A Scoping review protocol exploring aggression and hostility directed at pharmacists in healthcare settings and community pharmacies.

Introduction

Aggression and hostility directed towards healthcare professionals are widely recognised occupational hazards, with significant implications for staff wellbeing, patient safety, and workforce sustainability.¹ Such behaviours may include verbal abuse, threats, intimidation, and physical violence, and are increasingly reported across healthcare systems internationally.² Exposure to workplace aggression has been associated with adverse psychological outcomes, including stress, anxiety, burnout, reduced job satisfaction, and increased intentions to leave the profession, ultimately compromising the quality and safety of patient care.

While substantial research attention has focused on aggression experienced by nurses and physicians—particularly in emergency, psychiatric, and acute care settings—pharmacists have received comparatively limited focused investigation. This gap is notable given the evolving scope of pharmacy practice and the increasing visibility of pharmacists in both community and hospital settings. The central role of pharmacists in medication optimisation, patient counselling, chronic disease management, and the safe supply of medicines across both hospital and community settings across Ireland has evolved in recent years.³

Pharmacists frequently engage in interactions that may heighten the risk of aggressive or hostile behaviour. These include consultations involving medication access, prescription delays or refusals, opioid substitution therapy, controlled drugs, long waiting times, and encounters with patients or carers experiencing distress, pain, or frustration.³ In community settings, pharmacists are often highly accessible and may be the first point of contact for system-level pressures within primary care. In hospital environments, pharmacists work within complex, high-acuity systems where communication breakdowns and workload pressures may contribute to conflict.⁴ Within the Irish healthcare context, increasing service demand, workforce shortages, and expanding clinical responsibilities may further exacerbate exposure to aggression across pharmacy practice.⁵

Aggression and hostility towards pharmacists may have consequences extending beyond individual harm. Repeated exposure can negatively affect morale, professional engagement, and mental health, while also influencing communication with patients and colleagues. Such impacts may increase the risk of medication errors, compromise therapeutic relationships, and reduce overall quality of care.⁵ At an organisational level, unmanaged aggression contributes to absenteeism, reduced productivity, and workforce attrition, posing challenges to service delivery and health system resilience.

Understanding the nature, prevalence, risk factors, and consequences of aggression and hostility against pharmacists is therefore essential to inform policy development, workplace prevention strategies, education, and staff support mechanisms. However, existing evidence remains fragmented across jurisdictions, settings, and methodological approaches.⁶ Much of the emerging literature consists of cross-sectional studies, surveys, and national workforce or professional body reports, reflecting growing concern but lacking comprehensive synthesis.

A scoping review is an appropriate methodological approach to address this evidence gap. Scoping reviews enable systematic mapping of the breadth and characteristics of available evidence, accommodate diverse study designs, and support clarification of key concepts and definitions. This approach is particularly suitable where the evidence base is evolving and where recent empirical data require integration. An updated review is timely to incorporate new evidence, highlighting knowledge gaps, and discover future research requirements.⁷

An initial search of PubMed, the Cochrane Database of Systematic Reviews, PROSPERO, and the Open Science Framework registries identified no current or ongoing systematic or scoping reviews addressing aggression and hostility against pharmacists. This confirms the need for the proposed review to provide an in-depth overview of the available evidence and support policy and practice responses in Ireland and internationally. This scoping review is publicly available on the Open Science Framework (OSF) (URL: https://osf.io/cktbh/overview), to ensure transparency and reproducibility.

Review question

Sub questions:

Aims and objectives

Methods and analysis

This scoping review will follow the Joanna Briggs Institute (JBI) methodology for scoping reviews.⁸ The updated framework for scoping reviews established by Arksey & O’Malley, comprising six distinct stages, is outlined in the subsequent sections of this protocol.⁷ Furthermore, this review will adhere to PRISMA-ScR guidelines (Preferred Reporting Items for Systematic Reviews and Meta-Analyses – Scoping Review) to ensure comprehensive and transparent reporting.¹¹

Conclusion

This scoping review will provide a comprehensive overview of the existing literature on aggression and hostility against pharmacists in hospital and community settings. The findings will inform understanding of the scope and nature of the problem, identify gaps in knowledge, and support the development of targeted interventions and policies to protect pharmacists and improve workplace safety.

Declaration

This scoping review protocol is part of doctoral research conducted by the lead author. Ethical approval is not required, as the study involves the synthesis of publicly available literature and does not include primary data collection involving human participants.