The role of sense of coherence in workplace violence directed at nurses in the shadow of COVID-19: A cross-sectional study

Anat Amit-Aharon*, Sigalit Warshawski, Michal Itzhaki

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review


Aims: To explore (a) the associations between sense of coherence (SOC), previous exposure to COVID-19, and the intention to act violently towards nurses, and (b) the role of SOC and sociodemographic variables as risk or protective factors involved in the intention to act violently. Design: A cross-sectional study with a convenience sample. Methods: A structured self-report questionnaire was distributed from February to March 2022. The questionnaire included socioeconomic variables, previous exposure to COVID-19, and a validated questionnaire on SOC. Three vignettes (online shaming, verbal and physical violence) describing nurse–patient communication conflicts were presented to participants. A multinomial logistic regression was conducted to explore the associations with acting violently by comparing three options of no/sometimes/high intention to act violently. The study adhered to STROBE guidelines. Results: Questionnaires were completed by 808 adults. SOC and religiosity were revealed as protective factors in the three vignettes. Verbal violent behaviour was found to be a risk factor for online and physical violent behaviour intention. Previous exposure to COVID-19, non-academic education, and ethnicity were found to be risk factors for the intention to behave violently toward nurses. Conclusion: The findings suggest that training nurses in practical SOC dimensions (enhancing comprehensible, manageable and meaningful treatment processes) may reduce patients' lack of understanding and frustration and, in turn, reduce the tendency to behave violently. Impact: This study focused on SOC as a variable that may affect the intention to act violently towards nurses. The results reveal that SOC may be a protective factor, where people with higher SOC will have less intention to behave violently towards nurses. The results can provide an insight for nurses, nurse leaders and policymakers, towards supplying coherent and cultural competency treatment processes for patients and assisting nurses in dealing with stressful situations during normal routines and pandemics. Patient or Public Contribution: The questionnaire was distributed among the general public by master's degree nursing students. The students distributed the questionnaires among their friends and acquaintances using a snowball-sampling approach.

Original languageEnglish
Pages (from-to)4767-4777
Number of pages11
JournalJournal of Advanced Nursing
Issue number12
StatePublished - Dec 2023


  • exposure to COVID-19
  • media shaming
  • nurses
  • sense of coherence
  • verbal and physical violence
  • workplace violence


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