Background: Aggressive behavior and violence directed by patients at nurses are increasing worldwide. Aggressive behavior against nurses in their workplace can result in personal problems, such as impairment of physical and mental well-being, and, consequently, in organizational problems. Underreporting of patients' aggressive behavior is prevalent among nurses. Although underreporting might lead to inefficient attention to strategies for preventing aggressive behavior, the reasons for such behavior not being reported frequently have not been well examined. Objectives: To explore the frequency of nurses' reporting to their managers of patients' aggressive behavior by type and degree of impact suffered by the nurses, to examine the association between reporting of aggressive behavior and demographic factors, and to determine the reasons for underreporting. Design: A questionnaire-based cross-sectional survey. Setting: Six acute care hospitals in two regions in Japan. Participants: A total of 1953 nurses working at general acute care hospitals participated. Methods: Data were collected through a questionnaire seeking sociodemographic information, information on experience of aggressive behavior from patients, and the frequency with which they had reported such behavior in the previous month. The questionnaire also contained items assessing barriers to reporting of patients' aggressive behavior. The association between the possible influencing factors and reporting behavior was assessed using multiple logistic regression analyses. Results: Of the 1953 questionnaires distributed, 1498 (76.7%) were returned, and 1385 (70.9%) fully completed questionnaires were analyzed. More than one-third of the respondents had experienced the mildest assessed level of impact from patients' aggressive behavior, and 70% of those hardly reported any incidents. The milder the impact was, the less the nurse victims tended to report the incident. Nurse's tendency to feel that aggressive behavior was mitigated by the situation, less work experience, and lack of confidence that management would defend staff nurses from patients' aggressive behavior were found to be negatively associated with reporting behavior. Conclusions: This study identified factors associated with nurses' reporting of patients' aggressive behavior. Underreporting was found to be associated with the level of impact, managerial attitudes, nurses' work experience, and nurses' perception that the behavior was mitigated by the situation. Improving education among nurses to promote reporting incidents and establishing an organized system is needed.
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