No excuses, no exceptions except with compassion: A narrative review of visitor aggression in pediatrics

Visitor aggression in pediatrics is a form of workplace violence that has not received much focus across pediatric health care systems. There are many different practices, strategies, and policies implemented across children's hospitals to mitigate visitor aggression on both clinical and organizational levels. To date, there has not been a published review on interventions in pediatrics to de-escalate the intensity of these circumstances in the context of providing care and treatment to children. The goals of this review are to identify and assess the efficacy of each effort implemented across diverse pediatric health care settings. This review also proposes research, organizational, clinical, and policy implications and considerations that could help inform future practice in hospital-based violence prevention. A narrative review of the literature identified eleven peer-reviewed studies that delineated practices, strategies, and educational efforts between 1994 and 2020. All studies were descriptive in nature. There were four cross-sectional studies, three qualitative studies, one mixed-methods study, two prospective studies (one of which also had a group comparison design), and one non-experimental study. The primary measures implemented across children's hospitals involved increasing security and police presence in patient care areas (n = 3), development of multidisciplinary workgroups to review and revise visitation policies (n = 2), crisis response teams (n = 2), and incident reporting systems (n = 2). Hospital risk management, administration, and clinical leadership teams were stakeholders involved in designing interventions across studies. Hospitals varied in allocation of support resources and in defining visitor aggression which contributed to mixed findings across studies.