Occupational violence and aggression in urgent and critical care in rural health service settings: A systematic review of mixed studies

Rural/remote health services are vulnerable to occupational violence and aggression due to factors such as weapon accessibility, poor network coverage and distance to backup. This systematic review investigated (1) the nature of occupational violence and aggression perpetrated in rural/remote health service urgent care settings and (2) the availability and effectiveness of policies/interventions/recommendations that address occupational violence and aggression in this context. We searched Business Source Complete, CINAHL Complete, Health & Society, APAIS Health, Health Collection, PsycINFO, PubMed, Scopus, SocIndex and Web of Science. Included articles (peer-reviewed, no grey literature and English language) addressed occupational violence and aggression in rural health service urgent care settings. Fifteen articles matched these criteria (total [rural/remote only, where specified] N similar to 2555) and were included in the final analysis. The Mixed Methods Appraisal Tool was applied to assess the risk of bias. A data extraction table and narrative synthesis are presented. The most common occupational violence and aggression type was verbal aggression. The primary perpetrator was patients. Risk factors reflected practitioner age, remoteness, sector, staffing, shift type and area of practice. Precipitating factors were alcohol/drugs, dissatisfaction and mental health conditions. Policy content and limitations and education/training programme effectiveness were not addressed. Community collaboration supported occupational violence and aggression prevention/management. Organisational culture should promote reporting, debriefing and post-incident care for staff well-being. Work environment and job/task design are priorities for safety, but with possible limitations for traumatised clients. Occupational violence and aggression policies/interventions in rural health settings must be systematically evaluated to inform best practices. Co-funded by Swinburne Social Innovation Research Institute Interdisciplinary Seed Funding Scheme and SMART Rural Health Network.