TABLE 2.

Data extraction table for empirical studies

	Author	Study design	Aim	Setting	Sample	Methods	Quality score	Findings
1	Birks et al. (2018)	Descriptive, cross‐sectional survey study	To explore Australian nursing students' experiences of bullying and harassment whilst on clinical placements.	Online survey available to all Australian nursing students enrolled in baccalaureate nursing degrees.	Convenience sample of 884 Australian baccalaureate nursing students' surveys, 398 returned qualitative comments 88% female, mean age 26 yrs	Cross‐sectional online survey ‐ content analysis of open‐ended comments	MMAT: 100%	Examples of student sexual harassment included lewd conversations and sexual suggestions towards them or around them, direct homophobia and transphobia (including a gay student falsely accused of sexual harassment), stalking, being “hit on”, inappropriate touching by a preceptor, an educator rubbing himself in an aroused state against a student.
2	Bronner et al. (2003)	Descriptive, cross‐sectional survey study	To determine the prevalence of different types of sexual harassment, identify common perpetrators, explore the feelings evoked in nurses and nursing students and identify individual responses to such incidents.	Five medical centres in Israel	Convenience sample (487) 281 nurses, 206 nursing students 390 female, 97 male	Self‐report questionnaire ‐ Validated	MMAT: 100%	Workplace sexual harassment is common for nurses and nursing students. Compared to females, males showed significantly fewer negative emotions following mild or moderate sexual harassment (65% and 33% respectively). For 23% of nursing students who were harassed, the level was severe compared to 33% of nurses (p = .032) and students reported a median of two versus 3 types of sexual harassment (p = .006). Nurses responded assertively more often than students (35.8% vs. 25.6%) and females more than males. In response to mild or moderate harassment, the most common perpetrators were male patients (18–38%), followed by male physicians (10–30%) and male nurses (15–22%). Female perpetrators were uncommon, but female patients performed more severe types of harassment (10–15%) while female nurses performed more mild types of harassment (12–14%). Training in assertiveness, and education on appropriate sexual conduct is required for nurses and nursing students. Male students and nurses may be subjected more commonly to severe forms of sexual harassment, and often respond less assertively than their female counterparts.
3	Budden et al. (2017)	Descriptive, cross‐sectional survey study	To determine the incidence and type of bullying and harassment experienced by student nurses on clinical placement, the type of perpetrators, the impact on students and the management of reporting	Online survey available to all Australian nursing students enrolled in baccalaureate nursing degrees	888 Australian nursing students. 89% were female and median age 26 years.	Self‐report questionnaire ‐ Validated	MMAT: 80% Unable to assess risk of non‐response bias	Of 888 participants, 11.6% reported sexual harassment occurring often or sometimes, and 35% reported occasional sexual harassment. Types of harassment included sexist remarks (15%), suggestive sexual gestures (13%), inappropriate touching (11%), unwanted request for intimate physical contact (6.6%), and threat of sexual assault (1%). Reporting of other measured elements not separated from other types of harassment.
4	Çelebioĝlu et al. (2010)	Descriptive, cross‐sectional survey study	To determine nursing students' experiences of violence in clinical settings. Also aimed to explore the type of violence, effects of such interactions, and whether students often confronted this behaviour.	School of Nursing and School of Health, Ataurk University.	Convenience sample 380 nursing students gender not specified	Questionnaire	MMAT: 100%	Of 191 reported cases of violence 4.2% was sexual violence. In the 8 cases of sexual violence 3 perpetrators were patient/family, 3 were doctors and 2 were other staff. Education around communication, and responses to violence in the workplace should be implemented.
5	Celik and Bayraktar (2004)	Descriptive cross‐sectional survey study	To identify the frequency, type, source, and effects of abuse on nursing students. Also aimed to explore students coping strategies following abuse.	Nursing school in Ankara, Turkey	Convenience sample 225 nursing students Gender not specified	Questionnaire ‐ validated	MMAT: 100%	Abuse of nursing students was identified as a major issue with 53.3% of students having experienced sexual abuse. Sexual abuse is most often perpetrated by patients (32.5%) followed by patient relatives (30%) and faculty staff (9.2%). 22.7% of nursing students reported experiences of sexual harassment on placement. Examples were unwanted sexual jokes/conversation, being asked out, unwanted mail or phone contact, suggestive behaviours and touching or being shown someone's body in a sexual way. Sources of abuse were patients (32.5% < family (30% < physicians (28%) and faculty (9.2%). Training and education surrounding violence is suggested.
6	Chang et al. (2021)	Randomised controlled trial	To evaluate the effects of a clinical‐based sexual harassment prevention e‐book on nursing students' knowledge, prevention strategies, coping behaviours, and learning motivation	A university in central Taiwan	Stratified block randomisation 66 fourth‐year nursing students	Randomised controlled trial	MMAT: 80% (unable to assess whether outcome assessors are blinded to intervention)	A clinical‐based sexual harassment prevention e‐book was effective in significantly improving nursing students' prevention knowledge and competence in responding to sexual harassment. Coping behaviours were significantly higher in both groups after the intervention (but no difference between groups)
7	Chang et al. (2020)	Descriptive, cross‐sectional survey study	To report nursing students' experiences, knowledge, responses, and determinants of sexual harassment during clinical placement.	four universities in Central Taiwan	Convenience sample 291 senior nursing students 253 female, 38 male	Cross‐sectional survey using a self‐report questionnaire	MMAT: 100%	22.7% of participants had experienced sexual harassment during placement. Improved educational programmes are required to prevent incidents of sexual harassment towards nursing students and improve gender sensitivity among the population.
8	Cogin and Fish (2009)	Mixed method (quantitative survey & semi‐structured interviews)	To explore the prevalence of sexual harassment in nursing. Also aims to identify environmental factors that contribute to such incidents.	Eight Australian public hospitals in NSW and Victoria	Representative convenience sample (538 participants) 287 nurses, 251 nursing studentsl442 female, 96 male	mixed methods: questionnaire & semi‐structured interviews	MMAT: 70% (poor integration of qualitative and quantitative components; Response rate of 21.6%)	60% of female participants and 30% of male participants reported experiencing an incident of sexual harassment in the 2 years prior to the interview/survey with a higher prevalence for students (68%) versus graduate nurses (45%). Nurses' perceptions surrounding leadership styles of their managers are an important variable in sexual harassment. An unbalanced gender ratio in the workplace contributes to the high incidence of sexual harassment in nursing. Sexual harassment directed to nurses from patients are less likely to instil feelings of intimidation, humiliation or embarrassment compared to the same behaviour from physicians or colleagues.
9	El‐Ganzory et al. (2014)	Pre‐post intervention survey study	to investigate the effect of an educational guideline programme on internship nursing students facing sexual harassment behaviours.	Ain Shams University Hospital (Egypt)	Purposive sample 60 nursing students 52 female, 8 male	Structured questionnaire	MMAT: 60% (unable to assess risk of nonresponse bias) Conflicting data on age reported between table and text	Patients were the perpetrator in 71% of cases followed by relatives and physicians. Only 28.3% reported the harassment. None had received education on sexual harassment prior to the intervention. This educational intervention significantly improved student nurses' knowledge of, emotional reactions to, and coping mechanisms, related to incidents of sexual harassment.
10	Ferns and Meerabeau (2008)	Descriptive, cross‐sectional survey study	To explore the nature, degree, prevalence and perpetrators of verbal abuse towards nursing students during clinical placements.	One pre‐registration nursing programme in England.	Convenience sample 114 nursing students 91 female, 14 male	Questionnaires ‐ Validated	MMAT: 100%	64.7% of general verbal abuse (inclusive of sexual verbal abuse) was perpetrated by patients, followed by visitors/relatives (15.7%), & colleagues (19.6%). Quantitative results did not differentiate sexual from other abuse, however, qualitative data exemplified distressing sexual harassment of students. Education, support, and current policies surrounding verbal abuse are not efficient in preparing nursing students, and should be better implemented.
11	Finnis and Robbins (1994).	Quantitative & qualitative survey	Outlines the extent, nature, common perpetrators and circumstances of sexual harassment of nursing students and nurses. Also aims to explore the relationship between sex role identity and assertiveness to sexual harassment.	One university (location not specified) Published in the United Kingdom	Convenience (91) 65 nurses, 26 students 87 female, 5 male (Nurses asked to reflect on harassment experiences as students)	Piloted questionnaire Theoretical lens	MMAT: 100%	77% reported experiencing sexual harassment as students during clinical placement. Both physical and verbal sexual harassment was highly prevalent for nurses and nursing students, especially females with the perpetrator being male in 92% of cases. Most common perpetrators for students were patients and doctors. Sexual harassment caused physical responses such as sleep disturbance, and headaches, anger, disgust, annoyance, resentment, and embarrassment.
12	Hallett et al. (2021)	Convergent mixed methods	To explore the prevalence of aggression towards nursing students during placement and report the rates and experiences of reporting the same. Aims to provide a thorough understanding of students' experiences of workplace violence.	Two universities in the United Kingdom	Convenience sample 129 Pre‐registration nursing students 120 female, 7 male	Mixed methods: cross‐sectional survey and qualitative focus group	MMAT: 100%	Nursing students commonly experience many types of aggression whilst on placement. One in three (39.5%) of students had been harassed sexually in the previous year, with nearly one‐third experiencing four or more incidents. Around half of sexual harassment cases were reported. Extended research into long‐term outcomes and effects of aggression as well as targeted educational programmes for nursing students would improve preparation for these experiences.
13	Kettl et al. (1993)	Pre‐post intervention survey study	To determine the prevalence of sexual harassment towards health care students whilst on clinical placement at a psychiatric hospital	3 Universities (locations not specified) Published in Pennsylvania	Convenience sample 158 nursing and occupational therapy students 151 female, 7 male	Quantitative questionnaire	MMAT: 80% unable to assess risk for nonresponse bias)	Nursing students were analysed separately from occupational therapy students with no significant differences in results. Harassment took the form of verbal innuendo (40%), verbal request for sex (22%) minor physical sexual assault 18%) and forceful sexual assault (16%). Common responses to sexual harassment identified include ignoring the behaviour (39%), verbal redirection, limit setting, education about the relationship, and physical intervention. 49% had received education about handling sexual harassment, yet 86% felt such training was necessary.
14	Lee et al. (2011)	Qualitative descriptive study	Identify Korean nursing students' experiences and perceptions of sexual harassment during clinical placement	12 Nursing colleges in Korea	Convenience sample 542 nursing students only single, female students sought for inclusion)	self‐report questionnaire	MMAT: 100%	Nursing students are a risk group for sexual harassment, with 52% of students indicating they had experienced at least one incident. The perpetrator was found to be male in 97.9% of cases (NB: there were no male students recruited). Psychiatric wards were the highest venue of prevalence (67%). 60% had received training in sexual harassment in the past and 88% believed training was necessary to create a safe educational space for clinical placement.
15	Magnavita and Heponiemi (2011)	Descriptive, cross‐sectional survey study	To better understand the characteristics and effects of violence towards nurses and nursing students, compare the differences between the two groups, and build preventative measures.	Three Italian universities, and one general Italian hospital	Convenience 275 nurses, 346 students 461 female, 155 male	Retrospective survey	MMAT: 100%	20% of students reported experiencing sexual harassment in the 12 months prior to the study compared to 37% of nurses. Majority of nurse and student victims of sexual harassment and stalking were female (82–88%) Protective measures are required to manage violence in clinical practice towards nurses and nursing students from both patients and colleagues.
16	Kim et al. (2018)	Interpretive phenomenological study	To examine nursing students experience of sexual harassment during clinical placements.	Two universities in South Korea	Purposive snowball sampling 13 nursing students 11 female, 2 male	Individual in‐depth interviews	MMAT: 100%	Twelve themes included: “unprepared to respond”, “lack of education”, “unsure about when behaviour crosses the line”, “power differential for nursing students”, “balancing self‐preservation with obligations to patients”, “shame”, “feeling responsible for not being able to prevent the harassment”, “impact on patient care”, “fear of what might have happened”, “fear of repercussions”, “long term impact”, and “peer support”. Nursing students struggled to balance the obligation to care with feelings of vulnerability due to sexual harassment and negative emotions arising from sexual harassment Support in recognition and response to sexual harassment is vital to ensure quality learning and quality care.
17	Seed (1995)	Longitudinal grounded theory study	To narrate the experiences of student nurses whilst providing intimate care in the clinical setting over the course of their studies.	Multiple clinical placement settings of students over a 3‐year period throughout the United Kingdom	Not stated, query theoretical sampling of 23 student nurses 20 female, 3 male	Participant observation & interviews Grounded theory	MMAT: 80% (does not explicitly state aim of paper)	Students found giving intimate care to “different” (gendered) bodies stressful. They described having to consciously view them as “patients” rather than “men” (or for male students, women). Perpetrators were difficult to avoid at work. Female students were cast in the role of “available female”. Female students were criticised for talking to younger male patients and were redirected to tasks such as cleaning so that “establishment of nurse patient relationships was discouraged by systems of work”. Sexual harassment was normalised socially as “just something men do”. Some students hid their nursing identity outside of work because of a “sexy nurse” stereotype promoted in popular culture and tabloid media. The caring of male students was seen as atypical in that “caring is ‘given to’ women and that ‘not caring’ becomes the defining characteristic of manhood. Humour and ignoring the incident was used as a coping mechanism.
18	Tollstern et al. (2020)	Descriptive, cross‐sectional survey study	To identify the prevalence, subtypes, and consequences of sexual harassment towards nurses and nursing students at a hospital in Tanzania.	A regional university hospital in Tanzania	Convenience sample 97 nurses and 100 nursing students 133 female, 64 male	Cross‐sectional questionnaire ‐ Validated	MMAT: 100%	10% of participants had been subjected to sexual harassment in the workplace. No significant difference between nurses and students in frequency of different types of sexual harassment. 1.4% of students had experienced severe sexual assault (trying to have sex with them). When including by proxy victims, the prevalence of sexual harassment rose to 36.5%. The most frequent forms were ‘sexual jokes and comments’, and ‘unwelcome hugging or kissing’. Females (73.7%) and students (11% versus 8%) experienced higher rates of sexual harassment. Perpetrators were mostly male physicians. Over 30% of participants reported feeling depressed and uncomfortable returning to work, and 40% stated they felt angry and afraid.
19	Zeng et al. (2019)	Systematic review and meta‐analysis of observational studies	To analyse the prevalence of sexual harassment of nurses and nursing students in China	China	Reviewed literature from English & Chinese databases: English: Pubmed, EMBASE, PsychINFO, Web of Science, & OVID Chinese: China National Knowledge Internet, WanFang, SinoMed, & Chinese VIP information	Meta‐analysis	CASP systematic review checklist 77.7% (clearly focussed issue but no research question. Not all outcomes considered. Question 10 re benefits excluded as no intervention)	Sexual harassment is highly prevalent for nurses (7.5%) and nursing students (7.2%) in China, with an estimated 129,600 students being possibly subjected. Preventative workplace methods should be developed and implemented.