{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,20]],"date-time":"2026-07-20T16:06:21Z","timestamp":1784563581280,"version":"3.55.0"},"reference-count":31,"publisher":"BMJ","issue":"7","license":[{"start":{"date-parts":[[2026,7,20]],"date-time":"2026-07-20T00:00:00Z","timestamp":1784505600000},"content-version":"unspecified","delay-in-days":19,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2026,7,3]]},"published-print":{"date-parts":[[2026,7]]},"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Healthcare professionals in general and academic hospitals increasingly face challenging behaviour from patients and their close contacts, particularly in acute care settings. Ranging from aggression to socially inappropriate actions, such behaviour is understood as interactional and context-dependent. Yet research largely focuses on verbal and physical aggression, leaving other forms and hospital context underexplored, despite concerns about staff safety, workforce sustainability and care quality.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods and analysis<\/jats:title>\n                    <jats:p>This scoping review aims to map literature on challenging behaviour in adult general and university hospital care (types of behaviour, prevalence, associated risk and protective factors, contextual influences, management and prevention strategies, definitions, conceptualisations of challenging behaviour and their implications for research, practice and policy). We will include adult patients and their close contacts (eg, family members, informal caregivers) (\u226518 years) receiving somatic care in general or university hospitals. Psychiatric, forensic, prison, long-term care, rehabilitation and specialised geriatric settings will be excluded. The review focuses on behaviour within patient-provider or close contact-provider interactions. Peer-reviewed studies of any design and grey literature (eg, guidelines, policy documents, toolkits) published in English from 2010 onwards will be included. Searches will be conducted in MEDLINE, Embase, APA PsycINFO, CINAHL, Web of Science, Scopus and the Cochrane Library, supplemented by grey-literature searches in Google, Overton and relevant organisational websites. Data will be charted on study characteristics, types and prevalence of behaviour, associated factors, contextual features and management and prevention strategies and synthesised narratively and in tables.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Ethics and dissemination<\/jats:title>\n                    <jats:p>Ethical approval is not required as the review uses publicly available sources. Although formal ethics review was not required, the authors considered the broader ethical dimensions of the work, including the potentially sensitive and stigmatising nature of the concept of challenging behaviour, the role of contextual and organisational factors and the responsible involvement of stakeholders and experts by experience in interpreting and contextualising the findings. Findings will be disseminated through open-access publication, conference presentations, stakeholder meetings, local\/national practice and policy networks. Stakeholder collaboration supports safe, effective care, enhances staff safety and supports high-quality, patient-centred care and workforce sustainability.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Trial registration number<\/jats:title>\n                    <jats:p>DOI10.17605\/OSF.IO\/GA3EX.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2025-114718","type":"journal-article","created":{"date-parts":[[2026,7,20]],"date-time":"2026-07-20T15:30:29Z","timestamp":1784561429000},"page":"e114718","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Challenging behaviour by patients or close contacts, as experienced by healthcare workers in adult general and university hospital care: a scoping review protocol"],"prefix":"10.1136","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8802-5442","authenticated-orcid":false,"given":"Philom\u0450ne Margit","family":"Klok","sequence":"first","affiliation":[{"name":"Department of Psychiatry, Radboud University Medical Center, Nijmegen, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lotte","family":"Broersma","sequence":"additional","affiliation":[{"name":"Department of Psychiatry, Radboud University Medical Center, Nijmegen, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2681-9180","authenticated-orcid":false,"given":"Wichor Matthijs","family":"Bramer","sequence":"additional","affiliation":[{"name":"Medical Library, Erasmus Medical Center, Rotterdam, Zuid-Holland, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Indira","family":"Tendolkar","sequence":"additional","affiliation":[{"name":"Department of Psychiatry, Radboud University Medical Center, Nijmegen, The Netherlands"},{"name":"Donders Institute for Brain Cognition and Behavior, Center for Cognitive Neuroimaging, Nijmegen, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1219-1118","authenticated-orcid":false,"given":"Maarten","family":"Van Schijndel","sequence":"additional","affiliation":[{"name":"Department of Psychiatry, Rijnstate Hospital, Arnhem, The Netherlands"},{"name":"Erasmus School of Health Policy and Management, Erasmus Universiteit Rotterdam, Rotterdam, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2026,7,20]]},"reference":[{"key":"2026072008301479000_16.7.e114718.1","doi-asserted-by":"crossref","unstructured":"Mart\u00ednez-Mu\u00f1oz M , Barba-Flores MA , Andr\u00e9s Escobedo D , et al . 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