Abstract
Healthcare students may experience violence from patients and bystanders while undertaking clinical placements. There is ambiguity around responsibility and strategies used to support students before, during and after incidents. A scoping review was conducted of peer reviewed publications (CINAHL, Embase, Medline, Web of Science) and grey literature (Open Grey, WONDER, WorldCat, Trove, Google Scholar). Twenty-nine studies were identified. Studies varied in the way responsibility for risks was shared between students, clinical facilitators, placement providers and universities. Five studies discussed underreporting of incidents as a known issue. Students on clinical placement who experience violence from patients or bystanders face unique challenges in identifying where to report or find support. While universities are generally aware of the risks of violence towards students undertaking placements there is no consensus between education and placement providers on responsibility for reducing violence or supporting students following incidents.
Keywords
Introduction
Clinical placements are a mandatory requirement for many students undertaking healthcare degrees. 1 For example, Registered Nursing students in Australia are required to spend a minimum of 800 hours undertaking clinical placement during their degree. 2 In order to provide appropriate clinical placement experiences many education providers outsource their placements by engaging with external healthcare organisations who agree to place their students within their organisations in a contractual relationship. 3 Students undergoing undergraduate healthcare placements are subject to a number of psychological and physical risks, including patient and bystander violence. 4
Patient and bystander violence occurs frequently within healthcare settings.
5
Violence and aggression against healthcare workers can come in a variety of forms. The World Health Organization Violence Prevention Alliance defines violence broadly as: The intentional use of physical force or power, threatened or actual, against oneself, another person, or against a group or community, that either results in or has a high likelihood of resulting in injury, death, psychological harm, maldevelopment, or deprivation . . .
6
Using a broad definition of violence allows space to acknowledge the significant impact that non-physical violence can have. 7 This definition is utilised for the term violence used throughout this paper.
Violence in healthcare is a ‘wicked problem’ that requires balancing the rights of the patient to receive care and the rights of the healthcare workers to safety within their workplace. 8 Feeling safe is fundamentally linked to individual and social wellbeing. 9 Society has an ethical obligation to provide healthcare workers with a safe workplace where they can provide care for patients. 10 This has been translated into a legal obligation in a number of countries and jurisdictions with the use of occupational safety regulations and legislation. Some countries have gone further and sought to protect healthcare workers by amending legislation to increase penalties for attacks on healthcare workers comparative to general populations. 11 These strategies do not just target the direct perpetrators of the violence, they have also sought to increase penalties for organisations that through lack of appropriate processes, equipment or systems fail to protect staff from foreseeable workplace injury. 11 This may encourage organisations to see that implementing stronger protections for frontline healthcare workers makes both moral and financial sense. 12 There are a number of existing organisational programs in healthcare settings designed to help staff members respond to violence, however the evidence for their impact is low. 13
There are some individual level risk factors that may increase the likelihood of a healthcare worker experiencing patient violence, one of which is inexperience. 14 Students who are new to the clinical environment may be enthusiastic about taking opportunities to engage with patients, but lacking in situational awareness and the risks associated with those interactions. 15 It is known that students who experience violence while on clinical placement may experience both short term impacts such as shock, and longer term impacts such as decreased confidence in themselves and disillusionment with their studies and future career plans.16,17 Violence against healthcare students presents a significant ethical challenge for educators and those looking to promote a stable future healthcare workforce. 10
When students experience violence at work or on placement it can have flow-on impacts to healthcare workforce and quality of patient care. 10 There can also be reputational risks that impact on the willingness of future students engaging with the healthcare professions. 17 As awareness of the impacts of workplace violence increases, there is an expectation that high quality workplace violence prevention programs and systems will become more integral to the working of healthcare systems. 12 For healthcare students there is a need for those systems to occur concurrently within both education and placement providers.
The onus of responsibility for supporting and ensuring safety of students who are undertaking supervised clinical placement while studying at external education providers can be unclear. 3 It has been reported that there is a lack of clarity about the boundaries of professional responsibility for university placement coordinators and their role in actively engaging in risk reduction and management for students on clinical placements. 18
The aim of this study is to identify how universities consider the risk of violence when undergraduate healthcare students are assigned to clinical placements. To do that we asked the following research questions:
(1) What specific violence related risks and vulnerabilities are known to exist in the literature for students on clinical placement?
(2) What information and data are available to assess the violence related risks for students on clinical placement?
(3) What roles do universities play in sharing the risks of violence related incidents towards students on clinical placement?
For simplicity this review will be limited to violence perpetrated by patients or bystanders and exclude horizontal violence or bullying from workplace and educational supervisors.
Methods
This review was conducted as a scoping review. Scoping reviews can provide a broad overview of the literature that exists in a particular topic and are appropriate in situations where it may be unclear what evidence exists or how the evidence in that space is being presented. 19
The key concepts identified for this review were ‘Risk of violence’, ‘Undergraduate students’ and ‘Student placement’. The three concepts were broken down and the key words related to each concept are listed in Table 1.
Key Concepts and Words.
The full search strategy for each database used is outlined in Appendix 1.
Experts in student placement and an experienced research librarian were consulted to develop key terms and a search strategy. This review utilised four academic databases: Medline, Cumulative Index to Nursing and Allied Health Literature, Embase (Ovid) and Web of Science. The review also considered grey literature. Grey literature is not published or controlled by commercial publishers and can come from a variety of government, business or academic sources. 20 Grey literature is often not identified through academic databases. A search for grey literature was conducted in February 2024 using the four steps set out by Godin et al. 21 This included searching of grey literature databases, use of customised google search engines, targeting relevant websites and consulting with experts. This study used Google Scholar and Grey Literature databases Open Grey, WONDER, WorldCat, and Trove. As stated by Mahood et al 20 grey literature search databases and search engines may not utilise controlled vocabulary, so terms associated with the key concepts of ‘risk’, ‘Undergraduate’ and ‘clinical placement’ were utilised. Where large numbers of hits were identified, results were sorted by relevance and the first 100 documents were obtained. This strategy is in line with Godin et al 21 who has suggested that when utilising large non-academic databases it may be acceptable to conduct a search that identifies a large number of responses and then utilise only the first 100 ‘hits’ for the search, because of the targeted prioritisation metrics utilised by the search engines. A university clinical placement coordinator was consulted as a content expert.
Inclusion
(1) Violence perpetrated by healthcare patients
(2) Undergraduate healthcare students
(3) Clinical placements undertaken as part of an undergraduate qualification
(4) University responsibility
(5) Any type of article/source
(6) Any date
(7) In English
Exclusion
(1) International placements
(2) Bullying/lateral violence
(3) Abstract/conference presentation only
Screening through citations while conducting a systematic review is a time consuming and tedious process that often results in identifying a high number of uncontroversial false positives. 22 To alleviate this burden on the research team, the lead author on this paper undertook an additional round of title screening where all obviously irrelevant titles were removed prior to abstract screening. Abstracts and full texts were screened using Covidence 23 by two reviewers, as detailed in the Prisma table set out in Figure 1. Where disagreements occurred the third author was available to provide input and discussion was had until consensus was reached.
Prisma diagram of search strategy.
A quality appraisal of studies was not conducted. This is in line with the view of Peters et al 24 who suggest that critical appraisal of the quality of studies in a scoping review is generally not recommended. Data was extracted in Covidence by a single author, and fact checking of data was conducted by multiple authors to ensure accuracy.
Results
Twenty nine studies were identified for inclusion. A grey literature search identified three relevant thesis (n = 3) in addition to the peer reviewed academic journal articles (n = 26). The largest number of studies came from Australia (n = 8) followed by United Kingdom (n = 4), Canada (n = 3), United States (n = 2) and Turkey (n = 2), with single studies coming from Germany, Iran, Ireland, Italy, Korea, Scotland, South Africa, Switzerland and Taiwan. The majority of studies looked at nursing students (n = 21). Other student disciplines identified included physiotherapy (n = 2), medicine (n = 2), paramedicine (n = 2), midwifery (n = 1) and social work (n = 1). One study identified both paramedic and midwifery students. Of the 29 studies, 18 focused exclusively on violence by patients and bystanders, nine studies included patient and bystander violence alongside horizontal violence and six studies included occupational risks from other workplace factors.
Seven studies did not report on the gender breakdown of the participants. Two studies looked at entirely female cohorts, 15 studies looked at cohorts with over 75% females.
Eighteen studies (55%) utilised cross sectional student surveys to collect information. Other studies utilised qualitative interviews (n = 3), pre-post intervention designs (n = 2), mixed methods (n = 2), retrospective audits of incident reports (n = 2), longitudinal survey research (n = 1) and program evaluation methodologies (n = 1). Four studies considered the impact of tailored violence prevention programs for students.25 -28 No studies considered the effectiveness of training programs by looking at changes in incident rates. A summary of the identified studies is set out in Table 2. Further detailed information is available in Supplementary File 1.
Summary of Included Studies.
What Specific Violence Related Risks and Vulnerabilities Are Known to Exist in the Literature for Students on Clinical Placement?
We separated violence into nine pre-defined subcategories (Physical Aggression, Verbal Aggression, Sexual harassment, Sexual assault, Threats, Discriminatory abuse, Risks going to/from work, Vexatious complaints and other). Studies were assessed to identify the presence of each subcategory of violence, with studies able to be assessed as including more than one type. Most studies assessed more than one risk. The vast majority of studies 28 (93%) identified a risk of physical violence from patients. Only Barbier et al 29 did not identify physical aggression as the study focused specifically on sexualised experiences of aggression. Verbal threats was the second most commonly identified risk 73% (n = 22). Fifty percent of studies (n = 15)16,26,29 -41 identified sexual harassment as a risk for students.
The studies reported inconsistently on the issue of sexual harassment. The authors categorised sexual harassment as sexualised behaviour not including touching or reaching the level of criminal behaviour, and sexual assault as any form of sexualised touching or behaviour that reached a criminal level. The data was extracted in accordance with whether the data was consistent with the categories, rather than how the incidents were described by the studies. As an example, the study by McManamny et al 35 described an incident in which a paramedic student was touched on the leg by a patient in a sexualised way but self described the incident as harassment. This was counted as a sexual assault in the analysis. Students were identified as a population particularly vulnerable to patient aggression for a variety of reasons. Most commonly because they were junior and/or female. Service level vulnerabilities in clinical placement providers were most often associated with the type of patients that the facility served.
What Information and Data Is Available to Assess the Risks?
18 studies specifically looked at the frequency of violence occurring towards students on clinical placements.26,29 -42 The Paramedic Workplace Violence Exposure Questionnaire was used in three studies.16,30,40 The Metropolitan Chicago Healthcare Survey was used in one study. 43
Attitudes towards violent incidents were also measured using survey tools including the Management of Aggression and Violence Attitude Scale, 44 the Mental Health Nursing Clinical Confidence Scale 28 the Impact of Event Scale 40 the Workplace Violence Scale (Turkish). 17 Eleven (33%) of the studies collected data through qualitative methods of open ended survey texts (n = 6)17,26,28,34,36,42 interviews(n = 3)16,45,46 or focus groups (n = 2).33,35 Acknowledging the heterogeneity of measures, it is not possible to conduct a meta-analysis of prevalence, with estimates varying widely between studies. Incident prevalence varies widely and is commonly believed to be underreported. Budden et al 31 identified that 71.3% of students who did experience violence, or bullying did not report that in any formal way. Reported rates range from Gaida et al 47 who identified no reported incidents of violence amongst a cohort of physiotherapy students, to Hallett et al 33 who identified 81% of student nurses had experienced violence.
Reporting rates and under reporting of violent incidents by students were identified in six studies.16,35,42,44,47,48 In a 2011 study of physiotherapy students in the United Kingdom, Stubbs et al 44 found that while 52% (n = 33) of their respondents had experienced aggression during clinical placement, none of the students had reported this to the university. McManamny et al 35 found that none of the incidents of physical, sexual or verbal violence identified in their study had been reported to the university. Gaida et al 47 conducted a large data audit of all incident reports submitted by physiotherapy students over a 4 year period and found that no instances of patient aggression had been recorded.
Five studies discussed underreporting and reasons for why it may have occurred.16,31,42,47,48 Looking at Paramedic students in Australia, Mitchell 16 found that while 98% of respondents (n = 69) were aware they could report incidents to their ambulance team leader, and 90% (n = 63) knew they could talk about incidents to their university course coordinator, only 21.7% (n = 15) were aware that they could formally report incidents to a university wide reporting system.
In a study of 888 Australian nursing students Budden et al 31 identified reasons for not reporting incidents including fear of ‘being victimised’ 53.3%(n = 292), believing that ‘nothing will be done’ about it 45%(n = 243), not knowing ‘where/how to report it’ 31.0%(n = 167), feeling that an incident is ‘not important enough ‘to report 26%,(n = 139), or perceiving that experiencing violence is ‘part of the job’24% (n = 129). Boucaut and Knobben 48 conducted an analysis of occupational health reports from a university school of nursing and found that less than 10% of reports related to violence, concluding that they were likely underreported due to known complexities with reporting forms and the onerous requirement for students to report to both the clinical placement provider and the university. In a Canadian study from 2005, Waddell et al 42 reported on the experiences of a medical student who had difficulty finding where to report an incident which occurred on clinical placement, because they were not a unionised employee and not eligible to fill in an employee incident report form.
Who Is Seen as Sharing the Risks?
Studies identified that a number of different parties were assigned responsibility for addressing the risk of aggression towards students on placement. Studies focused on risk prevention rather than follow up support. Students themselves were most commonly attributed responsibility 50%,(n = 15), followed by universities 46% (n = 14). In 13 studies (43%) it was not possible to identify the responsible party. A study from Iran by Samadzadeh et al 39 found societal perceptions played a significant role in contributing to violence against nurses and used this to suggest that the responsibility for reducing violence should lay with wider society. The overlaps between responsibility of the parties is illustrated in Figure 2 which shows a Venn diagram of overlaps in the 20 studies that identified at least one of students, universities, clinical facilitators or placement providers as responsible for the risk of aggression experienced by students on placement. One study 26 explicitly rejected the concept of overlapping responsibility, claiming that teaching students de-escalation techniques was a responsibility of nursing educators and that this was something that should not be passed on to be the responsibility of potential future employers.
Illustration of the overlapping responsibility for managing the risk of patient violence towards students on clinical placement by number of studies identifying.
Discussion
The aim of this study was to identify how universities consider the risk of violence when undergraduate healthcare students are assigned to clinical placements. This review provides a unique contribution to understanding how the risks of violence towards undergraduate health students are identified and understood. We considered the specific violence related risks and vulnerabilities that students may experience, the information that is available on those risks and who is taking responsibility for reducing or mitigating risks. We found that all except one study identified patient or bystander initiated physical violence as a risk. Fifteen of the studies identified sexual harassment and 11 studies identified sexual assault from patients as a risk for students. Universities and placement providers have discrete reporting processes that can be complex to undertake. A number of studies identified students who reported incidents to the researchers that they had not previously reported. Education providers are aware that students under report incidents and that there is significant ambiguity around who is responsible for risks that occur while students are on placement. While this review has focused specifically on university level healthcare education, the findings may also be relevant to other vocational healthcare education providers.
For Universities risk management of clinical placements is a balancing act. There are multiple stakeholders involved, and there is increasing awareness of the importance of including all of the parties involved in student placement to create student centric placement models. 49 The potential financial, reputational and legal risks to the university must be balanced against the strategic benefits of ensuring they are able to continue their core learning and teaching activities. Positive experiences of clinical placement can strengthen the relationships between universities and their external partners. 50 This review has found that many higher education institutions training healthcare workers are aware of the risks of physical, verbal and sexual aggression towards their students coming from patients and bystanders during clinical placements, but there is little publicly available data on strategies or models being used to manage this.
It has been established that violence towards students undertaking clinical placement in healthcare facilities poses a risk to the ongoing reputations of healthcare professions and is a disincentive to students considering entering the healthcare workforce. 17 However the risks to the universities that send those students on placements may be less clear cut. There are legal, reputational, operational, financial and strategic risks that are created when universities engage in contracts with external parties to facilitate student placements. 3 Clinical placements provide students with opportunities to learn offsite in workplaces and working conditions controlled by the third party placement providers rather than the university itself. 50 In this study it was identified that a significant number of studies looking at the risk to students on clinical placement did not identify who was responsible for ensuring student safety during placements with 13 studies (43%) not clearly identifying who was responsible for risks to students. Where the responsible parties were identified it was the student themselves 50% (n = 15), the universities 46% (n = 14) and shared between students and universities 17% (n = 5), with only one study identifying clinical placement providers as solely responsible, and no studies placing responsibility solely with clinical placement facilitators.
Particularly in healthcare disciplines where placements can be difficult to find, maintaining relationships with placement partners can be a priority. Universities are known to place significant priority in maintaining positive relationships with external placement providers. 3 No studies in this review identified or discussed what might be done if a clinical placement provider was found to be exposing students to unacceptable levels of workplace violence and aggression, and if there would be any circumstance where a placement was deemed too unsafe for students to continue. Some studies reported on the strength of relationships between the university and clinical placement providers. In a 2011 study in South Korea Lee et al 34 identified that there were lower rates of sexual harassment and assault towards students in hospitals affiliated with their university than in hospitals that were un-affiliated or were located in rural areas away from the university. It is important to emphasise the role of stakeholder collaboration and engagement in risk reduction. 2
To combat issues of violence effectively it is important to have adequate information on what is occurring through accurate reporting when incidents occur. Six of the studies in this review16,31,35,42,47,48 specifically referred to under reporting of violent incidents. We know that across the board incidents workplace violence in healthcare are underreported, particularly when there is a perceived lack of organisational support. 51 In a 2023 review, Spencer et al 52 identified the common reasons why nurses do not report on patient or visitor initiated violence. The study identified individual, management and organisational level barriers to reporting and found that of the three management was the strongest determinant of whether a person would report. When study participants identified that no action was taken following previous reports of violence this led to them perceiving reporting as ‘useless’. 52
Fear around consequences of reporting and the impact on future career progression can also play a significant role in decisions to report. 52 Healthcare students are very junior in their careers and may have additional perceived incentives for not reporting on incidents of violence that they experience on placement. Students may also lack awareness of reporting procedures at their clinical placement and/or university, which do not share data efficiently.16,31 Universities and education providers may be limited in their ability to respond to incidents that they are not aware of. When there is known underreporting it may create an implied ethical obligation on organisations to seek strategies to increase awareness of reporting options.
In the healthcare workforce students can experience power dynamics that place them in a position of vulnerability with both staff and patients. 31 While the interplay of relationships with staff and bullying is outside the scope of this study, it is acknowledged that the experience of patient aggression often sits beside and exacerbated by the power dynamics at play. Some specific subgroups of students were viewed as particularly vulnerable due to their inexperience, female gender and age. Two studies34,40 reported on entirely female cohorts. International students, or ethnic minorities were only identified as vulnerable by three studies, and none of those studies focused on them specifically. Clinical placement providers were seen as higher risk when they catered to high risk patients or were located in high crime areas.
Hospitals and healthcare providers have increased their focus on the rights and satisfaction of patients, which while important, may lead to unintended consequences for the safety of staff and students. 34 In a concerning case study from the United Kingdom, a nursing student reported on an incident where they experienced a physical assault (slap across the face) from a patient living with dementia. Immediately following the incident the student laughed with another colleague about the incident and was subsequently reported to the conduct in practice committee for unprofessional conduct by a staff member who witnessed the conversation. 53 While the student was cleared of all wrongdoing, they reflected on how this experience highlights difficulties students may face when they experience violence at work and the lack of available support for students who experience assault from patients. In a study in South Korea, Lee et al 34 found that students were focused on building the strong patient relationships that were required to meet their learning outcomes, and that the fear of harming those relationships could weigh on the students decisions to accept violent behaviours.
There has been a concerted push towards increased awareness of the risks of violence towards healthcare students and to providing them with safe placements for clinical work. 10 However, workforce pragmatics and staffing constraints may impact on the way that risks are seen and managed. It is known that people working in non-clinical roles in healthcare settings such as registration or finance are more likely to identify patient behaviours as reaching the threshold for criminal offences than the clinical staff caring for them. 54
In a study in Germany in 2007, Nau et al 46 interviewed students who had attended placements in psychiatric wards and found that they were tasked with caring for known aggressive patients when more experienced staff on the ward were overtaxed by other clinical roles. This lines up with the findings of Beech, 25 who conducted an intervention study for a student education program in the United Kingdom and reported that low staffing levels in hospitals had led to students being thrown in the deep end of dealing with patient de-escalation. Interestingly, when interpreting the significance of older studies around violence and aggression acceptance, McGuire et al 54 has found no clear consistent trends showing that healthcare workers with more years of experience were either more or less likely to view specific examples of patient aggression as reportable criminal offences.
In Spelten et al’s 55 Cochrane review on organisational interventions to reduce aggression in healthcare it was identified that there is very limited evidence associated with how organisations manage support in the post incident period. While follow up is important in all instances, it may be particularly important for students who are still considering what careers to pursue following graduation and whether to join the healthcare workforce. Student experiences of violence during their clinical placement may pose a significant challenge for the ongoing reputation and sustainability of caring professions. 17 A dramatic example of this is found in the recent work of Ferrara et al 9 who conducted a survey of 603 nursing students in Italy and found that almost a quarter of them were considering discontinuing their studies in response to experiences of aggression on clinical placement. Further work is needed to identify what supports students require. This cannot be ignored as an issue that has such potential to impact on the future healthcare workforce.
Recommendations
Governmental and regulatory actors are advised to consider the unique challenges of students on clinical placement when revising guidelines for workplace and worker safety.
Healthcare organisations should build data sharing around student risk into future contracts for clinical placement services, ensuring that data can be shared quickly following incidents and the ongoing support of students is prioritised.
Healthcare organisations should seek to improve student experiences following incidents of violence on clinical placement by collaborating to produce wrap around supportive interventions that ensure no matter where or how a student reports an incident of violence that they are offered appropriate supports.
Healthcare providers have an opportunity to collaborate with Universities to better understand the supports that students are seeking and receiving following incidents of violence on clinical placements through targeted research, allowing them to identify what current initiatives are working and what can be improved.
Limitations
This study included data from a wide range of countries and healthcare contexts, including a number of unpublished theses. It is known that incidents of aggression in healthcare are routinely underreported. Reporting is a known issue that was addressed in a number of the included studies. This study was also limited by publication bias as many documents related to universities internal risk assessment are not publicly available. Awareness of this bias has allowed for a robust discussion that considers the issues of reporting appropriately.
Conclusion
Undergraduate healthcare students are required to undertake clinical placement as part of their qualifications. Students are known to be at risk of physical, verbal and sexual violence from patients. While students are undertaking placement the responsibility for their safety and the processes for them reporting violent incidents, as well as follow-up, may not be clear. It is important that universities consider the risk of patient aggression towards students who are undertaking these placements. Students underreport incidents of violence to both placement providers and universities. Students who experience violence may be more likely to discontinue their studies or their healthcare careers impacting on the future healthcare workforce. Further work is needed to improve rates of incident reporting and establish clear responsibility for all areas of student safety.
Supplemental Material
sj-docx-1-his-10.1177_11786329251366383 – Supplemental material for Exploring the Current Practices of Universities Regarding the Risk of Violence Towards Undergraduate Students on Clinical Placements: A Scoping Review
Supplemental material, sj-docx-1-his-10.1177_11786329251366383 for Exploring the Current Practices of Universities Regarding the Risk of Violence Towards Undergraduate Students on Clinical Placements: A Scoping Review by Alycia Jacob, Evelien Spelten and Leigh Kinsman in Health Services Insights
Footnotes
Appendix 1: Full Search Strategy
| Medline AND CINAHL. |
|---|
| Risk assessment (MeSH), attitude to risk (MeSH), risk* |
| Aggression (MeSH), sexual harassment (MeSH) occupational hazards (MeSH), violence (MeSH), workplace violence (MeSH), exposure to violence (MeSH), Violen*, Danger*, Aggress*, Hostil*, Hazard*, Harass*, |
| Students, undergraduate (MeSH), students, college (MeSH), students, allied health (MeSH), students, health occupations (MeSH), students, nursing (MeSH), students, nursing, baccalaureate (MeSH), students, medical (MeSH), “college student*”, “university student*”, “health student*”, “allied health student*”, “undergraduate student*”, “medical student*”, “nursing student*” |
| Student placement (MeSH), fieldwork (MeSH), internship and residency (MeSH), residency, “work integrated learning” OR “WIL”, practicum, Intern*, fieldwork OR “field work” OR “field experience”, placement*, “professional experience”, “clinical placement”, “workplace learning”, “practice based learning”, clinicals, “clinical learning environment” |
| Limited to English |
| Web of Science. |
| Risk assessment, attitude to risk, risk* |
| Aggression, sexual harassment, occupational hazards”, “Workplace safety”, Violen*, Danger*, Aggress*, Hostil*, Hazard*, Harass* |
| “college student*” OR “university student*” OR “health student*” OR “undergraduate student*” OR College OR University |
| “work integrated learning” OR “WIL” OR practicum OR internship OR fieldwork OR “field work” OR “field experience” OR placement* OR “professional experience” OR “clinical placement” OR “workplace learning” OR “practice based learning” OR clinicals OR “clinical learning environment” |
| Limited to English |
| Search Terms for Embase. |
| risk*.mp. or Danger*.mp.or “danger, risk, safety and related phenomena”/“risk assessment”.mp. or risk assessment/ |
| harassment/or aggression/or Harass*.mp. or violence/or sexual harassment/Hazard*.mp. or hazard assessment/aggression/or hostility/or Hostil*.mp. “workplace violence”.mp. or workplace violence/ |
| university student/or exp health student/or undergraduate student/or college student/or student*.mp. |
| “work integrated learning”.mp. or/“WIL”.mp. practicum.mp. or/Fieldwork.mp. or field work/or/“field experience”.mp. or/Placement*.mp. or/“professional experience”.mp. or/“clinical placement”.mp. or clinical education/or “workplace learning”.mp. or/“practice based learning”.mp. or/“clinical learning environment”.mp. or/clinicals.mp. |
| Limited to English |
| Grey Literature: Trove. |
| kw:“risk” AND kw:student OR undergraduate AND kw: “clinical placement” OR placement |
| kw.“violence” OR “Aggression” AND kw:student OR undergraduate AND kw: “clinical placement” OR placement |
Author Contributions
AJ: Conceptualisation, methodology, investigation, formal analysis, original draft preparation and editing. ES: Supervision, conceptualisation, methodology, investigation, review and editing. LK: Supervision, conceptualisation, methodology, investigation, review and editing.
Funding
The author(s) received no financial support for the research, authorship, and/or publication of this article.
Declaration of Conflicting Interests
The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Supplemental Material
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References
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