A Prescriptive Model for Protecting Nurses’ Dignity and Safety: Understanding Coping Processes in the Face of Workplace Violence

Nurs Open. 2026 May;13(5):e70557. doi: 10.1002/nop2.70557.

ABSTRACT

AIMS: This study aims to design a prescriptive model for protecting nurses’ dignity and safety by systematically exploring their coping processes in response to workplace violence and examining how these empirically derived processes can inform the development of a conceptually grounded prescriptive framework.

DESIGN: A qualitative, two-phase design was used. In Phase I, grounded theory based on Strauss and Corbin’s approach explored nurses’ coping processes and the mechanisms influencing dignity and safety in violent work settings. In Phase II, conceptual synthesis was performed using Walker and Avant’s model development method to construct a prescriptive framework informed by and logically derived from the grounded findings.

METHODS: Data were collected through semi-structured interviews with 39 nurses from hospitals in Kerman between June 2019 and December 2021. Given the extended data collection period, potential contextual influences, including the COVID-19 pandemic, were considered during data interpretation. Theoretical saturation was achieved after 35 interviews, with subsequent interviews confirming the stability and completeness of emerging categories.

FINDINGS: The grounded theory study revealed that, in response to a main concern of perceived threats to dignity and job security within contextual conditions at multiple levels, nurses adopted action/interaction strategies (coping) involving adaptive, protective and meaning-oriented approaches that shaped their perceptions of dignity and safety. This coping process was influenced by intervening conditions, including facilitators such as accountable and reassuring colleagues and supportive institutions and barriers such as managerial neglect and structural deficiencies. These coping strategies led to consequences characterised by divergent outcomes: adaptive responses fostered emotional recovery, confidence and motivation, whereas maladaptive responses resulted in burnout, anxiety and ongoing psychological distress. Building on these findings, the prescriptive model comprises three interrelated conceptual components: (1) Context Familiarisation (systematic assessment of risks and situational conditions), (2) Professional and Organisational Support (conceptual mechanisms of empowerment and resource alignment) and (3) Continuous Evaluation and Reinforcement (iterative monitoring of outcomes and refinement of responses). These components reflect an integrated process linking awareness, empowerment and evaluation, with each component grounded in participants’ reported coping experiences. Rather than representing an empirically validated intervention, this framework conceptually outlines organisational responsibilities across different levels, thereby strengthening the conceptual coherence of the model. This framework translates empirical insights into a structured yet adaptable form of guidance.

CONCLUSIONS: The proposed model offers a conceptually grounded framework that outlines key organisational mechanisms through which healthcare organisations can strengthen nurses’ capacity to preserve dignity and safety in the face of workplace violence. However, the model remains interpretive and context-sensitive and has not undergone empirical validation. While the model provides theoretically informed and practice-oriented directions, further empirical testing is required. By providing a structured framework for the design, implementation and evaluation of comprehensive violence prevention systems, the model supports, rather than confirms, organisational action.

IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE: By operationalising dignity and safety as explicit organisational outcomes, the model provides a practical framework for developing culturally sensitive, context-specific interventions. However, some strategies may require adaptation across different healthcare contexts to ensure broader applicability. Implementing these prescriptive strategies may contribute to enhancing nurses’ well-being, retention and quality of patient care.

REPORTING METHOD: The study followed COREQ guidelines.

IMPACTS: Despite ongoing prevention initiatives, workplace violence against nurses persists, undermining their dignity and safety. The proposed prescriptive model offers a structured pathway for translating nurses’ coping experiences into conceptually grounded organisational and policy actions. For nursing managers, it emphasises the institutionalisation of supportive mechanisms that may enhance resilience and strengthen reporting practices. For policymakers, it highlights the need to embed dignity and safety indicators within national standards for workplace violence prevention. Interventions must remain context-sensitive-responsive to cultural norms, clinical environments and crisis conditions such as the COVID-19 pandemic-and undergo continuous evaluation and refinement. Future research should empirically test and validate the model across diverse healthcare settings to strengthen its generalisability and practical utility.

PATIENT OR PUBLIC CONTRIBUTION: No patient or public contribution.

PMID:42183657 | DOI:10.1002/nop2.70557