Workplace violence against healthcare workers in emergency settings during and after COVID-19: a systematic review

Background: Workplace violence is a persistent occupational hazard for healthcare workers (HCWs), especially in high-risk environments such as Emergency Departments (EDs), Intensive Care Units (ICUs), and Emergency Medical Services (EMS). The COVID-19 pandemic further intensified this phenomenon, yet the post-pandemic landscape remains underexplored. This systematic review aimed to assess the prevalence of Workplace Violence (WPV), the extent of underreporting, and the barriers to disclosure among HCWs in emergency and critical care settings during the COVID-19 pandemic and the post-pandemic era. Methods: A systematic search was conducted in six databases (PubMed, Comulative Index to Nursing and Allied Health Literature (CINAHL), ProQuest, Scopus, Web of Science, PsycINFO) following Prefered Reporting Items for Systematic Review (PRISMA 2020) guidelines. Eligible studies included cross-sectional, qualitative, and mixed-methods designs published between March 2020 and February 2025. Methodological quality was appraised using standardized critical appraisal tools. Data were narratively synthesized based on three research questions: prevalence, underreporting, and barriers to disclosure. Results: Twenty-two studies were included. WPV prevalence remained high, with verbal abuse reported by over 75% of HCWs in several studies and physical violence ranging from 5.8% to 62%. Underreporting was widespread, with fewer than 25% of incidents formally documented. Main barriers to disclosure included perceived ineffectiveness of reporting, normalization of violence, lack of time, fear of retaliation, and unclear institutional procedures. Conclusion: WPV continues to represent a critical occupational hazard in emergency care settings post-COVID-19. Addressing it requires integrated, system-level interventions that foster leadership support, institutional accountability, and psychologically safe work environments for HCWs. The PROSPERO Registration: PROSPERO database (CRD420251035696).

Workplace violence; Emergency department; Critical care; Healthcare workers; Post-COVID-19; Systematic review; Prevalence; Underreporting

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