A first element of complexity in studying WPV pertains to the definition of “violence” itself. To overcome this problem, the solution accepted by most scholars is to use a definition of violence that is generalized and generalizable, since the components and declination of violence are multiple and variegate [23]. For the aim of this paper, we refer to the World Health Organization [24], which describes violence as, “The intentional use of power, threatened or actual, against another person or against a group, in work-related circumstances, that either results in or has a high degree of likelihood of resulting in injury, death, psychological harm, maldevelopment, or deprivation”. Two fundamental aspects emerge from this definition. First of all, violence is considered an intentional act, committed by an agent who actively wants to harm another person. The second key point is that the idea of violence as a mere physical injury has been replaced by a broader concept that includes also psychological harm [25].

Although the concept of WPV is more specific than the concept of violence, for it encompasses a narrower field, there is not a unique definition in the literature. It is described using a wide range of words and situations that differ from each other, from physical and sexual aggression to verbal, mental and/or moral abuse [25,26,27,28,29,30,31]. A further complexity in identifying and classifying WPV is related to the contextual influences, as pinpointed by Waddington and colleagues [23]. The concept of violence cannot be detached from the socio-cultural context in which it is embedded. As stated by Escribano and colleagues [3], “workplace aggression does not occur in a social vacuum”, but it emerges in an interconnected framework that includes both organizational and psychosocial factors [32,33,34].

Since the socio-cultural context may play a significant role in studying the WPV phenomenon, as already done previously in other studies, e.g., [19,20], the aim of the present scoping review is to give a comprehensive picture of it in a European country, namely Italy.

For a long time in Italy, there has not been a specific law regarding violence in the workplace, nor any law concerning violence specifically designed for the health sector. The only existing protocol to control violent behavior in the health area was the one developed in 2005, initially on an experimental basis, by the Ministry of Labor, Health and Social Policies, named Protocol for Sentinel Events Monitoring. The latest version of this document dates back to 2009. It is a ministerial circular, a regulatory act that encourages and promotes good practices through the analysis of violent behavior. Its purpose, in fact, was to observe and monitor the so-called “sentinel events”, with the aim of defining this type of events in the same way at a national level. The objective of the Protocol for Sentinel Events was to have the same vision and the same line of action between Regions, Provinces and local health authorities operating in the area, to guarantee an Essential Level of Assistance. In recent years, to evaluate WPV in health sectors and contain its effects, various guidelines, good practices and recommendations have been issued by trade associations, the Ministry of Health, etc. However, these tools did not favor a systemic and quantitative approach to risk assessment or to identifying in an organic way the prevention and protection measures for the health care workers. Only very recently, with the law no. 4 (15 January 2021), the first in Europe, the Italian President of the Republic ratified the Convention of the International Labor Organization (n. 190) on the elimination of violence and harassment in the workplace, initially adopted in Geneva on 21 June 2019. The Convention may become an important tool in combating violence and sexual harassment in the workplace. First, as we did in this study, it provides the broad, internationally approved definition of violence of the World Health Organization (harassment or violence is any behavior likely to cause physical, psychological and economic harm). Furthermore, explicit reference is made to discrimination based on gender, recognizing that women are particularly exposed to physical, economic and psychological aggression in the workplace.

The aim of this work is to deepen the knowledge of violence in the workplace in healthcare settings within the Italian context, in order to lay the foundations for the structuring and the implementation of future prevention and containment interventions. For the purpose of this paper, we adopted the widely used classification in four main categories proposed by the University of Iowa Injury Prevention Research Center [35] (Westlawn, Iowa, with a specific focus on Type II workplace violence (in Type II, a customer, a patient, a client or an inmate is responsible for it, and the staff is the victim).

Based on the results of our scoping review, we can conclude that workplace violence is a phenomenon present among healthcare workers in Italy. Between 11.9 and 93.3% of HCWs reported having been victims of verbal aggressions and threats, while 27.5–50.3% claim to have been victims of physical violence. Considering the detection difficulties and the large methodological heterogeneity in monitoring the problem, it is recommended that the registers of aggression be standardized throughout the Italian territory and an adequate policy be structured in order to promote a greater awareness of HCW on the issues of violence in the workplace. More training would be needed, as well as carrying out targeted periodic dissemination campaigns, underling the importance of reporting all aggressions and providing specific information on the definition of the concept of “workplace violence”. In this way, it could be possible to obtain more information, to better monitor the phenomenon and implement more effective prevention and intervention protocols.