.

52

nurses.mp. or Nurses/

53

nurse.mp.

54

nursing staff.mp.

55

nursing assistant.mp.

56

nursing assistants.mp.

57

Nurses' Aides/

58

Nurse Midwives/

59

midwife.mp.

60

midwives.mp.

61

Dentists/ or dental personnel.mp. or Dental Staff/

62

dentist.mp.

63

dentists.mp.

64

dental assistant.mp.

65

dental assistants.mp. or Dental Assistants/

66

Pharmacists' Aides/ or Pharmacists/

67

pharmacist.mp.

68

physical therapists.mp. or Physical Therapists/

69

physical therapist.mp.

70

physiotherapist*.mp.

71

therapist*.mp.

72

Physical Therapist Assistants/

73

technician*.mp.

74

radiographer.mp.

75

radiographers.mp.

76

emergency medical services.mp. or Emergency Medical Services/

77

Patient Transfer/ or "Transportation of Patients"/ or transporting patients.mp.

78

patient transport.mp.

79

Allied Health Personnel/

80

paramedic*.mp.

81

paramedical personnel.mp.

82

emergency department.mp. or Emergency Service, Hospital/

83

emergenc*.mp.

84

health manager.mp.

85

health care manager.mp.

86

healthcare manager.mp.

87

clinical officer.mp.

88

reception.mp.

89

23 or 24 or 25 or 26 or 27 or 28 or 29 or 30 or 31 or 32 or 33 or 34 or 35 or 36 or 37 or 38 or 39 or 40 or 41 or 42 or 43 or 44 or 45 or 46 or 47 or 48 or 49 or 50 or 51 or 52 or 53 or 54 or 55 or 56 or 57 or 58 or 59 or 60 or 61 or 62 or 63 or 64 or 65 or 66 or 67 or 68 or 69 or 70 or 71 or 72 or 73 or 74 or 75 or 76 or 77 or 78 or 79 or 80 or 81 or 82 or 83 or 84 or 85 or 86 or 87 or 88

90

22 and 89

91

Organizational Policy/

92

Policy/

93

organi?ational polic*.mp.

94

policy.mp.

95

interven*.mp.

96

policies.mp.

97

management.mp.

98

Safety Management.mp. or Safety Management/

99

Staff Development.mp. or Staff Development/

100

Inservice Training.mp. or Inservice Training/

101

professional development.mp.

102

program*.mp.

103

aggression management.mp.

104

reduction.mp.

105

evaluation.mp.

106

decreas*.mp.

107

(prevention and control).mp.

108

measures.mp.

109

improv*.mp.

110

91 or 92 or 93 or 94 or 95 or 96 or 97 or 98 or 99 or 100 or 101 or 102 or 103 or 104 or 105 or 106 or 107 or 108 or 109

111

90 and 110

112

Randomized Controlled Trials as Topic/

113

randomi?ed controlled trial.mp.

114

randomi?ed.mp.

115

placebo.mp.

116

controlled clinical trial.mp. or Controlled Clinical Trial/

117

Clinical Trials as Topic/

118

randomly.mp.

119

trial.mp.

120

Random Allocation/

121

randomi?ation.mp.

122

Randomized Controlled Trial/

123

112 or 113 or 114 or 115 or 116 or 117 or 118 or 119 or 120 or 121 or 122

124

111 and 123

125

controlled before‐after study.mp. or Controlled Before‐After Studies/

126

controlled before‐after stud*.mp.

127

"controlled before and after stud*".mp.

128

CBA stud*.mp.

129

before‐after study.mp.

130

before‐after studies.mp.

131

125 or 126 or 127 or 128 or 129 or 130

132

111 and 131

133

prospective studies.mp. or Prospective Studies/

134

prospective study.mp.

135

longitudinal studies.mp. or Longitudinal Studies/

136

133 or 134 or 135

137

111 and 136

Appendix 2. Data extraction form

Cochrane Work Group

Cochrane Work title 029: Organisational interventions for preventing and minimising aggression directed towardshealthcare workers

Data collection form for intervention reviews: RCTs, cluster‐RCTs and CBAs

Review title or ID

Study ID

Report ID

Report ID of other reports of this study including errata or retractions

Notes

General information

Date form completed

Name/ID of person extracting data

Reference citation

Study author contact details

Publication type

Notes:

Study eligibility

Study characteristics

Eligibility criteria

Eligibility criteria met?

Location in text or source

Yes

No

Unclear

Type of study

Randomised controlled trial

Controlled before‐and‐after study

Participants

Types of intervention

Types of comparison

Types of outcome measures

INCLUDE

EXCLUDE

Reason for exclusion

Notes:

DO NOT PROCEED IF STUDY IS EXCLUDED FROM REVIEW

Characteristics of included studies
Methods

Descriptions as stated in report/paper

Location in text or source

Aim of study

Design

Unit of allocation

Start date

End date

Duration of participation

Ethical approval needed/obtained for study

Yes No Unclear

Notes:

Participants

Description

Location in text or source

Population description

Setting

Inclusion criteria

Exclusion criteria

Method of recruitment of participants

Informed consent obtained

Yes No Unclear

Total no. randomised

Clusters

Baseline imbalances

Withdrawals and exclusions

Age

Sex

Race/ethnicity

Severity of illness

Comorbidities

Other relevant sociodemographics

Subgroups measured

Subgroups reported

Notes:

Intervention groups

Intervention group 1

Description as stated in report/paper

Location in text or source

Group name

No. randomised to group

Theoretical basis

Description

Duration of treatment period

Timing

Delivery

Providers

Co‐interventions

Economic information

Resource requirements

Integrity of delivery

Compliance

Notes:

Outcomes (separate for each outcome)

  1. Number of episodes of aggression

  2. Number of episodes of aggression resulting in no harm or injury, psychological harm or injury, or physical harm or injury

Description as stated in report/paper

Location in text or source

Outcome name

Time points measured

Time points reported

Outcome definition

Person measuring/reporting

Unit of measurement

Scales: upper and lower limits

Is outcome/tool validated?

Yes No Unclear

Imputation of missing data

Assumed risk estimate

Power

Notes:

Other

Study funding sources

Possible conflicts of interest

Notes:

'Risk of bias' assessment

Domain

Risk of bias

Support for judgement

(include direct quotes where available with explanatory comments)

Location in text or source

Low

High

Unclear

Random sequence generation (selection bias)

Allocation concealment (selection bias)

Blinding of participants and personnel (performance bias)

Outcome group: All/

(if separate judgement by outcome(s) required)

Outcome group:

Blinding of outcome assessment (detection bias)

Outcome group: All/

(if separate judgement by outcome(s) required)

Outcome group:

Incomplete outcome data (attrition bias)

Outcome group: All/

(if separate judgement by outcome(s) required)

Outcome group:

Selective outcome reporting? (reporting bias)

Other bias

Notes:

Data and analysis (for each outcome)
Dichotomous outcome

Description as stated in report/paper

Location in text or source

Comparison

Outcome

Subgroup

Time point

Results

Intervention

Comparison

No. with event

Total in group

No. with event

Total in group

Any other results reported

No. missing participants

Reasons missing

No. participants moved from other group

Reasons moved

Unit of analysis

Statistical methods used and appropriateness of these

Reanalysis required?

Yes No Unclear

Reanalysis possible?

Yes No Unclear

Reanalysed results

Notes:

Continuous outcome

Description as stated in report/paper

Location in text or source

Comparison

Outcome

Subgroup

Time point

Post‐intervention or change from baseline?

Results

Intervention

Comparison

Mean

SD

No. participants

Mean

SD

No. participants

Any other results reported

No. missing participants

Reasons missing

No. participants moved from other group

Reasons moved

Unit of analysis

Statistical methods used and appropriateness of these

Reanalysis required?

Yes No Unclear

Reanalysis possible?

Yes No Unclear

Reanalysed results

Notes:

Other outcome

Description as stated in report/paper

Location in text or source

Comparison

Outcome

Subgroup

Time point

No. participant

Intervention

Control

Results

Intervention result

SE (or other variance)

Control result

SE (or other variance)

Overall results

SE (or other variance)

Any other results reported

No. missing participants

Reasons missing

No. participants moved from other group

Reasons moved

Unit of analysis

Statistical methods used and appropriateness of these

Reanalysis required?)

Yes No Unclear

Reanalysis possible?

Yes No Unclear

Reanalysed results

Notes:

Other information

Description as stated in report/paper

Location in text or source

Key conclusions of study authors

References to other relevant studies

Correspondence required for further study information

Notes:

Appendix 3. EMBASE search strategy

Database(s): Embase Classic+Embase

Search no. Keyword

1 workplace violence/

2 violence/

3 violen*.mp.

4 aggress*.mp.

5 angry.mp.

6 hostil*.mp.

7 (inappropriate behavior or inappropriate behaviour).mp.

8 bullying.mp.

9 pester*.mp.

10 Bullying/

11 Aggression/

12 Hostility/

13 inappropriate behavio?r.mp.

14 (mob or mobs or mobbing).mp.

15 Agonistic Behavior/

16 harass*.mp.

17 disrupt*.mp.

18 incivility.mp.

19 abus*.mp.

20 assault*.mp.

21 Violence/

22 1 or 2 or 3 or 4 or 5 or 6 or 7 or 8 or 9 or 10 or 11 or 12 or 13 or 14 or 15 or 16 or 17 or 18 or 19 or 20 or 21

23 Health Occupations/ or Allied Health Occupations/

24 health personnel.mp. or Health Personnel/

25 personnel, hospital.mp. or Personnel, Hospital/

26 health care worker.mp.

27 health care workers.mp.

28 health care personnel.mp.

29 health‐personnel.mp.

30 health provider.mp.

31 health providers.mp.

32 health care provider.mp.

33 health care providers.mp.

34 health staff.mp.

35 health care staff.mp.

36 healthcare staff.mp.

37 health professional.mp.

38 health care professional.mp.

39 healthcare professional.mp.

40 health worker.mp.

41 medical staff.mp.

42 medical personnel.mp.

43 medical professional.mp.

44 medical worker.mp.

45 medical provider.mp.

46 military‐medical personnel.mp.

47 Physicians/ or physicians.mp.

48 Physician.mp.

49 doctor.mp.

50 practitioner.mp.

51 clinician.mp.

52 nurses.mp. or Nurses/

53 nurse.mp.

54 nursing staff.mp.

55 nursing assistant.mp.

56 nursing assistants.mp.

57 Nurses Aides/

58 Nurse Midwives/

59 midwife.mp.

60 midwives.mp.

61 Dentists/ or dental personnel.mp. or Dental Staff/

62 dentist.mp.

63 dentists.mp.

64 dental assistant.mp.

65 dental assistants.mp. or Dental Assistants/

66 Pharmacists Aides/ or Pharmacists/

67 pharmacist.mp.

68 physical therapists.mp. or Physical Therapists/

69 physical therapist.mp.

70 physiotherapist*.mp.

71 therapist*.mp.

72 Physical Therapist Assistants/

73 technician*.mp.

74 radiographer.mp.

75 radiographers.mp.

76 emergency medical services.mp. or Emergency Medical Services/

77 Patient Transfer/ or Transportation of Patients.mp.

78 patient transport.mp.

79 Allied Health Personnel/

80 paramedic*.mp.

81 paramedical personnel.mp.

82 emergency department.mp. or Emergency Service, Hospital/

83 emergenc*.mp.

84 health manager.mp.

85 health care manager.mp.

86 healthcare manager.mp.

87 clinical officer.mp.

88 reception.mp.

89 23 or 24 or 25 or 26 or 27 or 28 or 29 or 30 or 31 or 32 or 33 or 34 or 35 or 36 or 37 or 38 or 39 or 40 or 41 or 42 or 43 or 44 or 45 or 46 or 47 or 48
or 49 or 50 or 51 or 52 or 53 or 54 or 55 or 56 or 57 or 58 or 59 or 60 or 61 or 62 or 63 or 64 or 65 or 66 or 67 or 68 or 69 or 70 or 71 or 72 or 73 or
74 or 75 or 76 or 77 or 78 or 79 or 80 or 81 or 82 or 83 or 84 or 85 or 86 or 87 or 88

90 22 and 89

91 Organizational Policy/

92 Policy/

93 organi?ational polic*.mp.

94 policy.mp.

95 interven*.mp.

96 policies.mp.

97 management.mp.

98 Safety Management.mp. or Safety Management/

99 Staff Development.mp. or Staff Development/

100 Inservice Training.mp. or Inservice Training/

101 professional development.mp.

102 program*.mp.

103 aggression management.mp.

104 reduction.mp.

105 evaluation.mp. 2021448
106 decreas*.mp.

107 (prevention and control).mp.

108 measures.mp.

109 improv*.mp.

110 91 or 92 or 93 or 94 or 95 or 96 or 97 or 98 or 99 or 100 or 101 or 102 or 103 or 104 or 105 or 106 or 107 or 108 or 109

111 90 and 110

112 Randomized Controlled Trials as Topic/

113 randomi?ed controlled trial.mp.

114 randomi?ed.mp.

115 placebo.mp.

116 controlled clinical trial.mp. or Controlled Clinical Trial/

117 Clinical Trials as Topic/

118 randomly.mp.

119 trial.mp.

120 Random Allocation/

121 randomi?ation.mp.

122 Randomized Controlled Trial/

123 112 or 113 or 114 or 115 or 116 or 117 or 118 or 119 or 120 or 121 or 122

124 111 and 123

125 controlled before‐after study.mp. or Controlled Before‐After Studies/

126 controlled before‐after stud*.mp.

127 (controlled before and after stud*).mp.

128 CBA stud*.mp.

129 before‐after study.mp.

130 before‐after studies.mp.

131 125 or 126 or 127 or 128 or 129 or 130

132 111 and 131

133 prospective studies.mp. or Prospective Studies/

134 prospective study.mp.

135 longitudinal studies.mp. or Longitudinal Studies/

136 133 or 134 or 135

137 111 and 136

138 124 or 132 or 137

Appendix 4. PSYCHINFO search strategy

Database(s): PsycINFO

Search Strategy:
# Searches Results
1 exp Workplace Violence/
2 exp VIOLENCE/
3 violen*.mp.
4 aggress*.mp.
5 angry.mp.
6 hostil*.mp.
7 inappropriate behavio#r.mp.
8 pester*.mp.
9 exp BULLYING/
10 exp Aggressive Behavior/
11 exp HOSTILITY/
12 inappropriate behavio#r.mp.
13 (mob or mobs or mobbing).mp.
14 Agonistic Behavior.mp.
15 harass*.mp.
16 disrupt*.mp.
17 incivility.mp.
18 abus*.mp.
19 assault*.mp.
20 exp VIOLENCE/
21 bullying.mp.
22 1 or 2 or 3 or 4 or 5 or 6 or 7 or 8 or 9 or 10 or 11 or 12 or 13 or 14 or 15 or 16 or 17 or 18 or 19 or 20 or 21
23 (Health Occupations or Allied Health Occupations).mp.
24 Health Personnel.mp. or exp Health Personnel/
25 Personnel, Hospital.mp.
26 health care worker.mp.
27 health care workers.mp.
28 health care personnel.mp.
29 health‐personnel.mp.
30 health provider.mp.
31 health providers.mp.
32 health care provider.mp.
33 health care providers.mp.
34 health staff.mp.
35 health care staff.mp.
36 healthcare staff.mp.
37 health professional.mp
38 health care professional.mp.
39 healthcare professional.mp.
40 health worker.mp.
41 medical staff.mp.
42 medical personnel.mp.
43 medical professional.mp.
44 medical worker.mp.
45 medical provider.mp.
46 military‐medical personnel.mp.
47 exp PHYSICIANS/ or Physicians.mp.
48 Physician.mp.
49 doctor.mp.
50 practitioner.mp.
51 clinician.mp.
52 nurses.mp. or exp NURSES/
53 nurse.mp.
54 nursing staff.mp.
55 nursing assistant.mp.
56 nursing assistants.mp.
57 Nurses Aides.mp.
58 Nurse Midwives.mp.

59 midwife.mp.
60 midwives.mp.
61 exp Dentists/ or dental personnel.mp.
62 dentist.mp.
63 dentists.mp.
64 dental assistant.mp.
65 dental assistants.mp.
66 Pharmacists Aides.mp.
67 exp PHARMACISTS/ or pharmacist.mp.
68 exp Physical Therapists/ or physical therapists.mp.
69 physical therapist.mp.
70 physiotherapist*.mp.
71 therapist*.mp.
72 Physical Therapist Assistants.mp.
73 technician*.mp.
74 radiographer.mp.
75 radiographers.mp.
76 emergency medical services.mp.
77 transporting patients.mp.
78 patient transport.mp.
79 exp Allied Health Personnel/
80 paramedic*.mp.
81 paramedical personnel.mp.
82 exp Emergency Services/ or emergency department.mp.
83 emergenc*.mp.
84 health manager.mp.
85 health care manager.mp.
86 healthcare manager.mp.
87 clinical officer.mp.
88 reception.mp.
89 23 or 24 or 25 or 26 or 27 or 28 or 29 or 30 or 31 or 32 or 33 or 34 or 35 or 36 or 37 or 38 or 39 or 40 or 41 or 42 or 43 or 44 or 45 or 46 or 47 or 48
or 49 or 50 or 51 or 52 or 53 or 54 or 55 or 56 or 57 or 58 or 59 or 60 or 61 or 62 or 63 or 64 or 65 or 66 or 67 or 68 or 69 or 70 or 71 or 72 or 73 or
74 or 75 or 76 or 77 or 78 or 79 or 80 or 81 or 82 or 83 or 84 or 85 or 86 or 87 or 88
90 22 and 89
91 Organizational Policy.mp.
92 Policy.mp.
93 organi#ational polic*.mp.
94 policy.mp.
95 interven*.mp.
96 policies.mp.
97 management.mp.
98 Safety Management.mp.
99 Staff Development.mp.
100 Inservice Training.mp. or exp Inservice Training/
101 professional development.mp.
102 program*.mp.
103 aggression management.mp.
104 reduction.mp.
105 evaluation.mp.
106 decreas*.mp.
107 (prevention and control).mp.
108 measures.mp.
109 improv*.mp.
110 91 or 92 or 93 or 94 or 95 or 96 or 97 or 98 or 99 or 100 or 101 or 102 or 103 or 104 or 105 or 106 or 107 or 108 or 109
111 90 and 110
112 Randomized Controlled Trials as Topic.mp.
113 randomi?ed controlled trial.mp.
114 randomi?ed.mp.
115 controlled clinical trial.mp.
116 Clinical Trials as Topic.mp.
117 randomly.mp.
118 trial.mp.

119 Random Allocation.mp.
120 randomi?ation.mp.
121 Randomized Controlled Trial.mp.
122 placebo.mp.
123 112 or 113 or 114 or 115 or 116 or 117 or 118 or 119 or 120 or 121 or 122
124 111 and 123
125 controlled before‐after study.mp.
126 controlled before‐after stud*.mp.
127 (controlled before and after stud*).mp.
128 CBA stud*.mp.
129 before‐after study.mp.
130 before‐after studies.mp.
131 125 or 126 or 127 or 128 or 129 or 130
132 111 and 131
133 exp Prospective Studies/ or prospective studies.mp.
134 prospective study.mp.
135 longitudinal studies.mp. or exp Longitudinal Studies/
136 133 or 134 or 135
137 111 and 136
138 124 or 132 or 137

Appendix 5. COCHRANE CENTRAL search strategy

Workplace Violence OR Violence OR violen* OR aggress* OR angry OR hostil* OR “inappropriate behavio?r” OR bullying OR pester* OR Bullying OR Aggression OR Hostility OR inappropriate behavio?r OR (mob or mobs or mobbing) OR Agonistic Behavior OR harass* OR disrupt* OR incivility OR abus* OR assault OR Violence

AND

Health Occupations OR Allied Health Occupations OR health personnel OR Health Personnel OR personnel, hospital OR Personnel, Hospital OR health care worker OR health care workers OR health care personnel OR health‐personnel OR health provider OR health providers OR health care provider OR health care providers OR health staff OR health care staff OR healthcare staff OR health professional OR health care professional OR healthcare professional OR health worker OR medical staff OR medical personnel OR medical professional OR medical worker OR medical provider OR military‐medical personnel OR Physicians OR physicians OR Physician OR doctor OR practitioner OR clinician OR nurses OR Nurses OR nurse OR nursing staff OR nursing assistant OR nursing assistants OR Nurses’ Aides OR Nurse Midwives OR midwife OR midwives OR Dentists OR dental personnel OR Dental Staff OR dentist OR dentists OR dental assistant OR dental assistants OR Dental Assistants OR Pharmacists’ Aides OR Pharmacists OR pharmacist OR physical therapists OR Physical Therapists OR physical therapist OR physiotherapist* OR therapist* OR Physical Therapist Assistants OR technician* OR radiographer OR radiographers OR emergency medical services OR Emergency Medical Services OR Patient Transfer OR “Transportation of Patients” OR transporting patients OR patient transport OR Allied Health Personnel OR paramedic* OR paramedical personnel OR emergency department OR Emergency Service, Hospital emergenc* OR health manager OR health care manager OR healthcare manager OR clinical officer OR reception

AND

Organizational Policy OR Policy OR organi?ational polic* OR policy OR interven* OR policies OR management OR Safety Management OR Safety Management OR Staff Development OR Staff Development OR Inservice Training OR Inservice Training OR professional development OR program* OR aggression management OR reduction OR evaluation OR decreas* OR (prevention and control) OR measures OR improv*

AND

Randomized Controlled Trials as Topic OR randomi?ed controlled trial OR randomi?ed OR placebo OR controlled clinical trial OR Controlled Clinical Trial OR Clinical Trials as Topic OR randomly OR trial OR Random Allocation OR randomi?ation OR Randomized Controlled Trial OR controlled before‐after study OR Controlled Before‐After Studies OR controlled before‐after stud* OR “controlled before and after stud*” OR CBA stud OR before‐after study OR before‐after studies OR prospective studies OR Prospective Studies OR prospective study longitudinal studies OR Longitudinal Studies

Appendix 6. OSHUPDATE search strategy

Results from OSH UPDATE + FIRE

#1 GW{Workplace Violence OR Violence OR violen* OR aggress* OR angry OR hostil* OR “inappropriate behavio?r” OR bullying OR pester* OR Bullying OR Aggression OR Hostility OR inappropriate behavio?r OR (mob or mobs or mobbing) OR Agonistic Behavior OR harass* OR disrupt* OR incivility OR abus* OR assault OR Violence}

#2 GW{Health Occupations OR Allied Health Occupations OR health personnel OR Health Personnel OR personnel, hospital OR Personnel, Hospital OR health care worker OR health care workers OR health care personnel OR health‐personnel OR health provider OR health providers OR health care provider OR health care providers OR health staff OR health care staff OR healthcare staff OR health professional OR health care professional OR healthcare professional OR health worker OR medical staff OR medical personnel OR medical professional OR medical worker OR medical provider OR military‐medical personnel OR Physicians OR physicians OR Physician OR doctor OR practitioner OR clinician OR nurses OR Nurses OR nurse OR nursing staff OR nursing assistant OR nursing assistants OR Nurses’ Aides OR Nurse Midwives OR midwife OR midwives}

#3 GW{Dentists OR dental personnel OR Dental Staff OR dentist OR dentists OR dental assistant OR dental assistants OR Dental Assistants OR Pharmacists’ Aides OR Pharmacists OR pharmacist OR physical therapists OR Physical Therapists OR physical therapist OR physiotherapist* OR therapist* OR Physical Therapist Assistants OR technician* OR radiographer OR radiographers OR emergency medical services OR Emergency Medical Services OR Patient Transfer OR “Transportation of Patients” OR transporting patients OR patient transport OR Allied Health Personnel OR paramedic* OR paramedical personnel OR emergency department OR Emergency Service, Hospital emergenc* OR health manager OR health care manager OR healthcare manager OR clinical officer OR reception}

#4 GW{#2 OR #3}

#5 GW{#1 AND #4}

#6 GW{Organizational Policy OR Policy OR organi?ational polic* OR policy OR interven* OR policies OR management OR Safety Management OR Safety Management OR Staff Development OR Staff Development OR Inservice Training OR Inservice Training OR professional development OR program* OR aggression management OR reduction OR evaluation OR decreas* OR (prevention and control) OR measures OR improv*}

#7 GW{#5 AND #6}

#8 GW{Randomized Controlled Trials as Topic OR randomi?ed controlled trial OR randomi?ed OR placebo OR controlled clinical trial OR Controlled Clinical Trial OR Clinical Trials as Topic OR randomly OR trial OR Random Allocation OR randomi?ation OR Randomized Controlled Trial}

#9 GW{#7 AND #8}

#10 GW{controlled before‐after study OR Controlled Before‐After Studies OR controlled before‐after stud* OR “controlled before and after stud*” OR CBA stud OR before‐after study OR before‐after studies}

#11 GW{#7 AND #10}

#12 GW{prospective studies OR Prospective Studies OR prospective study longitudinal studies OR Longitudinal Studies}

#13 GW{#7 AND #12}

#14 GW{#9 OR #11 OR #13}

Appendix 7. CINAHL search strategy

Interface – EBSCOhost. Research Databases Search Screen – Advanced Search. Database – CINAHL

Search no. Keyword
1 (MH "Workplace Violence")
2 (MH "Violence")
3 violen*
4 aggress*
5 angry
6 hostil*
7 “inappropriate behavio#r"
8 bullying
9 pester*
10 (MH "Bullying")
11 (MH "Aggression")
12 "Hostility"
13 inappropriate behavior
14 (mob or mobs or mobbing)
15 "Agonistic Behavior"
16 harassment
17 disrupt*
18 incivility
19 abus*
20 assault*
21 "Violence"
22 S1 OR S2 OR S3 OR S4 OR S5 OR S6 OR S7 OR S8 OR S9 OR S10 OR S11 OR S12 OR S13 OR S14 OR S15 OR S16 OR S17 OR S18 OR S19 OR S20 OR S21
23 (MH "Allied Health Professions") OR (MH "Health Occupations")
24 health personnel
25 (MH "Personnel, Health Facility") OR "personnel, hospital"
26 health care worker
27 health care workers
28 health care personnel
29 health personnel
30 health providers
31 health providers
32 health care providers
33 health care providers
34 health staff
35 health care staff
36 healthcare staff
37 health professionals
38 health care professional
39 healthcare professionals
40 health workers
41 medical staff
42 medical personnel
43 medical professionals
44 medical workers
45 medical providers
46 military medical personnel
47 (MH "Physicians") OR "Physicians"
48 Physician
49 doctors
50 practitioner
51 clinician
52 (MH "Nurses") OR "Nurses"
53 nurse
54 nursing staff
55 nursing assistant
56 nursing assistant
57 (MH "Nursing Assistants") OR "Nurses’ Aides"
58 (MH "Nurse Midwives") OR "Nurse Midwives"
59 midwife
60 midwives
61 "dental personnel"
62 (MH "Dentists") OR "dentists"
63 dentist
64 dental assistant
65 (MH "Dental Assistants") OR "Dental Assistants"
66 (MH "Pharmacists") OR (MH "Pharmacy Technicians")
67 pharmacist
68 (MH "Physical Therapists") OR "Physical Therapists"
69 physical therapist
70 physiotherapist*
71 therapist*
72 (MH "Physical Therapist Assistants") OR "Physical Therapist Assistants"
73 technician*
74 radiographer
75 radiographer
76 (MH "Emergency Medical Services") OR "Emergency Medical Services"
77 (MH "Transportation of Patients") OR "transporting patients"
78 patient transport
79 (MH "Allied Health Personnel") OR "Allied Health Personnel"
80 paramedic*
81 paramedical personnel
82 (MH "Emergency Service") OR "emergency department"
83 emergenc*
84 health manager
85 health care manager
86 healthcare managers
87 clinical officer
88 reception
89 S23 OR S24 OR S25 OR S26 OR S27 OR S28 OR S29 OR S30 OR S31 OR S32 OR S33 OR S34 OR S35 OR S36 OR S37 OR S38 OR S39 OR S40 OR S41 OR S42 OR S43 OR S44 OR S45 OR S46 OR S47 OR S48 OR S49 OR S50 OR S51 OR S52 OR S53 OR S54 OR S55 OR S56 OR S57 OR S58 OR S59 OR S60 OR S61 OR S62 OR S63 OR S64 OR S65 OR S66 OR S67 OR S68 OR S69 OR S70 OR S71 OR S72 OR S73 OR S74 OR S75 OR S76 OR S77 OR S78 OR S79 OR S80 OR S81 OR S82 OR S83 OR S84 OR S85 OR S86 OR S87 OR S88
90 S22 AND S89
91 (MH "Organizational Policies")
92 (MH "Policy Making")
93 organi?ational polic*
94 policy
95 interven*
96 policies
97 management
98 (MH "Occupational Safety") OR "Safety Management"
99 (MH "Staff Development") OR "Staff Development"
100 "Inservice Training"
101 professional development
102 program*
103 aggression management
104 reduction
105 evaluation
106 decreas*
107 (prevention and control)
108 measure
109 improv*
110 S91 OR S92 OR S93 OR S94 OR S95 OR S96 OR S97 OR S98 OR S99 OR S100 OR S101 OR S102 OR S103 OR S104 OR S105 OR S106 OR S107 OR S108 OR S109
111 S90 AND S110
112 (MH "Randomized Controlled Trials")
113 "randomi?ed controlled trial"
114 randomized
115 placebo
116 "Controlled clinical trial"
117 (MH "Clinical Trials")
118 randomly
119 trial
120 "Random Allocation"
121 randomization
122 (MH "Randomized Controlled Trials")
123 S112 OR S113 OR S114 OR S115 OR S116 OR S117 OR S118 OR S119 OR S120 OR S121 OR S122
124 S111 AND S123
125 (MH "Controlled Before‐After Studies") OR "controlled before‐after study"
126 controlled before‐after stud*
127 “controlled before and after stud*”
128 CBA stud*
129 before‐after study
130 before‐after studies
131 S125 OR S126 OR S127 OR S128 OR S129 OR S130
132 S111 AND S131
133 "prospective studies"
134 prospective study
135 "longitudinal studies"
136 S133 OR S134 OR S135
137 S111 AND S136
138 S124 OR S132 OR S137

Study flow diagram.

Figuras y tablas -
Figure 1

Study flow diagram.

Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.

Figuras y tablas -
Figure 2

Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.

Risk of bias summary: review authors' judgements about each risk of bias item for each included study.

Figuras y tablas -
Figure 3

Risk of bias summary: review authors' judgements about each risk of bias item for each included study.

Comparison 1: Vector‐directed at pre‐event versus practice as usual, Outcome 1: Incident scale (medium term)

Figuras y tablas -
Analysis 1.1

Comparison 1: Vector‐directed at pre‐event versus practice as usual, Outcome 1: Incident scale (medium term)

Comparison 1: Vector‐directed at pre‐event versus practice as usual, Outcome 2: Incident count (medium term)

Figuras y tablas -
Analysis 1.2

Comparison 1: Vector‐directed at pre‐event versus practice as usual, Outcome 2: Incident count (medium term)

Comparison 2: Vector‐directed at event versus practice as usual, Outcome 1: Incident scale (short term)

Figuras y tablas -
Analysis 2.1

Comparison 2: Vector‐directed at event versus practice as usual, Outcome 1: Incident scale (short term)

Comparison 3: Vector‐directed at pre‐event/event versus practice as usual, Outcome 1: Incident scale (long term)

Figuras y tablas -
Analysis 3.1

Comparison 3: Vector‐directed at pre‐event/event versus practice as usual, Outcome 1: Incident scale (long term)

Comparison 4: Multicomponent versus practice as usual, Outcome 1: Incident count (medium term)

Figuras y tablas -
Analysis 4.1

Comparison 4: Multicomponent versus practice as usual, Outcome 1: Incident count (medium term)

Comparison 5: Multicomponent versus physical fitness, Outcome 1: Incident count (short term)

Figuras y tablas -
Analysis 5.1

Comparison 5: Multicomponent versus physical fitness, Outcome 1: Incident count (short term)

Summary of findings 1. Vector‐directed intervention at pre‐event compared to practice as usual for preventing aggression directed towards healthcare workers by patients and patient advocates

Vector‐directed intervention at pre‐event compared to practice as usual for preventing aggression directed towards healthcare workers by patients and patient advocates

Patient or population: healthcare workers
Setting: nursing home and psychiatry
Intervention: vector pre‐event
Comparison: practice as usual

Outcomes

Anticipated absolute effects* (95% CI)

Relative effect
(95% CI)

№ of participants
(studies)

Quality of the evidence
(GRADE)

Comments

Risk with PAU

Risk with vector pre‐event

Overall aggression
assessed with: Cohen‐Mansfield Aggression Inventory
Scale from: 0 to infinite
Follow‐up: mean 26 weeks

The mean overall aggression change score was 0.1

MD change score 0.17 higher
(0.00 to 0.34 higher)

209
(1 RCT)

⊕⊕⊝⊝
Very low a,b

Larger change score means less violence

Overall aggression
assessed with: number of aggressive incidents
Follow‐up: mean 30 weeks

7222 per 1000

2600 per 1000
(1156 to 5633)

Risk ratio 0.36
(0.16 to 0.78)

20
(1 RCT)

⊕⊝⊝⊝

Very low a,b

*The risk in the intervention group (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI).

CI: confidence interval; MD: mean difference; PAU: practice as usual; RCT: randomised controlled trial

GRADE Working Group grades of evidence
High quality: further research is very unlikely to change our confidence in the estimate of effect.
Moderate quality: further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate.
Low quality: further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate.
Very low quality: we are very uncertain about the estimate.

aDowngraded one level because of possible selection bias.
bDowngraded two levels because small sample size (< 400) and one study only.

Figuras y tablas -
Summary of findings 1. Vector‐directed intervention at pre‐event compared to practice as usual for preventing aggression directed towards healthcare workers by patients and patient advocates
Summary of findings 2. Vector‐directed intervention at event compared to practice as usual for minimising aggression directed towards healthcare workers by patients

Vector‐directed intervention at event compared to practice as usual for minimising aggression directed towards healthcare workers by patients and patient advocates

Patient or population: healthcare workers

Setting: nursing home
Intervention: vector‐directed at event: playing music during bathing, special bathing techniques
Comparison: practice as usual

Outcomes

Anticipated absolute effects* (95% CI)

№ of participants
(studies)

Quality of the evidence
(GRADE)

Comments

Risk with PAU

Risk with vector event

Overall aggression
assessed with: number of aggressive incidents/CMAI
Scale from: 0 to infinite
Follow‐up: mean 8 weeks

SMD 0.49 lower
(0.93 lower to 0.05 lower)

82
(2 RCTs)

⊕⊕⊝⊝
Lowa,b

Indication of size of the effect: SMD of 0.20 is small effect, SMD of 0.40 is moderate effect and SMD of 0.80 is large effect

Physical aggression
assessed with: CMAI
Scale from: 0 to infinite
Follow‐up: mean 12 weeks

SMD 0.85 lower
(1.46 lower to 0.24 lower)

46
(1 RCT)

⊕⊝⊝⊝
Very Low

Verbal aggression
assessed with: CMAI
Scale from: 0 to infinite
Follow‐up: mean 12 weeks

SMD 0.31 lower
(0.89 lower to 0.27 higher)

46
(1 RCT)

⊕⊝⊝⊝
Very Lowc,d

*The risk in the intervention group (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI).

CI: confidence interval; CMAI: Cohen‐Mansfield Agitation Inventory; PAU: practice as usual; RCT: randomised controlled trial; SMD: standardised mean difference

GRADE Working Group grades of evidence
High quality: further research is very unlikely to change our confidence in the estimate of effect.
Moderate quality: further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate.
Low quality: further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate.
Very low quality: we are very uncertain about the estimate.

aDowngraded one level because of risk of bias: cross‐over trials without washout period and unclear random sequence generation.
bDowngraded one level because of small sample size (< 400).

c Downgraded with one level because of risk of bias: cross‐over trial without washout period and unclear sequence generation.

d Downgraded wit two levels because of small sample size and single study.

Figuras y tablas -
Summary of findings 2. Vector‐directed intervention at event compared to practice as usual for minimising aggression directed towards healthcare workers by patients
Summary of findings 3. Vector‐directed intervention at pre‐event/event compared to practice as usual for preventing and minimising aggression directed towards healthcare workers by patients and patient advocates

Vector‐directed intervention at pre‐event/event compared to practice as usual for preventing and minimising aggression directed towards healthcare workers by patients and patient advocates

Patient or population: healthcare workers
Setting: nursing home
Intervention: vector‐directed at both pre‐event and event
Comparison: practice as usual

Outcomes

Anticipated absolute effects* (95% CI)

№ of participants
(studies)

Quality of the evidence
(GRADE)

Comments

Risk with PAU

Risk with vector pre‐event/event

Physical aggression
assessed with: CMAI
Scale from: 0 to infinite
follow‐up: mean 2 years

The mean physical change score CMAI aggression was ‐ 0.27

MD change score CMAI 0.51 higher
(0.11 higher to 0.91 higher)

101
(1 observational study)

⊕⊝⊝⊝
Very lowa

Verbal aggression
assessed with: CMAI
Scale from: 0 to infinite
follow‐up: mean 2 years

The mean verbal change score CMAI aggression was ‐ 0.58

MD change score CMAI 0.76 higher
(0.02 lower to 1.54 higher)

101
(1 observational study)

⊕⊝⊝⊝
Very lowa

*The risk in the intervention group (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI).

CI: confidence interval; CMAI: Cohen‐Mansfield Agitation Inventory; PAU: practice as usual; MD: mean difference

GRADE Working Group grades of evidence
High quality: further research is very unlikely to change our confidence in the estimate of effect.
Moderate quality: further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate.
Low quality: further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate.
Very low quality: we are very uncertain about the estimate.

aDowngraded one level because of small sample size (< 400).

Figuras y tablas -
Summary of findings 3. Vector‐directed intervention at pre‐event/event compared to practice as usual for preventing and minimising aggression directed towards healthcare workers by patients and patient advocates
Summary of findings 4. Multicomponent intervention compared to practice as usual for preventing and minimising aggression directed towards healthcare workers by patients

Multicomponent compared to practice as usual for preventing and minimising aggression directed towards healthcare workers by patients and patient advocates

Patient or population: healthcare workers
Setting: emergency department
Intervention: multiple interventions including policy and practice change and education
Comparison: practice as usual

Outcomes

Anticipated absolute effects* (95% CI)

Relative effect
(95% CI)

№ of participants
(studies)

Quality of the evidence
(GRADE)

Comments

Risk with PAU

Risk with multi

Overall aggression
assessed with: aggression count
Follow‐up: mean 18 months

38 per 1000

0 per 1000
(0 to 0)

Not estimable

209
(1 observational study)

⊕⊝⊝⊝
Very low a,b

We could not obtain or calculate SDs. The change values were 0.04 for both the intervention and control groups.

*The risk in the intervention group (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI).

CI: confidence interval; SD: standard deviation

GRADE Working Group grades of evidence
High quality: further research is very unlikely to change our confidence in the estimate of effect.
Moderate quality: further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate.
Low quality: further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate.
Very low quality: we are very uncertain about the estimate.

aDowngraded one level because of CBA design.
bDowngraded one level because of small sample size (< 400).

Figuras y tablas -
Summary of findings 4. Multicomponent intervention compared to practice as usual for preventing and minimising aggression directed towards healthcare workers by patients
Summary of findings 5. Multicomponent intervention compared to physical fitness for preventing and minimising aggression directed towards healthcare workers by patients

Multicomponent intervention compared to physical fitness for preventing and minimising aggression directed towards healthcare workers by patients

Patient or population: healthcare workers
Setting: psychiatry
Intervention: multicomponent intervention
Comparison: physical fitness

Outcomes

Anticipated absolute effects* (95% CI)

Relative effect
(95% CI)

№ of participants
(studies)

Quality of the evidence
(GRADE)

Comments

Risk with physical fitness

Risk with multi

Overall aggression
assessed with: PCC
Follow‐up: mean 24 weeks

804 per 1000

777 per 1000
(720 to 825)

OR 0.85
(0.63 to 1.15)

1609
(1 RCT)

⊕⊕⊝⊝
Low a

*The risk in the intervention group (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI).

CI: confidence interval; OR: odds ratio; PCC: Patient‐staff Conflict Checklist; RCT: randomised controlled trial

GRADE Working Group grades of evidence
High quality: further research is very unlikely to change our confidence in the estimate of effect.
Moderate quality: further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate.
Low quality: further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate.
Very low quality: we are very uncertain about the estimate.

aDowngraded two levels because risk of bias due to unclear randomisation and blinding of outcome assessment.

Figuras y tablas -
Summary of findings 5. Multicomponent intervention compared to physical fitness for preventing and minimising aggression directed towards healthcare workers by patients
Table 1. Included studies summarised in the Haddon Matrix

Phase

Victim/healthcare worker

Vector/patient or their advocate

Social environment

Pre‐event

Bowers 2015

Gillespie 2014

Bowers 2015

Burack 2012

Gillespie 2014

Low 2014

van de Sande 2011

Bowers 2015

Gillespie 2014

Event

Bowers 2015

Gillespie 2014

Bowers 2015

Burack 2012

Clark 1998

Gillespie 2014

Sloane 2004

Bowers 2015

Gillespie 2014

Post‐event

No studies

No studies

No studies

Figuras y tablas -
Table 1. Included studies summarised in the Haddon Matrix
Comparison 1. Vector‐directed at pre‐event versus practice as usual

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1.1 Incident scale (medium term) Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Totals not selected

1.2 Incident count (medium term) Show forest plot

1

Risk Ratio (IV, Fixed, 95% CI)

Totals not selected

Figuras y tablas -
Comparison 1. Vector‐directed at pre‐event versus practice as usual
Comparison 2. Vector‐directed at event versus practice as usual

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

2.1 Incident scale (short term) Show forest plot

2

Std. Mean Difference (IV, Random, 95% CI)

Subtotals only

2.1.1 Total aggression score

2

82

Std. Mean Difference (IV, Random, 95% CI)

‐0.49 [‐0.93, ‐0.05]

2.1.2 Physical aggression

1

46

Std. Mean Difference (IV, Random, 95% CI)

‐0.85 [‐1.46, ‐0.24]

2.1.3 Verbal aggression

1

46

Std. Mean Difference (IV, Random, 95% CI)

‐0.31 [‐0.89, 0.27]

Figuras y tablas -
Comparison 2. Vector‐directed at event versus practice as usual
Comparison 3. Vector‐directed at pre‐event/event versus practice as usual

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

3.1 Incident scale (long term) Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Totals not selected

3.1.1 Physical agitation

1

Mean Difference (IV, Fixed, 95% CI)

Totals not selected

3.1.2 Verbal agitation

1

Mean Difference (IV, Fixed, 95% CI)

Totals not selected

Figuras y tablas -
Comparison 3. Vector‐directed at pre‐event/event versus practice as usual
Comparison 4. Multicomponent versus practice as usual

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

4.1 Incident count (medium term) Show forest plot

1

Odds Ratio (IV, Fixed, 95% CI)

Not estimable

Figuras y tablas -
Comparison 4. Multicomponent versus practice as usual
Comparison 5. Multicomponent versus physical fitness

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

5.1 Incident count (short term) Show forest plot

1

Odds Ratio (IV, Fixed, 95% CI)

Totals not selected

Figuras y tablas -
Comparison 5. Multicomponent versus physical fitness