- Patient and caregiver violence is moderately prevalent, correlating with increased nursing work interruptions, higher burnout, and lower perceived quality of nursing care.
- Burnout mediates the association between violence and reduced care quality; a sequential indirect pathway via work interruptions then burnout is statistically significant.
- Systemic interventions should target workflow disruptions and nurses' psychological well-being to mitigate violence effects and improve nursing care quality.
BMJ Open. 2026 Jul 23;16(7):e112313. doi: 10.1136/bmjopen-2025-112313.
ABSTRACT
OBJECTIVES: To examine the associations between violence perpetrated by patients and caregivers and nursing work interruptions, burnout and quality of nursing care, and to explore potential mediation pathways among these variables.
DESIGN: A descriptive, cross-sectional correlational study using path analysis.
SETTING: A tertiary university-affiliated hospital in South Korea.
PARTICIPANTS: A convenience sample of 200 registered nurses providing direct patient care, recruited between September and October 2024.
MAIN OUTCOME MEASURES: Patient and caregiver violence, nursing work interruptions, burnout and perceived quality of nursing care.
RESULTS: The average level of violence perpetrated by patients and caregivers was moderate, with verbal abuse being the most frequently reported type (mean=2.58 on a 5-point scale). Violence from patients and caregivers was significantly positively correlated with work interruptions (r=0.50, p<0.001) and burnout (r=0.32, p<0.001) and negatively correlated with quality of nursing care (r = -0.18, p=0.012). Path analysis indicated that violence from patients and caregivers was significantly associated with increased work interruptions (β=0.50, p<0.001) and burnout (β=0.22, p=0.003), while burnout was negatively associated with quality of nursing care (β = -0.37, p<0.001). Mediation analysis showed that burnout had a significant indirect association with the relationship between violence and quality of care (indirect effect = -0.054, p=0.001). A sequential indirect pathway from violence through work interruptions and burnout to quality of care was also statistically significant (indirect effect = -0.024, p=0.010).
CONCLUSIONS: Violence perpetrated by patients and caregivers is associated with reduced quality of nursing care through a sequential process involving increased work interruptions and burnout. These findings highlight the importance of addressing both workflow disruptions and nurses’ psychological well-being through systemic interventions aimed at improving care quality.
PMID:42493200 | DOI:10.1136/bmjopen-2025-112313
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