Association Between Witnessing and Justifying Workplace Violence Towards Nurses in Israel.

Background: Workplace violence perpetrated by patients and their families towards nurses has become a global problem.

Purpose: The present study explores associations between individuals' having witnessed violent incidents in the past and holding attitudes justifying violence in the present, and their intention to behave violently in a nurse-patient interaction at a healthcare facility.

Design: A cross-sectional study sampled 1,350 participants from among the general public in Israel.

Methods: A self-administered questionnaire measured attitudes regarding violence towards nurses and confronted the participants with two vignettes eliciting verbal and physical violence towards nurses. Multiple logistic regression was conducted to explore the association between attitudes and intention to act violently. A mediation analysis (using the PROCESS macro) was conducted to explore the mediation factors.

Results: Over half of the participants witnessed an incident of verbal violence in health care and substantially fewer witnessed a physically violent event (51.5% and 16.1%, respectively). An attitude of highly justifying violence was found to be directly associated with the intention to act verbally and physically violent. Past witnessing of verbal or physical violence in healthcare settings had an indirect association through an attitude that justifies violence, which served as a mediating factor for the intention to act verbally and physically violent in a situation presented via the vignettes.

Conclusions: Witnessing a violent event in healthcare systems has social consequences that may cause normalization of violence and lead to the intention to use verbal or even physical violence towards nurses.

Clinical Relevance: Nurses should be encouraged to report incidents of violence, while healthcare and judicial systems must address this issue seriously. It is recommended that systems alerting for risk indicators be applied, to identify patients with a potential for violence in healthcare facilities. Healthcare policymakers and workers must act to promote an environment of zero tolerance for violence in order to minimize such events. In order to prevent violence towards healthcare staff, a holistic multisystem approach should be implemented, involving a focus by sociocultural elements on social values and structures, as violence in healthcare reflects violence in society at large.