Fear of Violence and Work Alienation Among Nurses: The Mediating Role of Work Stress

Fear of Violence and Work Alienation Among Nurses: The Mediating Role of Work Stress | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Fear of Violence and Work Alienation Among Nurses: The Mediating Role of Work Stress Mustafa Aslan, Zeki Çetin, Esra Hatipoğulları This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7574420/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background Violence against healthcare workers has been investigated in many aspects, but the effects of the fear of violence have remained limited. This study examines the role of perceived work stress in the effect of fear of violence on work alienation among nurses. Methods The sample of the study consists of 392 nurses working in fully fledged hospitals in Istanbul, Türkiye. The data were collected by using the Fear of Violence Scale, the General Work Stress Scale, and the Work Alienation Scale. Confirmatory composite analysis was conducted for reliability and validity testing of the scales. Structural equation modeling was employed with SmartPLS 3.2.9, and multi-group analyses were carried out with SPSS 26 according to age, tenure, education level, gender, and history of exposure to violence. Results The results revealed that fear of violence has a positive and significant effect on perceived work stress and work alienation, both directly and indirectly through work stress. Work stress was found to have a strong positive effect on work alienation. Multi-group analyses showed that there were significant differences in fear of violence, work stress, and work alienation in terms of age, tenure, gender, and exposure to violence, while education level was not significant. Conclusions This study shows that fear of violence is not only an emotional response but also a systematic and enduring threat that reduces psychological resources and creates conditions for alienation. The results expand the stressor–strain–outcome framework and the Conservation of Resources Theory by revealing that the anticipation of violence functions as a primary stressor with long-term consequences. Fear of violence work stress of nurses work alienation of nurses workplace violence Figures Figure 1 INTRODUCTION The health sector, compared to other professions, has distinct responsibilities as it is directly related to protecting and improving human life and well-being. This responsibility also imposes a significant burden on the healthcare workers, causing them to feel higher levels of pressure. Furthermore, under these stressful conditions, while utilizing their technical knowledge and skills to serve patients, they must also cope with emotionally demanding situations raised by both patients and their relatives, with limited resources, and the constant need to make rapid decisions. These challenges affect healthcare workers both physically and psychologically. Moreover, the increasing incidence of violence in the healthcare sector has further intensified these challenges [ 1 , 2 , 3 , 4 , 5 , 6 ]. The World Health Organization (WHO) defines violence in healthcare as " the intentional use of physical force or threat that healthcare workers are exposed to while performing their duties, threatening the safety of themselves or their relatives. " This definition highlights that violence is not restricted to physical assaults; it may also manifest as threats, verbal harassment, insults, or psychological pressure [ 1 , 2 , 7 , 8 ]. Hence, violence in healthcare should be considered a multidimensional phenomenon that undermines both individual well-being and organizational performance. Violence can be grouped into three categories [ 9 , 10 ]: (i) physical violence (e.g., hitting, pushing, injury), (ii) verbal violence (e.g., insults, threats, mockery), and (iii) psychological violence (e.g., mobbing, exclusion, pressure). Each of these forms has adverse consequences for both physical and mental health, and also professional commitment. National and international studies demonstrate that violence in healthcare is no longer an isolated occurrence but a systemic problem. Research in Türkiye indicates that more than 70% of healthcare workers have experienced violence at least once in their careers [ 11 , 12 ]. Similarly, studies in Canada, the United States, and European countries report that more than half of healthcare workers have been subjected to different forms of violence [ 13 , 14 , 1 ]. These findings show that violence is not limited to developing countries but is a global threat. It is not a matter of individual misconduct but rather a complex social problem linked to structural and systemic factors. The contributing causes to violence are diverse, including but not limited to long waiting times, staff shortages, communication barriers, and uncertainties surrounding the health problems [ 2 , 15 ]. Everyone who has to go to the hospital prioritizes their own health or that of their loved one, and therefore, their expectations are shaped accordingly; they desire the highest level of care, attention, and priority. This heightened expectation is one of the reasons why international studies emphasize that personnel in high-risk departments, such as emergency services, are disproportionately exposed to violence [ 13 , 14 , 16 , 1 ]. The effects of violent incidents extend beyond the immediate trauma experienced. Over time, they can undermine employees' psychological health, job motivation, and professional commitment. An equally important phenomenon, which has attracted growing attention in the literature, is the fear of violence. Even in the absence of direct exposure, the persistent perception of being at risk can itself become a powerful stressor. Studies show that fear of violence is more prevalent than actual violent events and may harm mental health to a similar degree [ 17 , 18 ]. The concept of fear of violence, increasingly discussed in the literature, refers to the perception of being at risk of violence in the future, even without direct experience, and interpreting this as a continuing threat [ 19 , 20 ]. Research shows that this fear is more common than actual incidents and produces comparable levels of psychological harm [ 17 , 21 , 22 , 20 ]. One of the most prominent reflections of this fear is its effect on work stress. Recent studies confirm that fear of violence significantly contributes to increased work stress [ 21 , 22 , 23 ]. Work stress is one of the most significant outcomes of fear of violence. It emerges when job demands exceed the individual's capacity to cope [ 24 , 25 ]. Healthcare professionals already work in environments characterized by high pressure, and fear of violence only compounds this strain. Chronic stress not only causes individual health problems such as burnout, depression, anxiety, and psychosomatic symptoms, but it also leads to organizational risks, including reduced efficiency, increased errors, and threats to patient safety [ 26 , 27 ]. The consequences of stress are often discussed alongside work alienation. Work alienation refers to feelings of disconnection, meaninglessness, and powerlessness toward one's work [ 28 , 29 ]. Among healthcare workers, alienation is not merely a personal concern but a major threat to the quality of patient care, professional empathy, and ethical responsibilities [ 30 , 31 ]. When employees perceive their jobs as meaningless, oppressive, or unrewarding, alienation strengthens [ 32 , 28 ]. Among healthcare workers, factors such as high workload, insufficient organizational support, role conflict, and violent experiences are known to heighten alienation [ 30 , 29 ]. Fear of violence undermines trust in both the profession and the institution. A constant sense of threat reduces the meaningfulness of work, fosters emotional exhaustion, and distances nurses from their roles [ 33 , 34 ]. Often, this relationship operates indirectly through work stress [ 35 ], which suggests that fear of violence may lead to alienation indirectly, by increasing work stress [ 36 , 35 , 33 , 20 ]. This indicates a multilayered relationship among fear of violence, work stress, and work alienation. These findings highlight a gap in the literature, showing that the relationship among fear of violence, stress, and work alienation requires a holistic evaluation. While prior research has mainly emphasized individual psychological outcomes, fewer studies have examined how these factors interact with organizational dynamics. The contribution of this study lies in addressing these interconnections in a multidimensional way. Considering the high exposure of nurses to workplace violence [ 2 , 20 , 8 ] and the critical psychological consequences it may entail, this study specifically examines how fear of violence among nurses influences their perceived work stress and, ultimately, their sense of work alienation. METHOD Data Collection and Measures The questionnaire used for data collection consisted of four sections. The first section included a Demographic Information Form, which was prepared by the researchers in line with the purpose of the study and contained eight items. This form collected information regarding participants' gender, age, marital status, education level, type of hospital they were working at, tenure, and history of exposure to or witnessing of violence. The remaining three sections comprised previously validated and published scales. In the second section, we used the Fear of Violence Scale, developed by Rogers [ 37 ] and adapted into Turkish by Akbolat et al. [ 11 ]. This scale contains 10 items under a single factor, rated on a 5-point Likert scale (1 = Strongly Disagree, 5 = Strongly Agree). In the third section, we used the Perceived Work Stress Scale (sometimes referred to as the "general work stress scale"), developed by De Bruin [ 38 ] and adapted into Turkish by Teleş [ 39 ]. This scale includes nine single-dimension items, scored from 1 = Never to 5 = Always. Higher total scores reflect higher perceived work stress levels. Finally, in the fourth section, we employed the Work Alienation Scale, developed by Hirschfeld et al. [ 40 ] and adapted into Turkish by Kanten and Ülker [ 41 ]. This scale consists of eight items under a single factor, with responses collected on a 5-point Likert scale (1 = Strongly Disagree, 5 = Strongly Agree). Sampling The research universe is the nurses working in Istanbul. The inclusion criteria were to be a nurse and employed in a fully fledged hospital. According to the 2023 data of the Republic of Türkiye Ministry of Health [ 42 ], there are 248,287 nurses working across Türkiye, with no precise numbers for provinces. However, according to the Istanbul Chamber of Commerce [ 43 ], in 2023, there were 42,114 nurses working in hospitals in Istanbul. Hence, the sample size calculated using the Cochran [ 44 ] formula for a 95% confidence level, 5% sampling error, and finite universe correction is 381 participants. We distributed printed surveys to nurses during their lunch breaks and remained nearby to collect the completed forms. Using the convenience sampling method, we reached a total of 411 nurses. Nineteen surveys were found to be incomplete and were excluded from the analyses. Consequently, all statistical analyses were conducted with the responses of 392 nurses. The demographic characteristics of the participants are presented in Table 1 . Table 1 Demographics of the Participants (N = 392) f % Valid % Gender Female 276 70.4 70.4 Male 116 29.6 29.6 Age Below 25 14 3.6 3.6 Between 25–29 168 42.9 42.9 Between 30–34 100 25.5 25.5 Between 35–39 40 10.2 10.2 Between 40–44 30 7.7 7.7 Between 45–49 24 6.1 6.1 50 and Over 16 4.1 4.1 Marital Status Married 206 52.6 52.6 Single 186 47.4 47.4 Education Level High School 28 7.1 7.1 College 32 8.2 8.2 University 300 76.6 68.4 Graduate School 64 16.3 16.3 Type of Hospital State Owned 356 90.8 90.8 Privately Owned 36 9.2 9.2 Tenure 4 Years and Below 116 29.6 29.6 Between 5–9 Years 138 35.2 35.2 Between 10–14 Years 60 15.3 15.3 Between 15–19 Years 32 8.2 8.2 20 Years and Over 46 11.7 11.7 History of Violence Yes 156 39.8 39.8 No 236 60.2 60.2 As shown in Table 1 , the majority of the participants were female (70.4%, n = 276), with a mean age of 32.41 years ( SD = 7.32; median = 30.00), and most were university graduates (68.4%, n = 268). A smaller proportion were high school graduates (n = 28; 7.1%), as, until 2014, graduates of Health Vocational High Schools were eligible to practice as nurses. Regarding exposure to violence, 39.8% (n = 156) of the participants reported having experienced violence, while 60.2% (n = 236) reported no such experience. Data Analysis The collected data were analyzed using Partial Least Squares Structural Equation Modeling (PLS-SEM) with SmartPLS version 3.2.9, and SPSS (version 26) when deemed necessary. Confirmatory Composite Analysis (CCA), structural validity assessments (Convergence and Discriminant Validities), and Reliability Tests were performed. The acceptability of the research model was assessed with the coefficient of determination (R 2 ) and the prediction relevance value (Q 2 ). We employed several established criteria to assess the validity and reliability of the path model. For convergence validity, the Average Variance Extracted (AVE) value is required to be equal to or greater than 0.50, the Composite Reliability (CR) value equal to or greater than 0.70, and the Cronbach's Alpha value equal to or greater than 0.70 [ 45 , 46 ]. For discriminant validity, we utilized the Heterotrait-Monotrait Ratio (HTMT), which is required to be 0.90 for theoretically close constructs and 0.85 for those distinct [ 47 ]. Furthermore, the Variance Inflation Factor (VIF) values are expected to be below 5 [ 48 ]. In terms of overall model acceptability, the coefficient of determination (R²) is expected to be greater than 0.10 [ 46 , 49 ], and the Q² value, reflecting predictive relevance, is expected to be greater than zero [ 50 ]. Furthermore, factor loadings of items are expected to be equal to or greater than 0.70. Items with factor loadings below 0.40 were excluded from the analysis, while those between 0.40 and 0.70 will be retained only if the construct's CR, AVE, and Cronbach's Alpha values exceeded the recommended thresholds [ 46 ]. Findings We designed the path model (Fig. 1 ) based on the conceptual framework. As illustrated, the model depicts the hypothesized relationships among fear of violence, perceived work stress, and work alienation. The following analyses examine the reliability and validity of the constructs and test the significance of the structural paths. As reported in Table 2 , the results of Confirmatory Composite Analysis (CCA) show that the Cronbach's Alpha, CR, AVE values, and Factor Loadings satisfied the criteria set forth, and hence, we concluded that the scales collectively satisfied the internal consistency reliability and convergent validity conditions. Table 2 Factor Loadings, Cronbach's Alpha, CR, and AVE Values of the Constructs Construct Items Factor Loadings Cronbach's Alpha CR AVE Work Alienation Alien01 0.672 0.884 0.908 0.553 Alien02 0.669 Alien03 0.792 Alien04 0.811 Alien05 0.702 Alien06 0.781 Alien07 0.714 Alien08 0.790 Fear of Violence FoV01 0.877 0.966 0.970 0.767 FoV02 0.877 FoV03 0.889 FoV04 0.923 FoV05 0.855 FoV06 0.849 FoV07 0.814 FoV08 0.931 FoV09 0.852 FoV10 0.883 Perceived Work Stress Stress01 0.755 0.948 0.956 0.709 Stress02 0.857 Stress03 0.807 Stress04 0.844 Stress05 0.869 Stress06 0.883 Stress07 0.872 Stress08 0.878 Stress09 0.806 Although two items (Alien01 and Alien02) had factor loadings below the recommended .70 threshold, they were retained because their values exceeded .60 and the construct's CR (0.908), AVE (0.553), and Cronbach's Alpha (0.884) were all above the acceptable limits [ 46 ]. Table 3 HTMT Test Results Construct 1 2 3 1- Fear of Violence 2- Perceived Work Stress 0.333 3- Work Alienation 0.358 0.764 The assessment of discriminant validity was conducted using the HTMT test, and the results are reported in Table 3 . According to the results, the highest HTMT value was observed between Work Alienation and Perceived Work Stress (0.760), which is below the threshold value of 0.85 for theoretically distinct concepts [ 51 ]. Table 4 VIF Values Construct 1 2 3 1- Fear of Violence 1,000 1,117 2- Perceived Work Stress 1,117 3- Work Alienation The VIF values that are reported in Table 4 show that all values are below the threshold value of 5 [ 48 ]. Hence, we concluded that the convergence and discriminant validities were established. The R² and Q² values also show that the model has predictive power and is acceptable since R² values explain approximately 10.5% of the variance in Perceived Work Stress and 51.8% of the variance in Work Alienation and both are above 0.10 [ 46 , 49 ], and the Q² value measured as 0.073 for Perceived Work Stress and 0.279 for Work Alienation, and both are greater than zero [ 50 ]. The model's fit was evaluated using several indices, including the standardized root mean square residual (SRMR), d_ULS, d_G, chi-square, and the normed fit index (NFI). The results are reported in Table 5 . Table 5 Model Fit Summary Fit Index Saturated Model Estimated Model Threshold (if applicable) Interpretation SRMR 0.059 0.059 0.80 Acceptable fit The SRMR value for both the saturated and estimated models is 0.059, which is well below the commonly accepted threshold of 0.08, indicating a good model fit [ 51 ]. Similarly, the d_ULS (1.296) and d_G (0.798) values are relatively low and consistent between models, further supporting the model's adequacy. The Chi-square value of 1688.626, though statistically large, is expected in large sample structural equation modeling and should be interpreted in conjunction with other fit measures. The NFI value of 0.834 exceeds the minimum recommended threshold of 0.80, indicating an acceptable model fit [ 52 , 53 ]. Regarding model selection criteria, several information criteria were computed (see Table 6 ) to evaluate model parsimony and comparative performance. Table 6 Model Selection Criteria Criterion Perceived Work Stress Work Alienation AIC (Akaike's Information Crit.) -40.527 -280.836 AICu (Unbiased AIC) -38.522 -277.825 AICc (Corrected AIC) 353.535 113.267 BIC (Bayesian Information Crit.) -32.585 -268.923 HQ (Hannan-Quinn) -37.379 -276.115 HQc (Corrected HQ) -37.306 -275.976 As per the results reported in Table 6 , for both Perceived Work Stress and Work Alienation, the Akaike's Information Criterion (AIC), corrected AIC (AICc), unbiased AIC (AICu), and Bayesian Information Criterion (BIC), as well as Hannan–Quinn (HQ) and corrected HQ (HQc), all indicate a better fit for Work Alienation, as reflected by more negative AIC and BIC values (e.g., AIC = − 280.836 vs. − 40.527). Lower values of these criteria signify better model quality and parsimony, with the Work Alienation model showing superior performance across all selection indices. Hence, we concluded that the model demonstrates good global fit, particularly in explaining Work Alienation, with supportive SRMR, NFI, and model selection indicators. After establishing the validity and reliability, hypotheses were tested using a complete bootstrapping procedure with 5,000 subsamples. The direct, indirect, and total effects, along with 95% confidence intervals (2.5% and 97.5%), are reported in Table 7 . Table 7 Path Coefficients of Direct, Indirect, and Total Effects β M SD t p 2.5% 97.5% Direct Effects Fear of Violence ->Perceived Work Stress 0.324 0.330 0.048 6.724 0.000 0.227 0.421 Fear of Violence ->Work Alienation 0.121 0.122 0.036 3.330 0.001 0.052 0.194 Perceived Work Stress ->Work Alienation 0.671 0.673 0.033 20.627 0.000 0.608 0.736 Indirect Effects Fear of Violence ->Perceived Work Stress ->Work Alienation 0.218 0.222 0.033 6.586 0.000 0.151 0.283 Total Effects Fear of Violence ->Perceived Work Stress 0.324 0.330 0.048 6.724 0.000 0.227 0.421 Fear of Violence ->Work Alienation 0.339 0.344 0.045 7.467 0.000 0.253 0.433 Perceived Work Stress ->Work Alienation 0.671 0.673 0.033 20.627 0.000 0.608 0.736 As per the results reported in Table 7 , the effect of Fear of Violence on Perceived Work Stress is statistically significant (β = 0.324, t = 6.724, p < .001), suggesting that increased fear of violence significantly predicts higher perceived work stress. The 95% confidence interval [0.227, 0.421] does not include zero, reinforcing the reliability of this finding. This result indicates that the threat of violence is not merely an abstract concern but serves as a concrete and chronic source of tension in nurses' daily professional lives. The constant sense of potential assault significantly depletes workers' psychological resources, forces them into a state of continuous alertness, and amplifies the impact of other inherent workplace stressors (e.g., workload, long shifts), thereby increasing overall stress levels in a meaningful way. As such, this finding constitutes the first and most critical link in the study's core model and empirically confirms that fear of violence functions as a direct stressor. The effect of Fear of Violence on Work Alienation is statistically significant (β = 0.121, t = 3.330, p = .001) as well, but weaker than its effect on Perceived Work Stress. Suggesting that the fear of violence increases the work alienation of nurses. This finding shows that the impact of violence is not limited to its role in increasing work stress but also possesses an inherently alienating power. The presence of this effect implies that fear of violence undermines nurses' basic psychological need for safety, violates the implicit psychological contract with the organization, and directly assaults their professional identity. Furthermore, Perceived Work Stress has a significant and very high effect on Work Alienation (β = 0.671, t = 20.627, p < .001), indicating that perceived work stress is a major predictor of work alienation. According to this result, chronic and intense stress depletes nurses' psychological energy over time, causing them to lose a sense of control (powerlessness), disengage from the core mission of caregiving (meaninglessness), and withdraw emotionally and socially (social isolation). Hence, work stress emerges as the primary precursor to deep and enduring psychological detachment from work. The results also indicate that the Perceived Work Stress mediates the effect of Fear of Violence on Work Alienation (β = 0.218, t = 6.586, p < .001). This finding integrates previous results into a comprehensive process model. The study concludes that fear of violence affects work alienation primarily through an indirect mechanism. The process begins with fear of violence acting as a primary stressor, which then triggers accumulated and chronic stress, eventually causing nurses to become alienated from their work. Since both direct and indirect effects are statistically significant, the process operates as partial mediation. Moreover, the standardized coefficient of the indirect effect is greater than the direct effect, indicating that the most destructive influence of fear of violence manifests through the chronic stress it generates. The total effect of Fear of Violence on Work Alienation (combining direct and indirect paths) is substantial (β = 0.339, t = 7.467, p < .001) as well, showing that fear of violence significantly contributes to feelings of alienation at work both directly and through stress. These results not only uncover the psychological toll of violence in the healthcare sector but also provide practical guidance on steps that should be taken at various levels to address the issue. Accordingly, the study develops recommendations targeting healthcare professionals, institutional leaders, senior healthcare administrators, policymakers, and future researchers. Multi-Group Analysis We also conducted multi-group analyses using SPSS 26, based on participants' age, tenure, education level, gender, and history of exposure to violence, in order to examine whether the mean differences in Fear of Violence, Perceived Work Stress, and Work Alienation were statistically significant. The one-way ANOVA test showed that no statistically significant differences were found in Fear of Violence [F(3, 388) = 0.028, p = .994], Perceived Work Stress [F(3, 388) = 1.485, p = .218], or Work Alienation [F(3, 388) = 0.763, p = .515] across education levels. However, statistically significant differences were found across age and tenure groups, gender, and exposure to the violence. Age Groups In the study, whether there were statistically significant differences in fear of violence, perceived work stress, and work alienation levels according to age groups was analyzed using ANOVA and followed by LSD / Games-Howell post-hoc tests. ANOVA analysis results showed that there were statistically significant differences in fear of violence levels among age groups (F(6, 385) = 3.542, p = .002). Post-hoc analyses revealed that the 25–29 age group had significantly higher fear of violence levels. This group reported significantly more fear of violence compared to the 40–44, 45–49, and 50 and over age groups. In this context, the highest mean was observed in the 25–29 age group (M = 3.44) and the lowest mean in the 50 and over group (M = 2.56). In terms of work stress, significant differences were also found among age groups (F(6, 385) = 10.944, p < .001). Post-hoc analyses revealed that the 25–29 and 30–34 age groups had significantly higher stress levels. These groups experience higher stress, particularly compared to the 50 and over, 35–39, and 40–44 age groups. The highest average was observed in the 25–29 age group (M = 3.27) and the lowest in the 50 and over group (M = 1.76). Significant differences were also found in work alienation levels among age groups (F(6, 385) = 5.259, p < .001). While the highest alienation level was observed in the 30–34 age group, nurses aged 50 and over had the lowest alienation levels. It was also observed that the 25–29 age group experienced significantly more alienation compared to the 50 and over group. The highest mean was in the 30–34 age group (M = 3.13) and the lowest in the 50 and over group (M = 1.98). These results suggest that younger nurses, particularly those in the 25–29 age group, perceive the risk of violence more intensely. A lack of professional experience may contribute to the intensification of this fear, as older groups (40–44, 45–49, and 50 and over) reported significantly lower fear of violence. Similarly, stress levels were found to be higher during the early stages of working life, with the 25–29 and 30–34 age groups reporting significantly higher levels of stress compared to their older counterparts. This supports the interpretation that accumulated experience and professional maturity over time help reduce stress. Findings also indicate that work alienation is more prevalent among younger and middle-aged nurses, with the 30–34 age group showing the highest mean level of alienation and the 25–29 group also reporting significantly greater alienation compared to the 50 and over group. This suggests that younger generations may experience a sense of disconnection from psychological aspects such as organizational commitment, meaning of work, and perceived control. Furthermore, the coexistence of higher fear of violence and work stress among these groups appears to reinforce the development of alienation. Tenure According to ANOVA results, fear of violence significantly differed by years of service (F(4, 387) = 5.365, p < .001). Especially nurses with 20 years or more experience (M = 2.74) and those with 15–19 years (M = 2.75) had significantly lower levels of fear of violence compared to nurses with 4 years or less (M = 3.26), 10–14 years (M = 3.40), and 5–9 years (M = 3.49) of experience. This situation suggests that more experienced nurses may have greater psychological resilience or may have developed habituation in managing violent incidents. Work stress levels also significantly differed according to years of service (F(4, 387) = 16.291, p < .001). Nurses with 5–9 years of experience had the highest stress levels (M = 3.46). They were followed by those with 10–14 years (M = 3.15), 4 years or less (M = 2.88), 15–19 years (M = 2.59), and finally 20 years and over (M = 2.44). This finding suggests that mid-level experienced nurses may feel trapped between workload and expectations. Alienation also significantly differed by years of service (F(4, 387) = 7.398, p < .001). The lowest alienation level was observed among nurses with 15–19 years (M = 2.45) and 20 years and over (M = 2.66). On the other hand, the highest alienation was observed in nurses with 10–14 years (M = 3.22) and 5–9 years (M = 3.11) of experience. These results suggest that nurses with moderate tenure may experience weakened organizational belonging and may have a tendency to detach from their jobs. The results indicate that tenure is a significant factor in shaping nurses' perceptions of fear of violence, work stress, and alienation. Nurses with longer service durations (15 years or more) reported substantially lower fear of violence compared to those with fewer years of experience. This pattern may suggest that accumulated experience of clinical environments provides healthcare workers with greater psychological resilience, adaptive coping strategies, or a form of familiarization, causing them to perceive violent incidents as less threatening. Conversely, nurses with shorter service durations (particularly those with less than 10 years of experience) showed higher fear of violence, reflecting their relative vulnerability and limited exposure to challenging interactions. The results show that work stress levels do not decline linearly with increasing tenure; the highest levels were reported by mid-level experienced nurses (5–9 years of experience), followed by those with 10–14 years of experience, which may reflect a stage in professional life where individuals are assigned with more responsibilities yet may not have achieved the full autonomy or coping resources that come with seniority. By contrast, nurses with 20 years or more of experience reported the lowest levels of work stress. This finding supports the interpretation that accumulated experience and professional maturity contribute to a more stable and manageable work life. The findings on work alienation further reinforce this non-linear trend. Nurses with moderate tenure (5–14 years) reported the highest alienation, suggesting that the middle stages of a career may be associated with feelings of disconnection, reduced organizational commitment, and diminished perceived control over work processes. In contrast, nurses with 15 years or more of service reported the lowest alienation, indicating that long-term tenure may lead to a stronger sense of belonging, organizational commitment, and integration within the organization. Age and Tenure When the ANOVA results for both age and tenure are interpreted together, a clearer picture of the pattern emerges, showing distinct vulnerabilities and resilience factors across different groups. The ANOVA test results across age groups show that younger nurses (25–29 and 30–34 years) reported the highest fear of violence, stress, and alienation, whereas older nurses (40 and above) reported lower levels. The ANOVA test results across tenure groups show a similar pattern to a certain extent, such as that the nurses with shorter tenure (≤ 9 years) reported higher fear of violence and stress, while those in mid-level tenure (5–14 years) reported the highest alienation. Nurses with longer tenure (≥ 15 years) reported lower levels across all three constructs. These results suggest that younger nurses with short tenure are more vulnerable to violence-related fear and stress (similar to the findings of [ 6 ], likely due to limited professional experience and fewer coping strategies. While mid-career nurses (typically 30s and 40s with 5–14 years of tenure) seem to face a unique strain, although their fear of violence declines with age, their stress and alienation rise, possibly due to role overload, organizational pressures, or unmet career expectations, the older, long-tenured nurses appear to benefit from psychological resilience, habituation, and a stronger sense of organizational belonging, which buffers against fear, stress, and alienation. Difference Tests by Gender The analysis results show that although men (M = 3.39) had a higher average level of fear of violence than women (M = 3.20), the difference was not statistically significant (p = 0.156). This indicates that there is no significant difference in perceived fear of violence according to gender, and both women and men are equally afraid of being exposed to violence. The difference in work stress by gender is also not statistically significant. Women (M = 3.07) reported slightly higher stress levels than men (M = 3.00), but the difference was not significant (p = 0.479). Therefore, no gender-based difference is evident in terms of perceived work stress. However, a significant difference was found in work alienation. Men (M = 3.06) had a higher mean than women (M = 2.87), and this difference was statistically significant (p = 0.047). This result may indicate that male nurses experience significantly more alienation than females, and may feel lower levels of commitment, meaning, or emotional engagement with the organization. The findings suggest that gender does not play a significant role in nurses' levels of fear of violence or perceived work stress, which may indicate that both male and female nurses are exposed to similar risks in the healthcare setting and perceive the pressures of the work environment in a broadly comparable way. This finding reveals that the violence and stress that the healthcare workers are experiencing are structural problems rather than gender-specific ones. The results regarding the work alienation, in contrast, reveal that the mean difference between males and females is statistically significant. Male nurses reported higher levels of alienation than female nurses, suggesting that men may feel a greater sense of detachment from their work roles, lower organizational commitment, or reduced meaning in their professional tasks, which may be due to several factors, including but not limited to cultural expectations regarding caregiving roles, potential mismatches between men's expectations and the realities of nursing work, or differing coping mechanisms in response to workplace stressors. These findings indicate that while violence and stress perceptions are equally shared by both genders, alienation appears to disproportionately affect men, pointing to the importance of gender-sensitive organizational strategies. Interventions could include tailored support mechanisms, opportunities for professional identity strengthening, and programs that enhance meaning and engagement in nursing roles, particularly for male staff members. Difference Tests by Exposure to Violence Independent samples t-tests were conducted to examine whether there were statistically significant differences in fear of violence, perceived work stress, and work alienation between nurses who had experienced versus had not experienced workplace violence. The results revealed a significant difference in fear of violence scores between those who had been exposed to violence (M = 3.60, SD = 1.12) and those who had not (M = 3.03, SD = 1.19), t(390) = 4.75, p < .001. This suggests that previous exposure to violence substantially increases nurses' fear of encountering similar incidents in the future. A significant difference was also found in perceived stress, where the exposed group (M = 3.21, SD = 0.94) reported higher stress levels than their non-exposed counterparts (M = 2.95, SD = 0.96), t(390) = 2.66, p = .008. This finding is expected and also aligns with literature highlighting cumulative psychological burden following exposure to violence (e.g., [ 54 , 55 ]. There was a significant difference in work alienation, as well. Individuals who have previously been exposed to violence reported higher levels of alienation (M = 3.12, SD = 0.91) than the others (M = 2.80, SD = 0.87, t(390) = 3.57, p < .001). These findings reveal how exposure to workplace violence may not only increase immediate stress but also weaken nurses' connection to their professional roles and organizations [ 56 , 57 ]. Exposure to violence not only represents a situational challenge but also contributes to long-term stress and emotional exhaustion, causing individuals to feel on alert against the recurrence of similar incidents—an experience that is psychologically exhausting and overwhelmingly distressing [ 58 , 59 , 60 ]. These findings align with prior research emphasizing the ongoing psychological incidents of violence in the healthcare sector [ 54 , 55 ]. Discussion This study provides an in-depth insight into a problem frequently observed in Turkey's healthcare sector but addressed quantitatively in a limited way by thoroughly examining the effects of nurses' fear of being exposed to violence on perceived work stress, and ultimately on work alienation. The main model of the study was tested through four primary hypotheses, each of which was found to be statistically significant. In this context, the discussion section of the study must be conducted on different levels, addressing both individual psychological processes and organizational and structural dimensions. This research shows that fear of violence significantly increases perceived work stress. This finding reveals that the concept of "anticipated violence" is an underexplored source of stress in the literature. As much as physical or verbal violence itself, being in a constant state of anticipation that such violence may occur chronically activates alarm systems in the individual [ 61 , 62 ]. This means that the individual is in a constant state of "readiness"; however, this state of readiness rapidly depletes the individual's cognitive and emotional resources. When evaluated within the framework of Hobfoll's [ 63 ] Conservation of Resources Theory (COR), fear of violence includes a threat directed at one of the employee's most fundamental resources: personal safety. Therefore, the threat of resource loss itself directly causes chronic stress. Gates et al. [ 54 ] stated that the perception of threat diverts employees' attention from their primary duties and redirects it toward monitoring potential dangers. Accordingly, this study also offers an empirical counterpart to this theoretical framework by showing that nurses try to keep themselves at a "safe distance," but that this behavior reduces the quality of empathetic care. Particularly, the defensive communication that develops in relationships with patients and their relatives negatively affects the quality of healthcare and sows the seeds of new conflicts [ 55 ]. At this point, it is important to highlight that the finding is not only critical on an individual level but also carries vital implications for the health of organizational systems. The stress increased by fear of violence reduces nurses' patience, lowers their level of empathy, and weakens their communication skills. This creates dissatisfaction among patients and their relatives, and this dissatisfaction may trigger new acts of violence, forming a "tension–dissatisfaction–violence" cycle [ 2 , 61 ]. Therefore, this initial finding reveals not only an individual stress response but also the foundation of a structural problem that feeds and reproduces itself within the system. Taken together, the age- and tenure-related findings reveal a consistent career-stage pattern. Younger nurses with short tenure are more vulnerable to fear of violence and stress, likely due to limited professional experience and fewer coping strategies. By contrast, mid-career nurses (typically 5–14 years of service, often in their 30s and early 40s) reported the highest alienation, even though their fear of violence declined with age. This suggests that while accumulated experience reduces immediate fear, organizational pressures, role overload, and unmet career expectations may increase alienation at this stage. Older and long-tenured nurses, on the other hand, appear to benefit from resilience, habituation, and a stronger sense of belonging, which buffer against fear, stress, and alienation. The study also found that perceived work stress has a strong and positive effect on work alienation. The regression coefficient obtained (β = 0.671) clearly reflects the strength and explanatory power of this relationship. The main mechanism through which stress leads to alienation is the loss of the individual's capacity to generate professional meaning and their sense of control over their work. In this context, the study's findings redefine alienation not as a passive condition but as an active coping strategy [ 56 , 64 ]. As Boyle [ 56 ] also stated, the individual feels the need to emotionally withdraw from their work to protect their psychological integrity. This situation leads the nurses to perceive the institution, the profession, and the society they serve as a collective threat. Yalım's [ 34 ] study provides findings that directly support this effect. Especially the loss of the sense of safety, the breakdown of the psychological contract, and the erosion of trust in the institution can cause the nurse to develop alienation not only toward the profession but also toward society itself [ 57 , 65 ]. This effect points to alienation as a psychological defense mechanism. While excessive workload triggers a sense of "powerlessness," role conflict and uncertainty increase feelings of "meaninglessness," and high emotional labor demands lead to "self-alienation" [ 66 , 67 ]. In this context, it becomes evident that work stress should not be considered merely as an "intense workload," but rather as a factor that creates a multidimensional crisis of meaning. The mechanism revealed by the study is that fear of violence increases work stress, and in turn, this further increases work alienation. This finding is in full alignment with the classical Stressor–Strain–Outcome model [ 68 , 69 ]. Fear of violence, through stress, consumes the psychological resources of the nurses, and this depletion lays the groundwork for alienation. From the perspective of Hobfoll's [ 63 ] theory, the direct pathway represents a sudden and significant resource loss (traumatic impact), while the indirect pathway reflects a gradual and chronic depletion of resources. Arnetz et al. [ 70 ] emphasize that among these two types of effects, the latter is especially more exhausting and more difficult to reverse. In this study, the fact that the indirect effect is stronger than the direct effect indicates that the greatest threat posed by fear of violence lies in its ability to produce a "stealthy" and chronic stress that is experienced repeatedly every day. It should also be noted that education level did not yield statistically significant differences in fear of violence, work stress, or alienation, indicating that these phenomena are shaped more strongly by experiential and contextual factors than by formal educational background. Implications for Theory This study brings a new perspective to the alienation literature by revealing a previously overlooked cause-and-effect chain: the indirect influence of fear of violence. It shows that the anticipation of violence functions as a primary stressor with lasting consequences for employees' sense of connection to their organization. In doing so, the study extends the stressor–strain–outcome framework and Conservation of Resources Theory into the unique context of healthcare violence. The findings contribute to the theory in several ways: First, they recast fear of violence not merely as a fleeting emotional reaction but as a persistent and systematic threat that drains psychological resources and fosters alienation. This highlights that alienation stems not only from traditional stressors such as workload or role conflict but also from contextual and anticipatory threats that compromise personal safety. Second, the study shows that fear of violence exerts a stronger effect on alienation when channeled through work stress than when acting directly. This helps to clarify the mechanism of alienation, suggesting that it emerges from both immediate traumatic experiences (the loss of safety and trust) and longer-term processes of stress accumulation and depletion. Third, the multi-group analyses enrich the theoretical picture by linking fear of violence and alienation to career stage variables such as age and tenure. This suggests that alienation theories must consider career dynamics and how vulnerability to stressors shifts over time, with younger/short-tenure nurses most affected by fear, and mid-tenure nurses more prone to alienation. Integrating career-stage perspectives into alienation theory provides a more nuanced understanding of when and why nurses disengage. Finally, this study highlights the importance of integrating context-specific threats (such as healthcare violence) into broader alienation theories, which have often been developed in industrial or service contexts. By demonstrating that fear of violence systematically disrupts meaning, control, and belonging, the study expands the boundary conditions of alienation theory and calls for further research that explores similar anticipatory stressors in other high-risk professions. Implications for Practice Practically, it shows that healthcare institutions must address violence not only at the level of physical security, but also on the basis of psychological safety. It is also understood that work stress management strategies should aim to re-establish nurses' engagement and restore the meaning of work. The findings offer important signals in terms of health policy: First, it should be understııd that the fear of violence is not an individual emotional reaction, but a systematically produced and reproduced stressor that must be managed through institutional strategies. For example, systems such as the "White Code" should increase deterrence, but beyond that, a more inclusive policy on safety and commitment should be developed—one that enhances nurses' professional autonomy, protects their emotional labor, and allows them to generate meaning in their work. Moreover, the convergence of age and tenure findings suggests that early-career and mid-career nurses require differentiated interventions: For example, younger/short-tenure nurses may benefit from training, mentoring, and psychological support to help them manage exposure to violence and stress, and mid-tenure nurses may require career development opportunities, workload balancing, and recognition mechanisms to counteract alienation and disengagement. For senior/long-tenured nurses, the challenge is to maintain motivation and prevent complacency, but overall, their resilience is a protective factor. CONCLUSION This research sheds light on a problem frequently observed in Turkey's healthcare sector but not sufficiently examined quantitatively; it reveals in detail the psychological effects of the violence that nurses may be exposed to. The theoretical model of the study empirically tested how fear of violence increases work alienation both directly and indirectly, and all assumptions were statistically supported. It was revealed that fear of violence increases perceived work stress, and this stress in turn triggers work alienation. According to the findings, not only direct acts of violence but also the constant state of alertness against the possibility of being exposed to such incidents constitute a serious source of stress for healthcare workers. This situation both depletes the individual's psychological resources and weakens professional commitment and meaning-making. Particularly noteworthy is the very high effect of stress on work alienation (β = 0.671). This finding shows that work stress is not just a temporary discomfort but also a process that severs the individual's emotional bond with their work. Another important contribution of the study is that it shows the effect of fear of violence on work alienation occurs largely through stress. This demonstrates that fear of violence functions not only as a direct threat but also as a chronic source of stress, and over time, this stress weakens nurses' connection to their work. Therefore, the results obtained provide findings that should guide not only individual psychology but also institutional health policies. In the group comparisons, it was observed that younger nurses and those with lower tenure experienced higher levels of fear of violence, work stress, and alienation. This finding shows that professional experience not only brings skill but also increases psychological resilience. Additionally, another striking finding is that men experience significantly more alienation than women. In conclusion, this study shows that combating violence in healthcare institutions must be addressed not only at the level of physical security but also on the basis of psychological safety. Strategies aimed at reducing work stress should not be limited only to decreasing workload; they must also be supported with holistic policies that enhance nurses' professional autonomy, protect their emotional labor, and rebuild the meaning of work. Furthermore, fear of violence must be considered a stressor that is systematically produced and reproduced, and structural solutions must be developed at the organizational level to combat it. This is of great importance for healthcare workers to maintain their job commitment. Abbreviations WHO: World Health Organization PLS-SEM: Partial Least Squares Structural Equation Modeling CCA: Confirmatory Composite Analysis AVE: Average Variance Extracted CR: Composite Reliability HTMT: Heterotrait-Monotrait Ratio VIF: Variance Inflation Factor SRMR: Standardized Root Mean Square Residual NFI: Normed Fit Index AIC: Akaike's Information Criterion BIC: Bayesian Information Criterion ANOVA: Analysis of Variance LSD: Least Significant Difference SPSS: Statistical Package for the Social Sciences Declarations Ethics approval and consent to participate: This study was conducted in line with the principles of the Declaration of Helsinki and the approval of the Istanbul Nisantasi University (Türkiye) Ethics Committee (approval number: 2023-04 dated: 22 April 2025). Informed consent was obtained from all subjects involved in the study. Consent for publication: Not applicable. This study did not include any individual person's data in any form (including individual details, images, or videos). Availability of data and materials: Data is available upon request from the corresponding author, Dr. Mustafa Aslan, [email protected] Competing Interests: The authors declare that they have no conflict of interest. Funding: No funding was received for this study. Authors' contributions: Conceptualization, MA, EH, ZÇ; methodology, MA; software, MA; validation, MA, ZÇ; formal analysis, MA; data curation, EH, and ZÇ; writing—original draft preparation, EH, ZÇ, and MA; writing—review and editing, MA. All authors have read and agreed to the published version of the manuscript. Acknowledgements: This study was conducted collaboratively by the listed authors, without the involvement of any unacknowledged third-party individuals or services. The authors gratefully acknowledge the use of AI-assisted tools for language support during manuscript preparation. Specifically, DeepL was used to translate select portions of the literature review and methodological discussion from Turkish into English, and Grammarly was employed to improve grammar, sentence clarity, and overall consistency. All content produced or assisted by these tools was thoroughly reviewed and edited by the authors and verified using Turnitin to ensure accuracy and originality. No content was fully generated by AI. The authors confirm that all contributions have been appropriately acknowledged and that no additional contributors were involved beyond those listed as authors. References Spector, P. E., Zhou, Z. E., & Che, X. X. (2014). Nurse exposure to physical and nonphysical violence, bullying, and sexual harassment: A quantitative review. International Journal of Nursing Studies, 51 (1), 72–84. https://doi.org/10.1016/j.ijnurstu.2013.01.010 Magnavita, N. (2014). Workplace Violence and Occupational Stress in Healthcare Workers: A Chicken-and-Egg Situation—Results of a 6-Year Follow-up Study. Journal of Nursing Scholarship, 46 (5), 366–376. https://doi.org/10.1111/jnu.12088 Duğan, Ö. (2024). Sağlıkta şiddet: Youtube izleyicilerinin duyguları üzerinden bir analiz [Violence in Healthcare: An Analysis Based on the Emotions of YouTube Viewers]. Kıbrıs Türk Psikiyatri ve Psikoloji Dergisi, 6 (3), 249–254. https://doi.org/10.35365/ctjpp.24.3.06 Gülen, S., & Ormankaya, T. (2025). COVID-19 Pandemi sürecinde sağlıkta şiddet: Beyaz Kod verileri ile retrospektif bir değerlendirme [Violence in Healthcare During the COVID-19 Pandemic: A Retrospective Analysis Using White Code Data]. Sağlık Bilimlerinde Değer, 15 (2), 275–281. https://doi.org/10.33631/sabd.1563535 Hills, D., & Joyce, C. (2013). A review of research on the prevalence, antecedents, consequences and prevention of workplace aggression in clinical medical practice. Aggression and Violent Behavior, 18 (5), 554–569. https://doi.org/10.1016/j.avb.2013.07.014 Yang, H. L., Tai, J. C., Wang, C. H., Shyu, Y. K., Chou, K. R., & Pien, L. C. (2025). Workplace violence, work characteristics, and seniority levels among nurses: a cross-sectional study. BMC Nursing, 24, 281. https://doi.org/10.1186/s12912-025-02887-3 Aslan, B. B., & Durmuş, S. B. (2024). Sağlık çalışanlarına yönelik şiddetin çözümünde kriz iletişimi ve iletişim becerilerinin önemi: bir kamu hastanesi örneği [The Importance of Crisis Communication and Communication Skills in Addressing Violence Against Healthcare Workers: A Public Hospital Case Study]. Yeni Yüzyıl’da İletişim Çalışmaları, 2 (9), 44–54. Kwak, Y., & Han, Y. (2020). Impact of emotional labour and workplace violence on professional quality of life among clinical nurses. International Journal of Nursing Practice, 26 (1), e12792. https://doi.org/10.1111/ijn.12792 Colasanti, A., Natoli, A., Moliterno, D., Rossattini, M., De Gaspari, I. F., & Mauri, M. C. (2008). Psychiatric diagnosis and aggression before acute hospitalisation. European Psychiatry, 23, 441–448. https://doi.org/10.1016/j.eurpsy.2007.09.005 D'Ettorre, G., & Pellicani, V. (2017). Workplace Violence Toward Mental Healthcare Workers Employed in Psychiatric Wards. Safety and Health at Work, 8 (4), 337–342. https://doi.org/10.1016/j.shaw.2017.01.004 Akbolat, M., Sezer, C., Ünal, Ö., Amarat, M., & Durmuş, A. (2021). The effects of direct violence and witnessed violence on the future fear of violence and turnover intention: a study of health employees. Current Psychology, 40, 4684–4690. https://doi.org/10.1007/s12144-019-00410-x Ayhan, C. H., Aktaş, M. C., & Karan, E. (2025). Psychiatric nurses' experiences of patient violence on acute psychiatric units in Turkey: a qualitative study. BMC Nursing, 24, 363. https://doi.org/10.1186/s12912-025-03030-y Fernandes, C. M. B., Bouthillette, F., Raboud, J. M., Bullock, L., Moore, C. F., Christenson, J. M., Grafstein, E., Rae, S., Ouellet, L., Gillrie, C., & Way, M. (1999). Violence in the emergency department: A survey of health care workers. CMAJ, 161, 1245–1248. Wang, J., Liu, M., Zheng, H., & Xiang, M. (2025). Workplace violence experiences of intensive care unit healthcare providers: a qualitative systematic review and meta-synthesis. BMC Health Services Research, 25 (1), 399. https://doi.org/10.1186/s12913-025-12446-w Annagür, B. (2010). Sağlık çalışanlarına yönelik şiddet: risk faktörleri, etkileri, değerlendirilmesi ve önlenmesi [Violence Against Healthcare Workers: Risk Factors, Consequences, Assessment, and Prevention]. Psikiyatride Güncel Yaklaşımlar, 2 (2), 161–173. Camerino, D., Fry, C., Le Nezet, O., Conway, P. M., & Hasselhorn, H. (2008). Violence risks in nursing—Results from the European 'NEXT' Study. Occupational Medicine, 58 (2), 107–114. https://doi.org/10.1093/occmed/kqm142 Demiroğlu, T., Kılınç, E., & Atay, E. (2015). Sağlık çalışanlarına uygulanan şiddet: Kilis ili örneği [Violence Against Healthcare Workers: The Case of Kilis Province]. Sağlık Bilimleri Dergisi, 24 (1), 49–55. Magnavita, N., & Heponiemi, T. (2011). Workplace Violence Against Nursing Students and Nurses: An Italian Experience. Journal of Nursing Scholarship, 43 (2), 203–210. https://doi.org/10.1111/j.1547-5069.2011.01392.x Portoghese, I., Galletta, M., Leiter, M. P., Cocco, P., D’Aloja, E., & Campagna, M. (2017). Fear of future violence at work and job burnout: A diary study. Burnout Research, 7, 36–46. https://doi.org/10.1016/j.burn.2017.11.003 Alaçam, B., & Baykal, Ü. (2025). Opinions of nurse managers on impact of domestic violence on work life: a qualitative study. BMC Nursing, 24, 1153. https://doi.org/10.1186/s12912-025-03735-0 Fu, C., Ren, Y., Wang, G., Shi, X., & Cao, F. (2021). Fear of future workplace violence and its influencing factors among nurses in Shandong, China: a cross-sectional study. BMC Nursing, 20, 1–10. https://doi.org/10.1186/s12912-021-00644-w Fu, C., Lv, X., Cui, X., Huang, M., & Cao, F. (2023). The association between fear of future workplace violence and depressive symptoms among nurses. BMC Nursing, 22, 123. https://doi.org/10.1186/s12912-023-01265-1 Lanctôt, N., & Guay, S. (2014). The aftermath of workplace violence among healthcare workers: A systematic literature review. Aggression and Violent Behavior, 19 (5), 492–501. https://doi.org/10.1016/j.avb.2014.07.010 Lazarus, R. S., & Folkman, S. (1984). Stress, appraisal, and coping. Springer Publishing Company. Schaufeli, W. B., & Bakker, A. B. (2004). Job demands, job resources, and burnout. Journal of Organizational Behavior, 25 (3), 293–315. https://doi.org/10.1002/job.248 Akyavuz, E. K. (2017). Öğretmenlerin örgütsel adalet ve örgütsel güven algıları arasındaki ilişkinin incelenmesi [An Examination of the Relationship Between Teachers' Perceptions of Organizational Justice and Organizational Trust]. Uludağ Üniversitesi Eğitim Fakültesi Dergisi, 30 (2), 805–831. Akgerman, A. (2018). Hemşirelerin yöneticilerine güven düzeylerinin örgütsel bağlılıklarına etkisi [The Effect of Nurses' Trust Levels in Their Managers on Their Organizational Commitment] . Unpublished MSc Thesis. Istanbul University. You, Q., Bai, D., Wu, C., Gao, J., & Hou, C. (2022). Status of work alienation among nurses in China: A systematic review. Frontiers in Psychiatry, 13, 986139. https://doi.org/10.3389/fpsyt.2022.986139 Chiaburu, D. S., Thundiyil, T., & Wang, J. (2014). Alienation and its correlates: A meta-analysis. European Management Journal, 32 (1), 24–36. https://doi.org/10.1016/j.emj.2013.06.003 Gümüş, E., Alan, H., Eskici, G. T., & Bacaksız, F. E. (2021). Relationship between professional quality of life and work alienation among healthcare professionals. Florence Nightingale Journal of Nursing, 29 (3), 342. https://doi.org/10.5152/FNJN.2021.20095 Semiz, E., & Söyük, S. (2023). The relationship between work alienation behavior and cyberloafing. Çankırı Karatekin Üniversitesi İİBF Dergisi, 13 (4), 1381–1411. https://doi.org/10.18074/ckuiibfd.1261920 Seeman, M. (1959). On the Meaning of Alienation. American Sociological Review, 24 (6), 783–791. https://doi.org/10.2307/2088565 Shi, Y., Mao, F., & Zhang, X. (2025). Association between fear of future workplace violence and burnout among pediatricians. Journal of Occupational Health, 67 (1), uiaf029. https://doi.org/10.1093/joccuh/uiaf029 Yalım, M. K. (2024). Sağlık endüstrisinde şiddet korkusunun örgütsel bağlılığa etkisi [The Effect of Fear of Violence on Organizational Commitment in the Healthcare Industry] . Unpublished MSc Thesis. Afyon Kocatepe University. Li, N., Li, Y., Wang, J., Kong, C., Qin, Y., & Liu, J. (2023). Job stress mediates between climate and alienation. Western Journal of Nursing Research, 45 (10), 878–884. https://doi.org/10.1177/01939459231189926 Xia, B., Wang, X., Li, Q., He, Y., & Wang, W. (2022). How workplace incivility leads to work alienation. Frontiers in Psychology, 13, 921161. https://doi.org/10.3389/fpsyg.2022.921161 Rogers, A. K. (1994). Violence at work: Personal and organizational outcomes . Unpublished MSc Thesis. University of Guelph. De Bruin, G. P. (2006). The dimensionality of the general work stress scale. SA Journal of Industrial Psychology, 32 (4), 68–75. https://hdl.handle.net/10520/EJC89108 Teleş, M. (2021). Validity and reliability of the Turkish version of the General Work Stress Scale. Journal of Nursing Management, 29 (4), 710–720. https://doi.org/10.1111/jonm.13211 Hirschfeld, R. R., Feild, H. S., & Bedeian, A. G. (2000). Work alienation as an individual‐difference construct. Journal of Applied Social Psychology, 30 (9), 1880–1902. https://doi.org/10.1111/j.1559-1816.2000.tb02473.x Kanten, P., & Ülker, F. (2014). Yönetim tarzının üretkenlik karşıtı iş davranışlarına etkisinde işe yabancılaşmanın aracılık rolü. MSKÜ Sosyal Bilimler Dergisi, 32, 16–40. Republic of Türkiye Ministry of Health (2025). Health Statistics Yearbook – 2023 . https://dosyasb.saglik.gov.tr/Eklenti/50208/0/siy2023ingilizce31012025pdf.pdf Istanbul Chamber of Commerce (2025). Hemşire Sayısı [Number of Nurses]. https://www.itosam.org.tr/veri-istanbul/saglik-istatistikleri/hemsire-sayisi Cochran, W. G. (1977). Sampling techniques. John Wiley & Sons. Hair, J. F., Tomas, G., Hult, M., Ringle, C. M., & Sarstedt, M. (2014). A primer on partial least square structural equations modeling (PLS-SEM). SAGE. Hair, J. F., Risher, J. J., Sarstedt, M., & Ringle, C. M. (2019). When to use and how to report the results of PLS-SEM. European Business Review, 31 (1), 2–24. https://doi.org/10.1108/EBR-11-2018-0203 Henseler, J., Ringle, C. M., & Sarstedt, M. (2015). A new criterion for assessing discriminant validity. Journal of the Academy of Marketing Science, 43 (1), 115–135. https://doi.org/10.1007/s11747-014-0403-8 Rahman, O., Wong, K. K., & Yu, H. (2016). The effects of mall personality and fashion orientation on shopping value and mall patronage intension. Journal of Retailing and Consumer Services, 28, 155–164. https://doi.org/10.1016/j.jretconser.2015.09.008 Falk, R. F., & Miller, N. B. (1992). A primer for soft modeling. University of Akron Press. Ringle, C., Wende, S., & Becker, J. M. (2016). SmartPLS 3. https://www.smartpls.com Henseler, J., Hubona, G., & Ray, P. A. (2016). Using PLS path modeling in new technology research. Industrial Management & Data Systems, 116 (1), 2–20. https://doi.org/10.1108/IMDS-09-2015-0382 Bentler, P. M., & Bonett, D. G. (1980). Significance tests and goodness of fit in the analysis of covariance structures. Psychological Bulletin, 88 (3), 588–606. https://doi.org/10.1037/0033-2909.88.3.588 SmartPLS (n.d.). Model Fit . https://www.smartpls.com/documentation/algorithms-and-techniques/model-fit Gates, D. M., Gillespie, G. L., & Succop, P. (2011). Violence against nurses and its impact. Nursing Economics, 29 (2), 59–66. http://ldihealtheconomist.com/media/nv01.pdf Galanis, P., Moisoglou, I., Katsiroumpa, A., & Mastrogianni, M. (2024). Workplace bullying and job stress. Healthcare, 12 (6), 623. https://doi.org/10.3390/healthcare12060623 Boyle, D. A. (2011). Countering compassion fatigue. OJIN, 16 (1), Manuscript 2. https://doi.org/10.3912/OJIN.Vol16No01Man02 Brondolo, E., Eftekharzadeh, P., Clifton, C., Schwartz, J. E., & Delahanty, D. (2018). Work-related trauma, alienation, and posttraumatic and depressive symptoms in medical. Psychological Trauma, 10 (6), 689. Kim S, Mayer C, Jones CB. Relationships between nurses' experiences of workplace violence, emotional exhaustion and patient safety. Journal of Research in Nursing . 2020;26(1-2):35-46. https://doi.org/10.1177/1744987120960200 Havaei, F., Astivia, O. L. O., & MacPhee, M. (2020). Workplace violence and health outcomes. International Journal of Nursing Studies, 109, 103666. https://doi.org/10.1016/j.ijnurstu.2020.103666 Campione, A., & Henschke, C. (2025). Impact of violence on emotional exhaustion risk. BMC Nursing, 24, 1080. https://doi.org/10.1186/s12912-025-03745-y Sun, X., Qiao, M., Deng, J., Zhang, J., Pan, J., Zhang, X., & Liu, D. (2021). Mediating Effect of Work Stress on the Associations Between Psychological Job Demands, Social Approval, and Workplace Violence Among Health Care Workers in Sichuan Province of China. Frontiers in Public Health, 9 , 743626. https://doi.org/10.3389/fpubh.2021.743626 Itzhaki, M., Bluvstein, I., Peles Bortz, A., Kostistky, H., Bar Noy, D., Filshtinsky, V., & Theilla, M. (2018). Mental Health Nurse's Exposure to Workplace Violence Leads to Job Stress, Which Leads to Reduced Professional Quality of Life. Frontiers in Psychiatry, 9 , 346955. https://doi.org/10.3389/fpsyt.2018.00059 Hobfoll, S. E. (1989). Conservation of resources: A new attempt at conceptualizing stress. American Psychologist, 44 (3), 513–524. Bahadır, M., & Ercan, A. (2018). Sağlık çalışanlarında iş stresi ve yabancılaşma [Job Stress and Alienation Among Healthcare Workers] . II. Uluslararası Multidisipliner Çalışmaları Kongresi [ 2nd International Congress on Multidisciplinary Studies] . Magdy, A., & Salem, I. E. (2024). Understanding the impact of work environment. Tourism and Hospitality Management, 30 (4), 531–542. https://hrcak.srce.hr/file/465475 Goudarzian, A. H., Nikbakht Nasrabadi, A., Farhadi, B., & Navab, E. (2024). Exploring the concept and management strategies of caring stress among clinical nurses: A scoping review. Frontiers in Psychiatry, 15 , 1337938. https://doi.org/10.3389/fpsyt.2024.1337938 Lazányi, K. (2010). Emotional labour and its consequences. FIKUSZ'10 Symposium Proceedings, 149–156. Laeeque, S. H., Bilal, A., Babar, S., Khan, Z., & Ul Rahman, S. (2017). How Patient-Perpetrated Workplace Violence Leads to Turnover Intention Among Nurses: The Mediating Mechanism of Occupational Stress and Burnout. Journal of Aggression, Maltreatment & Trauma, 27 (1), 96–118. https://doi.org/10.1080/10926771.2017.1410751 Durmuş, A., Ünal, Ö., Türktemiz, H., & Öztürk, Y. E. (2024). The effect of nurses' perceived workplace incivility on their presenteeism and turnover intention: The mediating role of work stress and psychological resilience. International Nursing Review, 71 (4), 960-968. https://doi.org/10.1111/inr.12950 Arnetz, J. E., Baker, N., Arble, E., & Arnetz, B. B. (2024). Workplace violence, work-related exhaustion, and workplace cognitive failure among nurses: A cross-sectional study. Journal of Advanced Nursing, 81 (1), 271-285. https://doi.org/10.1111/jan.16217 Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7574420","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":532985215,"identity":"91d1e75a-7a1a-4549-9f62-1e96831caae1","order_by":0,"name":"Mustafa Aslan","email":"data:image/png;base64,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","orcid":"","institution":"Istanbul Bilgi University","correspondingAuthor":true,"prefix":"","firstName":"Mustafa","middleName":"","lastName":"Aslan","suffix":""},{"id":532985219,"identity":"d6cccf3d-12f9-4ed1-9ab3-f714295e6725","order_by":1,"name":"Zeki Çetin","email":"","orcid":"","institution":"Istanbul Nisantasi University","correspondingAuthor":false,"prefix":"","firstName":"Zeki","middleName":"","lastName":"Çetin","suffix":""},{"id":532985220,"identity":"427a7b29-e2d8-41d5-8696-ed939c6dc718","order_by":2,"name":"Esra Hatipoğulları","email":"","orcid":"","institution":"Istanbul Nisantasi University","correspondingAuthor":false,"prefix":"","firstName":"Esra","middleName":"","lastName":"Hatipoğulları","suffix":""}],"badges":[],"createdAt":"2025-09-09 13:38:30","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-7574420/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-7574420/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":94185960,"identity":"c2b6c308-d7fb-48e4-a4b0-c4d367bf3b51","added_by":"auto","created_at":"2025-10-23 10:44:39","extension":"docx","order_by":0,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":133968,"visible":true,"origin":"","legend":"","description":"","filename":"FearofViolenceandWorkAlienationAmongNursesTheMediatingRoleofWorkStress.docx","url":"https://assets-eu.researchsquare.com/files/rs-7574420/v1/625e96bcbc0bd3acad550ece.docx"},{"id":94185958,"identity":"7842d44f-c830-42a3-af2b-24b6418b7e92","added_by":"auto","created_at":"2025-10-23 10:44:39","extension":"json","order_by":1,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":6170,"visible":true,"origin":"","legend":"","description":"","filename":"d32af4b17ee24b43a25e98a12d20f58d.json","url":"https://assets-eu.researchsquare.com/files/rs-7574420/v1/056228f8905e24deba390710.json"},{"id":94186650,"identity":"b370d8cd-f332-4f64-b35c-03c78d038ccb","added_by":"auto","created_at":"2025-10-23 11:00:39","extension":"xml","order_by":2,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":192592,"visible":true,"origin":"","legend":"","description":"","filename":"d32af4b17ee24b43a25e98a12d20f58d1enriched.xml","url":"https://assets-eu.researchsquare.com/files/rs-7574420/v1/6e77c75d40938cae3474dea9.xml"},{"id":94185962,"identity":"bf6f3aca-c568-4665-ab77-9804b41552c1","added_by":"auto","created_at":"2025-10-23 10:44:39","extension":"png","order_by":3,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":39231,"visible":true,"origin":"","legend":"","description":"","filename":"floatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-7574420/v1/0a09fc86a43c53c52e20c2e4.png"},{"id":94186178,"identity":"cee71cb9-e893-4bba-8449-bb6d41cc75e8","added_by":"auto","created_at":"2025-10-23 10:52:39","extension":"png","order_by":4,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":19077,"visible":true,"origin":"","legend":"","description":"","filename":"Onlinefloatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-7574420/v1/c48d6216202300cef4848b5d.png"},{"id":94185965,"identity":"56ba7d8b-a9b2-49c0-96d7-3be513894847","added_by":"auto","created_at":"2025-10-23 10:44:39","extension":"xml","order_by":5,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":190601,"visible":true,"origin":"","legend":"","description":"","filename":"d32af4b17ee24b43a25e98a12d20f58d1structuring.xml","url":"https://assets-eu.researchsquare.com/files/rs-7574420/v1/05a49d7a3117bff4208d1d3d.xml"},{"id":94186179,"identity":"db37a9f6-a618-4cb1-ab7b-baaba3428d36","added_by":"auto","created_at":"2025-10-23 10:52:39","extension":"html","order_by":6,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":201100,"visible":true,"origin":"","legend":"","description":"","filename":"earlyproof.html","url":"https://assets-eu.researchsquare.com/files/rs-7574420/v1/e0095db1b953490f8e44761f.html"},{"id":94185959,"identity":"3e170cd5-2427-4654-aa69-cf328cb75bec","added_by":"auto","created_at":"2025-10-23 10:44:39","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":120169,"visible":true,"origin":"","legend":"\u003cp\u003ePath Model\u003c/p\u003e","description":"","filename":"floatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-7574420/v1/a6a14f37b0e5fe6ddff8ab50.png"},{"id":103907241,"identity":"6712d47f-d139-497e-a42c-63b06bf435b2","added_by":"auto","created_at":"2026-03-04 11:12:22","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1117859,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7574420/v1/534ba58a-b69d-431a-a82e-e5044cfc46fa.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Fear of Violence and Work Alienation Among Nurses: The Mediating Role of Work Stress","fulltext":[{"header":"INTRODUCTION","content":"\u003cp\u003eThe health sector, compared to other professions, has distinct responsibilities as it is directly related to protecting and improving human life and well-being. This responsibility also imposes a significant burden on the healthcare workers, causing them to feel higher levels of pressure. Furthermore, under these stressful conditions, while utilizing their technical knowledge and skills to serve patients, they must also cope with emotionally demanding situations raised by both patients and their relatives, with limited resources, and the constant need to make rapid decisions. These challenges affect healthcare workers both physically and psychologically. Moreover, the increasing incidence of violence in the healthcare sector has further intensified these challenges [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eThe World Health Organization (WHO) defines violence in healthcare as \"\u003cem\u003ethe intentional use of physical force or threat that healthcare workers are exposed to while performing their duties, threatening the safety of themselves or their relatives.\u003c/em\u003e\" This definition highlights that violence is not restricted to physical assaults; it may also manifest as threats, verbal harassment, insults, or psychological pressure [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. Hence, violence in healthcare should be considered a multidimensional phenomenon that undermines both individual well-being and organizational performance.\u003c/p\u003e\u003cp\u003eViolence can be grouped into three categories [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]: (i) physical violence (e.g., hitting, pushing, injury), (ii) verbal violence (e.g., insults, threats, mockery), and (iii) psychological violence (e.g., mobbing, exclusion, pressure). Each of these forms has adverse consequences for both physical and mental health, and also professional commitment.\u003c/p\u003e\u003cp\u003eNational and international studies demonstrate that violence in healthcare is no longer an isolated occurrence but a systemic problem. Research in T\u0026uuml;rkiye indicates that more than 70% of healthcare workers have experienced violence at least once in their careers [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. Similarly, studies in Canada, the United States, and European countries report that more than half of healthcare workers have been subjected to different forms of violence [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. These findings show that violence is not limited to developing countries but is a global threat. It is not a matter of individual misconduct but rather a complex social problem linked to structural and systemic factors.\u003c/p\u003e\u003cp\u003eThe contributing causes to violence are diverse, including but not limited to long waiting times, staff shortages, communication barriers, and uncertainties surrounding the health problems [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. Everyone who has to go to the hospital prioritizes their own health or that of their loved one, and therefore, their expectations are shaped accordingly; they desire the highest level of care, attention, and priority. This heightened expectation is one of the reasons why international studies emphasize that personnel in high-risk departments, such as emergency services, are disproportionately exposed to violence [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eThe effects of violent incidents extend beyond the immediate trauma experienced. Over time, they can undermine employees' psychological health, job motivation, and professional commitment. An equally important phenomenon, which has attracted growing attention in the literature, is the fear of violence. Even in the absence of direct exposure, the persistent perception of being at risk can itself become a powerful stressor. Studies show that fear of violence is more prevalent than actual violent events and may harm mental health to a similar degree [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eThe concept of fear of violence, increasingly discussed in the literature, refers to the perception of being at risk of violence in the future, even without direct experience, and interpreting this as a continuing threat [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. Research shows that this fear is more common than actual incidents and produces comparable levels of psychological harm [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. One of the most prominent reflections of this fear is its effect on work stress. Recent studies confirm that fear of violence significantly contributes to increased work stress [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eWork stress is one of the most significant outcomes of fear of violence. It emerges when job demands exceed the individual's capacity to cope [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e, \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]. Healthcare professionals already work in environments characterized by high pressure, and fear of violence only compounds this strain. Chronic stress not only causes individual health problems such as burnout, depression, anxiety, and psychosomatic symptoms, but it also leads to organizational risks, including reduced efficiency, increased errors, and threats to patient safety [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e, \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eThe consequences of stress are often discussed alongside work alienation. Work alienation refers to feelings of disconnection, meaninglessness, and powerlessness toward one's work [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e, \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e]. Among healthcare workers, alienation is not merely a personal concern but a major threat to the quality of patient care, professional empathy, and ethical responsibilities [\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e, \u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e]. When employees perceive their jobs as meaningless, oppressive, or unrewarding, alienation strengthens [\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e, \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e]. Among healthcare workers, factors such as high workload, insufficient organizational support, role conflict, and violent experiences are known to heighten alienation [\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e, \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eFear of violence undermines trust in both the profession and the institution. A constant sense of threat reduces the meaningfulness of work, fosters emotional exhaustion, and distances nurses from their roles [\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e, \u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e]. Often, this relationship operates indirectly through work stress [\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e], which suggests that fear of violence may lead to alienation indirectly, by increasing work stress [\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e, \u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e, \u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. This indicates a multilayered relationship among fear of violence, work stress, and work alienation.\u003c/p\u003e\u003cp\u003eThese findings highlight a gap in the literature, showing that the relationship among fear of violence, stress, and work alienation requires a holistic evaluation. While prior research has mainly emphasized individual psychological outcomes, fewer studies have examined how these factors interact with organizational dynamics. The contribution of this study lies in addressing these interconnections in a multidimensional way.\u003c/p\u003e\u003cp\u003eConsidering the high exposure of nurses to workplace violence [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e] and the critical psychological consequences it may entail, this study specifically examines how fear of violence among nurses influences their perceived work stress and, ultimately, their sense of work alienation.\u003c/p\u003e"},{"header":"METHOD","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003eData Collection and Measures\u003c/h2\u003e\u003cp\u003eThe questionnaire used for data collection consisted of four sections. The first section included a Demographic Information Form, which was prepared by the researchers in line with the purpose of the study and contained eight items. This form collected information regarding participants' gender, age, marital status, education level, type of hospital they were working at, tenure, and history of exposure to or witnessing of violence.\u003c/p\u003e\u003cp\u003eThe remaining three sections comprised previously validated and published scales. In the second section, we used the Fear of Violence Scale, developed by Rogers [\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e] and adapted into Turkish by Akbolat et al. [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. This scale contains 10 items under a single factor, rated on a 5-point Likert scale (1\u0026thinsp;=\u0026thinsp;Strongly Disagree, 5\u0026thinsp;=\u0026thinsp;Strongly Agree).\u003c/p\u003e\u003cp\u003eIn the third section, we used the Perceived Work Stress Scale (sometimes referred to as the \"general work stress scale\"), developed by De Bruin [\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e] and adapted into Turkish by Teleş [\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e]. This scale includes nine single-dimension items, scored from 1\u0026thinsp;=\u0026thinsp;Never to 5\u0026thinsp;=\u0026thinsp;Always. Higher total scores reflect higher perceived work stress levels.\u003c/p\u003e\u003cp\u003eFinally, in the fourth section, we employed the Work Alienation Scale, developed by Hirschfeld et al. [\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e] and adapted into Turkish by Kanten and \u0026Uuml;lker [\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e]. This scale consists of eight items under a single factor, with responses collected on a 5-point Likert scale (1\u0026thinsp;=\u0026thinsp;Strongly Disagree, 5\u0026thinsp;=\u0026thinsp;Strongly Agree).\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eSampling\u003c/h3\u003e\n\u003cp\u003eThe research universe is the nurses working in Istanbul. The inclusion criteria were to be a nurse and employed in a fully fledged hospital. According to the 2023 data of the Republic of T\u0026uuml;rkiye Ministry of Health [\u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e], there are 248,287 nurses working across T\u0026uuml;rkiye, with no precise numbers for provinces. However, according to the Istanbul Chamber of Commerce [\u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e], in 2023, there were 42,114 nurses working in hospitals in Istanbul. Hence, the sample size calculated using the Cochran [\u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e] formula for a 95% confidence level, 5% sampling error, and finite universe correction is 381 participants.\u003c/p\u003e\u003cp\u003eWe distributed printed surveys to nurses during their lunch breaks and remained nearby to collect the completed forms. Using the convenience sampling method, we reached a total of 411 nurses. Nineteen surveys were found to be incomplete and were excluded from the analyses. Consequently, all statistical analyses were conducted with the responses of 392 nurses. The demographic characteristics of the participants are presented in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eDemographics of the Participants (N\u0026thinsp;=\u0026thinsp;392)\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"5\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003ef\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003e%\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eValid %\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eGender\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eFemale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e276\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e70.4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e70.4\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e116\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e29.6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e29.6\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"6\" rowspan=\"7\"\u003e\u003cp\u003eAge\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eBelow 25\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e14\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e3.6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e3.6\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eBetween 25\u0026ndash;29\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e168\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e42.9\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e42.9\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eBetween 30\u0026ndash;34\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e100\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e25.5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e25.5\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eBetween 35\u0026ndash;39\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e40\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e10.2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e10.2\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eBetween 40\u0026ndash;44\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e30\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e7.7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e7.7\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eBetween 45\u0026ndash;49\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e24\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e6.1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e6.1\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e50 and Over\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e16\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e4.1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e4.1\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eMarital Status\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMarried\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e206\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e52.6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e52.6\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSingle\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e186\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e47.4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e47.4\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e\u003cp\u003eEducation Level\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eHigh School\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e28\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e7.1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e7.1\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCollege\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e32\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e8.2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e8.2\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eUniversity\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e300\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e76.6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e68.4\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eGraduate School\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e64\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e16.3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e16.3\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eType of Hospital\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eState Owned\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e356\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e90.8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e90.8\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePrivately Owned\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e36\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e9.2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e9.2\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"4\" rowspan=\"5\"\u003e\u003cp\u003eTenure\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e4 Years and Below\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e116\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e29.6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e29.6\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eBetween 5\u0026ndash;9 Years\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e138\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e35.2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e35.2\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eBetween 10\u0026ndash;14 Years\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e60\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e15.3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e15.3\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eBetween 15\u0026ndash;19 Years\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e32\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e8.2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e8.2\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e20 Years and Over\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e46\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e11.7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e11.7\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eHistory of Violence\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e156\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e39.8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e39.8\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e236\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e60.2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e60.2\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eAs shown in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e, the majority of the participants were female (70.4%, n\u0026thinsp;=\u0026thinsp;276), with a mean age of 32.41 years (\u003cem\u003eSD\u003c/em\u003e\u0026thinsp;=\u0026thinsp;7.32; \u003cem\u003emedian\u003c/em\u003e\u0026thinsp;=\u0026thinsp;30.00), and most were university graduates (68.4%, n\u0026thinsp;=\u0026thinsp;268). A smaller proportion were high school graduates (n\u0026thinsp;=\u0026thinsp;28; 7.1%), as, until 2014, graduates of Health Vocational High Schools were eligible to practice as nurses. Regarding exposure to violence, 39.8% (n\u0026thinsp;=\u0026thinsp;156) of the participants reported having experienced violence, while 60.2% (n\u0026thinsp;=\u0026thinsp;236) reported no such experience.\u003c/p\u003e\u003cdiv id=\"Sec5\" class=\"Section2\"\u003e\u003ch2\u003eData Analysis\u003c/h2\u003e\u003cp\u003eThe collected data were analyzed using Partial Least Squares Structural Equation Modeling (PLS-SEM) with SmartPLS version 3.2.9, and SPSS (version 26) when deemed necessary. Confirmatory Composite Analysis (CCA), structural validity assessments (Convergence and Discriminant Validities), and Reliability Tests were performed. The acceptability of the research model was assessed with the coefficient of determination (R\u003csup\u003e2\u003c/sup\u003e) and the prediction relevance value (Q\u003csup\u003e2\u003c/sup\u003e).\u003c/p\u003e\u003cp\u003eWe employed several established criteria to assess the validity and reliability of the path model. For convergence validity, the Average Variance Extracted (AVE) value is required to be equal to or greater than 0.50, the Composite Reliability (CR) value equal to or greater than 0.70, and the Cronbach's Alpha value equal to or greater than 0.70 [\u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e, \u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eFor discriminant validity, we utilized the Heterotrait-Monotrait Ratio (HTMT), which is required to be 0.90 for theoretically close constructs and 0.85 for those distinct [\u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e47\u003c/span\u003e]. Furthermore, the Variance Inflation Factor (VIF) values are expected to be below 5 [\u003cspan citationid=\"CR48\" class=\"CitationRef\"\u003e48\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eIn terms of overall model acceptability, the coefficient of determination (R\u0026sup2;) is expected to be greater than 0.10 [\u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e, \u003cspan citationid=\"CR49\" class=\"CitationRef\"\u003e49\u003c/span\u003e], and the Q\u0026sup2; value, reflecting predictive relevance, is expected to be greater than zero [\u003cspan citationid=\"CR50\" class=\"CitationRef\"\u003e50\u003c/span\u003e]. Furthermore, factor loadings of items are expected to be equal to or greater than 0.70. Items with factor loadings below 0.40 were excluded from the analysis, while those between 0.40 and 0.70 will be retained only if the construct's CR, AVE, and Cronbach's Alpha values exceeded the recommended thresholds [\u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e].\u003c/p\u003e\u003c/div\u003e"},{"header":"Findings","content":"\u003cp\u003eWe designed the path model (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e) based on the conceptual framework. As illustrated, the model depicts the hypothesized relationships among fear of violence, perceived work stress, and work alienation. The following analyses examine the reliability and validity of the constructs and test the significance of the structural paths.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003eAs reported in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e, the results of Confirmatory Composite Analysis (CCA) show that the Cronbach's Alpha, CR, AVE values, and Factor Loadings satisfied the criteria set forth, and hence, we concluded that the scales collectively satisfied the internal consistency reliability and convergent validity conditions.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eFactor Loadings, Cronbach's Alpha, CR, and AVE Values of the Constructs\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"6\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eConstruct\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eItems\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eFactor Loadings\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eCronbach's Alpha\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eCR\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003eAVE\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"7\" rowspan=\"8\"\u003e\u003cp\u003eWork Alienation\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eAlien01\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.672\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\" morerows=\"7\" rowspan=\"8\"\u003e\u003cp\u003e0.884\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\" morerows=\"7\" rowspan=\"8\"\u003e\u003cp\u003e0.908\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\" morerows=\"7\" rowspan=\"8\"\u003e\u003cp\u003e0.553\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eAlien02\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.669\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eAlien03\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.792\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eAlien04\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.811\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eAlien05\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.702\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eAlien06\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.781\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eAlien07\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.714\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eAlien08\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.790\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"9\" rowspan=\"10\"\u003e\u003cp\u003eFear of Violence\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eFoV01\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.877\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\" morerows=\"9\" rowspan=\"10\"\u003e\u003cp\u003e0.966\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\" morerows=\"9\" rowspan=\"10\"\u003e\u003cp\u003e0.970\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\" morerows=\"9\" rowspan=\"10\"\u003e\u003cp\u003e0.767\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eFoV02\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.877\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eFoV03\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.889\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eFoV04\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.923\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eFoV05\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.855\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eFoV06\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.849\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eFoV07\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.814\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eFoV08\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.931\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eFoV09\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.852\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eFoV10\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.883\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"8\" rowspan=\"9\"\u003e\u003cp\u003ePerceived Work Stress\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eStress01\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.755\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\" morerows=\"8\" rowspan=\"9\"\u003e\u003cp\u003e0.948\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\" morerows=\"8\" rowspan=\"9\"\u003e\u003cp\u003e0.956\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\" morerows=\"8\" rowspan=\"9\"\u003e\u003cp\u003e0.709\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eStress02\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.857\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eStress03\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.807\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eStress04\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.844\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eStress05\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.869\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eStress06\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.883\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eStress07\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.872\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eStress08\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.878\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eStress09\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.806\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eAlthough two items (Alien01 and Alien02) had factor loadings below the recommended .70 threshold, they were retained because their values exceeded .60 and the construct's CR (0.908), AVE (0.553), and Cronbach's Alpha (0.884) were all above the acceptable limits [\u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e].\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eHTMT Test Results\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"4\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eConstruct\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003e3\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e1- Fear of Violence\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e2- Perceived Work Stress\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e0.333\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e3- Work Alienation\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e0.358\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.764\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eThe assessment of discriminant validity was conducted using the HTMT test, and the results are reported in Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e. According to the results, the highest HTMT value was observed between Work Alienation and Perceived Work Stress (0.760), which is below the threshold value of 0.85 for theoretically distinct concepts [\u003cspan citationid=\"CR51\" class=\"CitationRef\"\u003e51\u003c/span\u003e].\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eVIF Values\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"4\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eConstruct\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003e3\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e1- Fear of Violence\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e1,000\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e1,117\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e2- Perceived Work Stress\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e1,117\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e3- Work Alienation\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eThe VIF values that are reported in Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e show that all values are below the threshold value of 5 [\u003cspan citationid=\"CR48\" class=\"CitationRef\"\u003e48\u003c/span\u003e]. Hence, we concluded that the convergence and discriminant validities were established.\u003c/p\u003e\u003cp\u003eThe R\u0026sup2; and Q\u0026sup2; values also show that the model has predictive power and is acceptable since R\u0026sup2; values explain approximately 10.5% of the variance in Perceived Work Stress and 51.8% of the variance in Work Alienation and both are above 0.10 [\u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e, \u003cspan citationid=\"CR49\" class=\"CitationRef\"\u003e49\u003c/span\u003e], and the Q\u0026sup2; value measured as 0.073 for Perceived Work Stress and 0.279 for Work Alienation, and both are greater than zero [\u003cspan citationid=\"CR50\" class=\"CitationRef\"\u003e50\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eThe model's fit was evaluated using several indices, including the standardized root mean square residual (SRMR), d_ULS, d_G, chi-square, and the normed fit index (NFI). The results are reported in Table\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab5\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eModel Fit Summary\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"5\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFit Index\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSaturated Model\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eEstimated Model\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eThreshold (if applicable)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eInterpretation\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSRMR\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e0.059\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.059\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.08\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eGood model fit\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ed_ULS\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e1.296\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e1.296\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u0026ndash;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eAcceptable\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ed_G\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e0.798\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.798\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u0026ndash;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eAcceptable\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eChi-Square\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e1.688.626\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e1.688.626\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u0026ndash;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eLarge (expected in large samples)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNFI\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e0.834\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.834\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u0026gt;\u0026thinsp;0.80\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eAcceptable fit\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eThe SRMR value for both the saturated and estimated models is 0.059, which is well below the commonly accepted threshold of 0.08, indicating a good model fit [\u003cspan citationid=\"CR51\" class=\"CitationRef\"\u003e51\u003c/span\u003e]. Similarly, the d_ULS (1.296) and d_G (0.798) values are relatively low and consistent between models, further supporting the model's adequacy. The Chi-square value of 1688.626, though statistically large, is expected in large sample structural equation modeling and should be interpreted in conjunction with other fit measures. The NFI value of 0.834 exceeds the minimum recommended threshold of 0.80, indicating an acceptable model fit [\u003cspan citationid=\"CR52\" class=\"CitationRef\"\u003e52\u003c/span\u003e, \u003cspan citationid=\"CR53\" class=\"CitationRef\"\u003e53\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eRegarding model selection criteria, several information criteria were computed (see Table\u0026nbsp;\u003cspan refid=\"Tab6\" class=\"InternalRef\"\u003e6\u003c/span\u003e) to evaluate model parsimony and comparative performance.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab6\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 6\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eModel Selection Criteria\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"3\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCriterion\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePerceived Work Stress\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eWork Alienation\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAIC (Akaike's Information Crit.)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e-40.527\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e-280.836\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAICu (Unbiased AIC)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e-38.522\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e-277.825\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAICc (Corrected AIC)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e353.535\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e113.267\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBIC (Bayesian Information Crit.)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e-32.585\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e-268.923\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHQ (Hannan-Quinn)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e-37.379\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e-276.115\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHQc (Corrected HQ)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e-37.306\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e-275.976\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eAs per the results reported in Table\u0026nbsp;\u003cspan refid=\"Tab6\" class=\"InternalRef\"\u003e6\u003c/span\u003e, for both Perceived Work Stress and Work Alienation, the Akaike's Information Criterion (AIC), corrected AIC (AICc), unbiased AIC (AICu), and Bayesian Information Criterion (BIC), as well as Hannan\u0026ndash;Quinn (HQ) and corrected HQ (HQc), all indicate a better fit for Work Alienation, as reflected by more negative AIC and BIC values (e.g., AIC = \u0026minus;\u0026thinsp;280.836 vs. \u0026minus;\u0026thinsp;40.527). Lower values of these criteria signify better model quality and parsimony, with the Work Alienation model showing superior performance across all selection indices.\u003c/p\u003e\u003cp\u003eHence, we concluded that the model demonstrates good global fit, particularly in explaining Work Alienation, with supportive SRMR, NFI, and model selection indicators.\u003c/p\u003e\u003cp\u003eAfter establishing the validity and reliability, hypotheses were tested using a complete bootstrapping procedure with 5,000 subsamples. The direct, indirect, and total effects, along with 95% confidence intervals (2.5% and 97.5%), are reported in Table\u0026nbsp;\u003cspan refid=\"Tab7\" class=\"InternalRef\"\u003e7\u003c/span\u003e.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab7\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 7\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003ePath Coefficients of Direct, Indirect, and Total Effects\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"8\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eβ\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eM\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eSD\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003et\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003ep\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c7\"\u003e\u003cp\u003e2.5%\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c8\"\u003e\u003cp\u003e97.5%\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"8\" nameend=\"c8\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003eDirect Effects\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFear of Violence -\u0026gt;Perceived Work Stress\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.324\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.330\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.048\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e6.724\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.000\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.227\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.421\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFear of Violence -\u0026gt;Work Alienation\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.121\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.122\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.036\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e3.330\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.052\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.194\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePerceived Work Stress -\u0026gt;Work Alienation\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.671\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.673\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.033\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e20.627\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.000\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.608\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.736\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"8\" nameend=\"c8\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003eIndirect Effects\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFear of Violence -\u0026gt;Perceived Work Stress -\u0026gt;Work Alienation\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.218\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.222\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.033\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e6.586\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.000\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.151\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.283\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"8\" nameend=\"c8\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003eTotal Effects\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFear of Violence -\u0026gt;Perceived Work Stress\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.324\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.330\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.048\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e6.724\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.000\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.227\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.421\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFear of Violence -\u0026gt;Work Alienation\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.339\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.344\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.045\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e7.467\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.000\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.253\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.433\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePerceived Work Stress -\u0026gt;Work Alienation\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.671\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.673\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.033\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e20.627\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.000\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.608\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.736\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eAs per the results reported in Table\u0026nbsp;\u003cspan refid=\"Tab7\" class=\"InternalRef\"\u003e7\u003c/span\u003e, the effect of Fear of Violence on Perceived Work Stress is statistically significant (β\u0026thinsp;=\u0026thinsp;0.324, t\u0026thinsp;=\u0026thinsp;6.724, p\u0026thinsp;\u0026lt;\u0026thinsp;.001), suggesting that increased fear of violence significantly predicts higher perceived work stress. The 95% confidence interval [0.227, 0.421] does not include zero, reinforcing the reliability of this finding. This result indicates that the threat of violence is not merely an abstract concern but serves as a concrete and chronic source of tension in nurses' daily professional lives. The constant sense of potential assault significantly depletes workers' psychological resources, forces them into a state of continuous alertness, and amplifies the impact of other inherent workplace stressors (e.g., workload, long shifts), thereby increasing overall stress levels in a meaningful way. As such, this finding constitutes the first and most critical link in the study's core model and empirically confirms that fear of violence functions as a direct stressor.\u003c/p\u003e\u003cp\u003eThe effect of Fear of Violence on Work Alienation is statistically significant (β\u0026thinsp;=\u0026thinsp;0.121, t\u0026thinsp;=\u0026thinsp;3.330, p\u0026thinsp;=\u0026thinsp;.001) as well, but weaker than its effect on Perceived Work Stress. Suggesting that the fear of violence increases the work alienation of nurses. This finding shows that the impact of violence is not limited to its role in increasing work stress but also possesses an inherently alienating power. The presence of this effect implies that fear of violence undermines nurses' basic psychological need for safety, violates the implicit psychological contract with the organization, and directly assaults their professional identity.\u003c/p\u003e\u003cp\u003eFurthermore, Perceived Work Stress has a significant and very high effect on Work Alienation (β\u0026thinsp;=\u0026thinsp;0.671, t\u0026thinsp;=\u0026thinsp;20.627, p\u0026thinsp;\u0026lt;\u0026thinsp;.001), indicating that perceived work stress is a major predictor of work alienation. According to this result, chronic and intense stress depletes nurses' psychological energy over time, causing them to lose a sense of control (powerlessness), disengage from the core mission of caregiving (meaninglessness), and withdraw emotionally and socially (social isolation). Hence, work stress emerges as the primary precursor to deep and enduring psychological detachment from work.\u003c/p\u003e\u003cp\u003eThe results also indicate that the Perceived Work Stress mediates the effect of Fear of Violence on Work Alienation (β\u0026thinsp;=\u0026thinsp;0.218, t\u0026thinsp;=\u0026thinsp;6.586, p\u0026thinsp;\u0026lt;\u0026thinsp;.001). This finding integrates previous results into a comprehensive process model. The study concludes that fear of violence affects work alienation primarily through an indirect mechanism. The process begins with fear of violence acting as a primary stressor, which then triggers accumulated and chronic stress, eventually causing nurses to become alienated from their work. Since both direct and indirect effects are statistically significant, the process operates as partial mediation. Moreover, the standardized coefficient of the indirect effect is greater than the direct effect, indicating that the most destructive influence of fear of violence manifests through the chronic stress it generates.\u003c/p\u003e\u003cp\u003eThe total effect of Fear of Violence on Work Alienation (combining direct and indirect paths) is substantial (β\u0026thinsp;=\u0026thinsp;0.339, t\u0026thinsp;=\u0026thinsp;7.467, p\u0026thinsp;\u0026lt;\u0026thinsp;.001) as well, showing that fear of violence significantly contributes to feelings of alienation at work both directly and through stress.\u003c/p\u003e\u003cp\u003eThese results not only uncover the psychological toll of violence in the healthcare sector but also provide practical guidance on steps that should be taken at various levels to address the issue. Accordingly, the study develops recommendations targeting healthcare professionals, institutional leaders, senior healthcare administrators, policymakers, and future researchers.\u003c/p\u003e\n\u003ch3\u003eMulti-Group Analysis\u003c/h3\u003e\n\u003cp\u003eWe also conducted multi-group analyses using SPSS 26, based on participants' age, tenure, education level, gender, and history of exposure to violence, in order to examine whether the mean differences in Fear of Violence, Perceived Work Stress, and Work Alienation were statistically significant. The one-way ANOVA test showed that no statistically significant differences were found in Fear of Violence [F(3, 388)\u0026thinsp;=\u0026thinsp;0.028, p\u0026thinsp;=\u0026thinsp;.994], Perceived Work Stress [F(3, 388)\u0026thinsp;=\u0026thinsp;1.485, p\u0026thinsp;=\u0026thinsp;.218], or Work Alienation [F(3, 388)\u0026thinsp;=\u0026thinsp;0.763, p\u0026thinsp;=\u0026thinsp;.515] across education levels. However, statistically significant differences were found across age and tenure groups, gender, and exposure to the violence.\u003c/p\u003e\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e\u003ch2\u003eAge Groups\u003c/h2\u003e\u003cp\u003eIn the study, whether there were statistically significant differences in fear of violence, perceived work stress, and work alienation levels according to age groups was analyzed using ANOVA and followed by LSD / Games-Howell post-hoc tests.\u003c/p\u003e\u003cp\u003eANOVA analysis results showed that there were statistically significant differences in fear of violence levels among age groups (F(6, 385)\u0026thinsp;=\u0026thinsp;3.542, p\u0026thinsp;=\u0026thinsp;.002). Post-hoc analyses revealed that the 25\u0026ndash;29 age group had significantly higher fear of violence levels. This group reported significantly more fear of violence compared to the 40\u0026ndash;44, 45\u0026ndash;49, and 50 and over age groups. In this context, the highest mean was observed in the 25\u0026ndash;29 age group (M\u0026thinsp;=\u0026thinsp;3.44) and the lowest mean in the 50 and over group (M\u0026thinsp;=\u0026thinsp;2.56).\u003c/p\u003e\u003cp\u003eIn terms of work stress, significant differences were also found among age groups (F(6, 385)\u0026thinsp;=\u0026thinsp;10.944, p\u0026thinsp;\u0026lt;\u0026thinsp;.001). Post-hoc analyses revealed that the 25\u0026ndash;29 and 30\u0026ndash;34 age groups had significantly higher stress levels. These groups experience higher stress, particularly compared to the 50 and over, 35\u0026ndash;39, and 40\u0026ndash;44 age groups. The highest average was observed in the 25\u0026ndash;29 age group (M\u0026thinsp;=\u0026thinsp;3.27) and the lowest in the 50 and over group (M\u0026thinsp;=\u0026thinsp;1.76).\u003c/p\u003e\u003cp\u003eSignificant differences were also found in work alienation levels among age groups (F(6, 385)\u0026thinsp;=\u0026thinsp;5.259, p\u0026thinsp;\u0026lt;\u0026thinsp;.001). While the highest alienation level was observed in the 30\u0026ndash;34 age group, nurses aged 50 and over had the lowest alienation levels. It was also observed that the 25\u0026ndash;29 age group experienced significantly more alienation compared to the 50 and over group. The highest mean was in the 30\u0026ndash;34 age group (M\u0026thinsp;=\u0026thinsp;3.13) and the lowest in the 50 and over group (M\u0026thinsp;=\u0026thinsp;1.98).\u003c/p\u003e\u003cp\u003eThese results suggest that younger nurses, particularly those in the 25\u0026ndash;29 age group, perceive the risk of violence more intensely. A lack of professional experience may contribute to the intensification of this fear, as older groups (40\u0026ndash;44, 45\u0026ndash;49, and 50 and over) reported significantly lower fear of violence. Similarly, stress levels were found to be higher during the early stages of working life, with the 25\u0026ndash;29 and 30\u0026ndash;34 age groups reporting significantly higher levels of stress compared to their older counterparts. This supports the interpretation that accumulated experience and professional maturity over time help reduce stress.\u003c/p\u003e\u003cp\u003eFindings also indicate that work alienation is more prevalent among younger and middle-aged nurses, with the 30\u0026ndash;34 age group showing the highest mean level of alienation and the 25\u0026ndash;29 group also reporting significantly greater alienation compared to the 50 and over group. This suggests that younger generations may experience a sense of disconnection from psychological aspects such as organizational commitment, meaning of work, and perceived control. Furthermore, the coexistence of higher fear of violence and work stress among these groups appears to reinforce the development of alienation.\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eTenure\u003c/h3\u003e\n\u003cp\u003eAccording to ANOVA results, fear of violence significantly differed by years of service (F(4, 387)\u0026thinsp;=\u0026thinsp;5.365, p\u0026thinsp;\u0026lt;\u0026thinsp;.001). Especially nurses with 20 years or more experience (M\u0026thinsp;=\u0026thinsp;2.74) and those with 15\u0026ndash;19 years (M\u0026thinsp;=\u0026thinsp;2.75) had significantly lower levels of fear of violence compared to nurses with 4 years or less (M\u0026thinsp;=\u0026thinsp;3.26), 10\u0026ndash;14 years (M\u0026thinsp;=\u0026thinsp;3.40), and 5\u0026ndash;9 years (M\u0026thinsp;=\u0026thinsp;3.49) of experience. This situation suggests that more experienced nurses may have greater psychological resilience or may have developed habituation in managing violent incidents.\u003c/p\u003e\u003cp\u003eWork stress levels also significantly differed according to years of service (F(4, 387)\u0026thinsp;=\u0026thinsp;16.291, p\u0026thinsp;\u0026lt;\u0026thinsp;.001). Nurses with 5\u0026ndash;9 years of experience had the highest stress levels (M\u0026thinsp;=\u0026thinsp;3.46). They were followed by those with 10\u0026ndash;14 years (M\u0026thinsp;=\u0026thinsp;3.15), 4 years or less (M\u0026thinsp;=\u0026thinsp;2.88), 15\u0026ndash;19 years (M\u0026thinsp;=\u0026thinsp;2.59), and finally 20 years and over (M\u0026thinsp;=\u0026thinsp;2.44). This finding suggests that mid-level experienced nurses may feel trapped between workload and expectations.\u003c/p\u003e\u003cp\u003eAlienation also significantly differed by years of service (F(4, 387)\u0026thinsp;=\u0026thinsp;7.398, p\u0026thinsp;\u0026lt;\u0026thinsp;.001). The lowest alienation level was observed among nurses with 15\u0026ndash;19 years (M\u0026thinsp;=\u0026thinsp;2.45) and 20 years and over (M\u0026thinsp;=\u0026thinsp;2.66). On the other hand, the highest alienation was observed in nurses with 10\u0026ndash;14 years (M\u0026thinsp;=\u0026thinsp;3.22) and 5\u0026ndash;9 years (M\u0026thinsp;=\u0026thinsp;3.11) of experience. These results suggest that nurses with moderate tenure may experience weakened organizational belonging and may have a tendency to detach from their jobs.\u003c/p\u003e\u003cp\u003eThe results indicate that tenure is a significant factor in shaping nurses' perceptions of fear of violence, work stress, and alienation. Nurses with longer service durations (15 years or more) reported substantially lower fear of violence compared to those with fewer years of experience. This pattern may suggest that accumulated experience of clinical environments provides healthcare workers with greater psychological resilience, adaptive coping strategies, or a form of familiarization, causing them to perceive violent incidents as less threatening. Conversely, nurses with shorter service durations (particularly those with less than 10 years of experience) showed higher fear of violence, reflecting their relative vulnerability and limited exposure to challenging interactions.\u003c/p\u003e\u003cp\u003eThe results show that work stress levels do not decline linearly with increasing tenure; the highest levels were reported by mid-level experienced nurses (5\u0026ndash;9 years of experience), followed by those with 10\u0026ndash;14 years of experience, which may reflect a stage in professional life where individuals are assigned with more responsibilities yet may not have achieved the full autonomy or coping resources that come with seniority. By contrast, nurses with 20 years or more of experience reported the lowest levels of work stress. This finding supports the interpretation that accumulated experience and professional maturity contribute to a more stable and manageable work life.\u003c/p\u003e\u003cp\u003eThe findings on work alienation further reinforce this non-linear trend. Nurses with moderate tenure (5\u0026ndash;14 years) reported the highest alienation, suggesting that the middle stages of a career may be associated with feelings of disconnection, reduced organizational commitment, and diminished perceived control over work processes. In contrast, nurses with 15 years or more of service reported the lowest alienation, indicating that long-term tenure may lead to a stronger sense of belonging, organizational commitment, and integration within the organization.\u003c/p\u003e\n\u003ch3\u003eAge and Tenure\u003c/h3\u003e\n\u003cp\u003eWhen the ANOVA results for both age and tenure are interpreted together, a clearer picture of the pattern emerges, showing distinct vulnerabilities and resilience factors across different groups.\u003c/p\u003e\u003cp\u003eThe ANOVA test results across age groups show that younger nurses (25\u0026ndash;29 and 30\u0026ndash;34 years) reported the highest fear of violence, stress, and alienation, whereas older nurses (40 and above) reported lower levels. The ANOVA test results across tenure groups show a similar pattern to a certain extent, such as that the nurses with shorter tenure (\u0026le;\u0026thinsp;9 years) reported higher fear of violence and stress, while those in mid-level tenure (5\u0026ndash;14 years) reported the highest alienation. Nurses with longer tenure (\u0026ge;\u0026thinsp;15 years) reported lower levels across all three constructs.\u003c/p\u003e\u003cp\u003eThese results suggest that younger nurses with short tenure are more vulnerable to violence-related fear and stress (similar to the findings of [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e], likely due to limited professional experience and fewer coping strategies. While mid-career nurses (typically 30s and 40s with 5\u0026ndash;14 years of tenure) seem to face a unique strain, although their fear of violence declines with age, their stress and alienation rise, possibly due to role overload, organizational pressures, or unmet career expectations, the older, long-tenured nurses appear to benefit from psychological resilience, habituation, and a stronger sense of organizational belonging, which buffers against fear, stress, and alienation.\u003c/p\u003e\u003cdiv id=\"Sec11\" class=\"Section2\"\u003e\u003ch2\u003eDifference Tests by Gender\u003c/h2\u003e\u003cp\u003eThe analysis results show that although men (M\u0026thinsp;=\u0026thinsp;3.39) had a higher average level of fear of violence than women (M\u0026thinsp;=\u0026thinsp;3.20), the difference was not statistically significant (p\u0026thinsp;=\u0026thinsp;0.156). This indicates that there is no significant difference in perceived fear of violence according to gender, and both women and men are equally afraid of being exposed to violence.\u003c/p\u003e\u003cp\u003eThe difference in work stress by gender is also not statistically significant. Women (M\u0026thinsp;=\u0026thinsp;3.07) reported slightly higher stress levels than men (M\u0026thinsp;=\u0026thinsp;3.00), but the difference was not significant (p\u0026thinsp;=\u0026thinsp;0.479). Therefore, no gender-based difference is evident in terms of perceived work stress.\u003c/p\u003e\u003cp\u003eHowever, a significant difference was found in work alienation. Men (M\u0026thinsp;=\u0026thinsp;3.06) had a higher mean than women (M\u0026thinsp;=\u0026thinsp;2.87), and this difference was statistically significant (p\u0026thinsp;=\u0026thinsp;0.047). This result may indicate that male nurses experience significantly more alienation than females, and may feel lower levels of commitment, meaning, or emotional engagement with the organization.\u003c/p\u003e\u003cp\u003eThe findings suggest that gender does not play a significant role in nurses' levels of fear of violence or perceived work stress, which may indicate that both male and female nurses are exposed to similar risks in the healthcare setting and perceive the pressures of the work environment in a broadly comparable way. This finding reveals that the violence and stress that the healthcare workers are experiencing are structural problems rather than gender-specific ones.\u003c/p\u003e\u003cp\u003eThe results regarding the work alienation, in contrast, reveal that the mean difference between males and females is statistically significant. Male nurses reported higher levels of alienation than female nurses, suggesting that men may feel a greater sense of detachment from their work roles, lower organizational commitment, or reduced meaning in their professional tasks, which may be due to several factors, including but not limited to cultural expectations regarding caregiving roles, potential mismatches between men's expectations and the realities of nursing work, or differing coping mechanisms in response to workplace stressors.\u003c/p\u003e\u003cp\u003eThese findings indicate that while violence and stress perceptions are equally shared by both genders, alienation appears to disproportionately affect men, pointing to the importance of gender-sensitive organizational strategies. Interventions could include tailored support mechanisms, opportunities for professional identity strengthening, and programs that enhance meaning and engagement in nursing roles, particularly for male staff members.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec12\" class=\"Section2\"\u003e\u003ch2\u003eDifference Tests by Exposure to Violence\u003c/h2\u003e\u003cp\u003eIndependent samples t-tests were conducted to examine whether there were statistically significant differences in fear of violence, perceived work stress, and work alienation between nurses who had experienced versus had not experienced workplace violence.\u003c/p\u003e\u003cp\u003eThe results revealed a significant difference in fear of violence scores between those who had been exposed to violence (M\u0026thinsp;=\u0026thinsp;3.60, SD\u0026thinsp;=\u0026thinsp;1.12) and those who had not (M\u0026thinsp;=\u0026thinsp;3.03, SD\u0026thinsp;=\u0026thinsp;1.19), t(390)\u0026thinsp;=\u0026thinsp;4.75, p\u0026thinsp;\u0026lt;\u0026thinsp;.001. This suggests that previous exposure to violence substantially increases nurses' fear of encountering similar incidents in the future.\u003c/p\u003e\u003cp\u003eA significant difference was also found in perceived stress, where the exposed group (M\u0026thinsp;=\u0026thinsp;3.21, SD\u0026thinsp;=\u0026thinsp;0.94) reported higher stress levels than their non-exposed counterparts (M\u0026thinsp;=\u0026thinsp;2.95, SD\u0026thinsp;=\u0026thinsp;0.96), t(390)\u0026thinsp;=\u0026thinsp;2.66, p\u0026thinsp;=\u0026thinsp;.008. This finding is expected and also aligns with literature highlighting cumulative psychological burden following exposure to violence (e.g., [\u003cspan citationid=\"CR54\" class=\"CitationRef\"\u003e54\u003c/span\u003e, \u003cspan citationid=\"CR55\" class=\"CitationRef\"\u003e55\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eThere was a significant difference in work alienation, as well. Individuals who have previously been exposed to violence reported higher levels of alienation (M\u0026thinsp;=\u0026thinsp;3.12, SD\u0026thinsp;=\u0026thinsp;0.91) than the others (M\u0026thinsp;=\u0026thinsp;2.80, SD\u0026thinsp;=\u0026thinsp;0.87, t(390)\u0026thinsp;=\u0026thinsp;3.57, p\u0026thinsp;\u0026lt;\u0026thinsp;.001). These findings reveal how exposure to workplace violence may not only increase immediate stress but also weaken nurses' connection to their professional roles and organizations [\u003cspan citationid=\"CR56\" class=\"CitationRef\"\u003e56\u003c/span\u003e, \u003cspan citationid=\"CR57\" class=\"CitationRef\"\u003e57\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eExposure to violence not only represents a situational challenge but also contributes to long-term stress and emotional exhaustion, causing individuals to feel on alert against the recurrence of similar incidents\u0026mdash;an experience that is psychologically exhausting and overwhelmingly distressing [\u003cspan citationid=\"CR58\" class=\"CitationRef\"\u003e58\u003c/span\u003e, \u003cspan citationid=\"CR59\" class=\"CitationRef\"\u003e59\u003c/span\u003e, \u003cspan citationid=\"CR60\" class=\"CitationRef\"\u003e60\u003c/span\u003e]. These findings align with prior research emphasizing the ongoing psychological incidents of violence in the healthcare sector [\u003cspan citationid=\"CR54\" class=\"CitationRef\"\u003e54\u003c/span\u003e, \u003cspan citationid=\"CR55\" class=\"CitationRef\"\u003e55\u003c/span\u003e].\u003c/p\u003e\u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis study provides an in-depth insight into a problem frequently observed in Turkey's healthcare sector but addressed quantitatively in a limited way by thoroughly examining the effects of nurses' fear of being exposed to violence on perceived work stress, and ultimately on work alienation. The main model of the study was tested through four primary hypotheses, each of which was found to be statistically significant. In this context, the discussion section of the study must be conducted on different levels, addressing both individual psychological processes and organizational and structural dimensions.\u003c/p\u003e\u003cp\u003eThis research shows that fear of violence significantly increases perceived work stress. This finding reveals that the concept of \"anticipated violence\" is an underexplored source of stress in the literature. As much as physical or verbal violence itself, being in a constant state of anticipation that such violence may occur chronically activates alarm systems in the individual [\u003cspan citationid=\"CR61\" class=\"CitationRef\"\u003e61\u003c/span\u003e, \u003cspan citationid=\"CR62\" class=\"CitationRef\"\u003e62\u003c/span\u003e]. This means that the individual is in a constant state of \"readiness\"; however, this state of readiness rapidly depletes the individual's cognitive and emotional resources. When evaluated within the framework of Hobfoll's [\u003cspan citationid=\"CR63\" class=\"CitationRef\"\u003e63\u003c/span\u003e] Conservation of Resources Theory (COR), fear of violence includes a threat directed at one of the employee's most fundamental resources: personal safety. Therefore, the threat of resource loss itself directly causes chronic stress.\u003c/p\u003e\u003cp\u003eGates et al. [\u003cspan citationid=\"CR54\" class=\"CitationRef\"\u003e54\u003c/span\u003e] stated that the perception of threat diverts employees' attention from their primary duties and redirects it toward monitoring potential dangers. Accordingly, this study also offers an empirical counterpart to this theoretical framework by showing that nurses try to keep themselves at a \"safe distance,\" but that this behavior reduces the quality of empathetic care. Particularly, the defensive communication that develops in relationships with patients and their relatives negatively affects the quality of healthcare and sows the seeds of new conflicts [\u003cspan citationid=\"CR55\" class=\"CitationRef\"\u003e55\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eAt this point, it is important to highlight that the finding is not only critical on an individual level but also carries vital implications for the health of organizational systems. The stress increased by fear of violence reduces nurses' patience, lowers their level of empathy, and weakens their communication skills. This creates dissatisfaction among patients and their relatives, and this dissatisfaction may trigger new acts of violence, forming a \"tension\u0026ndash;dissatisfaction\u0026ndash;violence\" cycle [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR61\" class=\"CitationRef\"\u003e61\u003c/span\u003e]. Therefore, this initial finding reveals not only an individual stress response but also the foundation of a structural problem that feeds and reproduces itself within the system.\u003c/p\u003e\u003cp\u003eTaken together, the age- and tenure-related findings reveal a consistent career-stage pattern. Younger nurses with short tenure are more vulnerable to fear of violence and stress, likely due to limited professional experience and fewer coping strategies. By contrast, mid-career nurses (typically 5\u0026ndash;14 years of service, often in their 30s and early 40s) reported the highest alienation, even though their fear of violence declined with age. This suggests that while accumulated experience reduces immediate fear, organizational pressures, role overload, and unmet career expectations may increase alienation at this stage. Older and long-tenured nurses, on the other hand, appear to benefit from resilience, habituation, and a stronger sense of belonging, which buffer against fear, stress, and alienation.\u003c/p\u003e\u003cp\u003eThe study also found that perceived work stress has a strong and positive effect on work alienation. The regression coefficient obtained (β\u0026thinsp;=\u0026thinsp;0.671) clearly reflects the strength and explanatory power of this relationship. The main mechanism through which stress leads to alienation is the loss of the individual's capacity to generate professional meaning and their sense of control over their work. In this context, the study's findings redefine alienation not as a passive condition but as an active coping strategy [\u003cspan citationid=\"CR56\" class=\"CitationRef\"\u003e56\u003c/span\u003e, \u003cspan citationid=\"CR64\" class=\"CitationRef\"\u003e64\u003c/span\u003e]. As Boyle [\u003cspan citationid=\"CR56\" class=\"CitationRef\"\u003e56\u003c/span\u003e] also stated, the individual feels the need to emotionally withdraw from their work to protect their psychological integrity.\u003c/p\u003e\u003cp\u003eThis situation leads the nurses to perceive the institution, the profession, and the society they serve as a collective threat. Yalım's [\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e] study provides findings that directly support this effect. Especially the loss of the sense of safety, the breakdown of the psychological contract, and the erosion of trust in the institution can cause the nurse to develop alienation not only toward the profession but also toward society itself [\u003cspan citationid=\"CR57\" class=\"CitationRef\"\u003e57\u003c/span\u003e, \u003cspan citationid=\"CR65\" class=\"CitationRef\"\u003e65\u003c/span\u003e]. This effect points to alienation as a psychological defense mechanism. While excessive workload triggers a sense of \"powerlessness,\" role conflict and uncertainty increase feelings of \"meaninglessness,\" and high emotional labor demands lead to \"self-alienation\" [\u003cspan citationid=\"CR66\" class=\"CitationRef\"\u003e66\u003c/span\u003e, \u003cspan citationid=\"CR67\" class=\"CitationRef\"\u003e67\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eIn this context, it becomes evident that work stress should not be considered merely as an \"intense workload,\" but rather as a factor that creates a multidimensional crisis of meaning.\u003c/p\u003e\u003cp\u003eThe mechanism revealed by the study is that fear of violence increases work stress, and in turn, this further increases work alienation. This finding is in full alignment with the classical Stressor\u0026ndash;Strain\u0026ndash;Outcome model [\u003cspan citationid=\"CR68\" class=\"CitationRef\"\u003e68\u003c/span\u003e, \u003cspan citationid=\"CR69\" class=\"CitationRef\"\u003e69\u003c/span\u003e]. Fear of violence, through stress, consumes the psychological resources of the nurses, and this depletion lays the groundwork for alienation.\u003c/p\u003e\u003cp\u003eFrom the perspective of Hobfoll's [\u003cspan citationid=\"CR63\" class=\"CitationRef\"\u003e63\u003c/span\u003e] theory, the direct pathway represents a sudden and significant resource loss (traumatic impact), while the indirect pathway reflects a gradual and chronic depletion of resources. Arnetz et al. [\u003cspan citationid=\"CR70\" class=\"CitationRef\"\u003e70\u003c/span\u003e] emphasize that among these two types of effects, the latter is especially more exhausting and more difficult to reverse. In this study, the fact that the indirect effect is stronger than the direct effect indicates that the greatest threat posed by fear of violence lies in its ability to produce a \"stealthy\" and chronic stress that is experienced repeatedly every day.\u003c/p\u003e\u003cp\u003eIt should also be noted that education level did not yield statistically significant differences in fear of violence, work stress, or alienation, indicating that these phenomena are shaped more strongly by experiential and contextual factors than by formal educational background.\u003c/p\u003e\u003cdiv id=\"Sec14\" class=\"Section2\"\u003e\u003ch2\u003eImplications for Theory\u003c/h2\u003e\u003cp\u003eThis study brings a new perspective to the alienation literature by revealing a previously overlooked cause-and-effect chain: the indirect influence of fear of violence. It shows that the anticipation of violence functions as a primary stressor with lasting consequences for employees' sense of connection to their organization. In doing so, the study extends the stressor\u0026ndash;strain\u0026ndash;outcome framework and Conservation of Resources Theory into the unique context of healthcare violence.\u003c/p\u003e\u003cp\u003eThe findings contribute to the theory in several ways: First, they recast fear of violence not merely as a fleeting emotional reaction but as a persistent and systematic threat that drains psychological resources and fosters alienation. This highlights that alienation stems not only from traditional stressors such as workload or role conflict but also from contextual and anticipatory threats that compromise personal safety.\u003c/p\u003e\u003cp\u003eSecond, the study shows that fear of violence exerts a stronger effect on alienation when channeled through work stress than when acting directly. This helps to clarify the mechanism of alienation, suggesting that it emerges from both immediate traumatic experiences (the loss of safety and trust) and longer-term processes of stress accumulation and depletion.\u003c/p\u003e\u003cp\u003eThird, the multi-group analyses enrich the theoretical picture by linking fear of violence and alienation to career stage variables such as age and tenure. This suggests that alienation theories must consider career dynamics and how vulnerability to stressors shifts over time, with younger/short-tenure nurses most affected by fear, and mid-tenure nurses more prone to alienation. Integrating career-stage perspectives into alienation theory provides a more nuanced understanding of when and why nurses disengage.\u003c/p\u003e\u003cp\u003eFinally, this study highlights the importance of integrating context-specific threats (such as healthcare violence) into broader alienation theories, which have often been developed in industrial or service contexts. By demonstrating that fear of violence systematically disrupts meaning, control, and belonging, the study expands the boundary conditions of alienation theory and calls for further research that explores similar anticipatory stressors in other high-risk professions.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec15\" class=\"Section2\"\u003e\u003ch2\u003eImplications for Practice\u003c/h2\u003e\u003cp\u003ePractically, it shows that healthcare institutions must address violence not only at the level of physical security, but also on the basis of psychological safety. It is also understood that work stress management strategies should aim to re-establish nurses' engagement and restore the meaning of work.\u003c/p\u003e\u003cp\u003eThe findings offer important signals in terms of health policy:\u003c/p\u003e\u003cp\u003eFirst, it should be understııd that the fear of violence is not an individual emotional reaction, but a systematically produced and reproduced stressor that must be managed through institutional strategies. For example, systems such as the \"White Code\" should increase deterrence, but beyond that, a more inclusive policy on safety and commitment should be developed\u0026mdash;one that enhances nurses' professional autonomy, protects their emotional labor, and allows them to generate meaning in their work.\u003c/p\u003e\u003cp\u003eMoreover, the convergence of age and tenure findings suggests that early-career and mid-career nurses require differentiated interventions: For example, younger/short-tenure nurses may benefit from training, mentoring, and psychological support to help them manage exposure to violence and stress, and mid-tenure nurses may require career development opportunities, workload balancing, and recognition mechanisms to counteract alienation and disengagement. For senior/long-tenured nurses, the challenge is to maintain motivation and prevent complacency, but overall, their resilience is a protective factor.\u003c/p\u003e\u003c/div\u003e"},{"header":"CONCLUSION","content":"\u003cp\u003eThis research sheds light on a problem frequently observed in Turkey's healthcare sector but not sufficiently examined quantitatively; it reveals in detail the psychological effects of the violence that nurses may be exposed to. The theoretical model of the study empirically tested how fear of violence increases work alienation both directly and indirectly, and all assumptions were statistically supported. It was revealed that fear of violence increases perceived work stress, and this stress in turn triggers work alienation.\u003c/p\u003e\u003cp\u003eAccording to the findings, not only direct acts of violence but also the constant state of alertness against the possibility of being exposed to such incidents constitute a serious source of stress for healthcare workers. This situation both depletes the individual's psychological resources and weakens professional commitment and meaning-making. Particularly noteworthy is the very high effect of stress on work alienation (β\u0026thinsp;=\u0026thinsp;0.671). This finding shows that work stress is not just a temporary discomfort but also a process that severs the individual's emotional bond with their work.\u003c/p\u003e\u003cp\u003eAnother important contribution of the study is that it shows the effect of fear of violence on work alienation occurs largely through stress. This demonstrates that fear of violence functions not only as a direct threat but also as a chronic source of stress, and over time, this stress weakens nurses' connection to their work. Therefore, the results obtained provide findings that should guide not only individual psychology but also institutional health policies.\u003c/p\u003e\u003cp\u003eIn the group comparisons, it was observed that younger nurses and those with lower tenure experienced higher levels of fear of violence, work stress, and alienation. This finding shows that professional experience not only brings skill but also increases psychological resilience. Additionally, another striking finding is that men experience significantly more alienation than women.\u003c/p\u003e\u003cp\u003eIn conclusion, this study shows that combating violence in healthcare institutions must be addressed not only at the level of physical security but also on the basis of psychological safety. Strategies aimed at reducing work stress should not be limited only to decreasing workload; they must also be supported with holistic policies that enhance nurses' professional autonomy, protect their emotional labor, and rebuild the meaning of work. Furthermore, fear of violence must be considered a stressor that is systematically produced and reproduced, and structural solutions must be developed at the organizational level to combat it. This is of great importance for healthcare workers to maintain their job commitment.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003e\u003cem\u003eWHO:\u003c/em\u003e World Health Organization\u003c/p\u003e\n\u003cp\u003e\u003cem\u003ePLS-SEM:\u003c/em\u003e Partial Least Squares Structural Equation Modeling\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eCCA:\u003c/em\u003e Confirmatory Composite Analysis\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eAVE:\u0026nbsp;\u003c/em\u003eAverage Variance Extracted\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eCR:\u0026nbsp;\u003c/em\u003eComposite Reliability\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eHTMT:\u0026nbsp;\u003c/em\u003eHeterotrait-Monotrait Ratio\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eVIF:\u0026nbsp;\u003c/em\u003eVariance Inflation Factor\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eSRMR:\u0026nbsp;\u003c/em\u003eStandardized Root Mean Square Residual\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eNFI:\u0026nbsp;\u003c/em\u003eNormed Fit Index\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eAIC:\u0026nbsp;\u003c/em\u003eAkaike\u0026apos;s Information Criterion\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eBIC:\u0026nbsp;\u003c/em\u003eBayesian Information Criterion\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eANOVA:\u0026nbsp;\u003c/em\u003eAnalysis of Variance\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eLSD:\u0026nbsp;\u003c/em\u003eLeast Significant Difference\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eSPSS:\u0026nbsp;\u003c/em\u003eStatistical Package for the Social Sciences\u003c/p\u003e\n"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate:\u003c/strong\u003e This study was conducted in line with the principles of the Declaration of Helsinki and the approval of the Istanbul Nisantasi University (T\u0026uuml;rkiye) Ethics Committee (approval number: 2023-04 dated: 22 April 2025). Informed consent was obtained from all subjects involved in the study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication:\u003c/strong\u003e Not applicable. This study did not include any individual person\u0026apos;s data in any form (including individual details, images, or videos).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials:\u0026nbsp;\u003c/strong\u003eData is available upon request from the corresponding author, Dr. Mustafa Aslan, [email protected]\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting Interests:\u0026nbsp;\u003c/strong\u003eThe authors declare that they have no conflict of interest.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding:\u0026nbsp;\u003c/strong\u003eNo funding was received for this study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026apos; contributions:\u003c/strong\u003e Conceptualization, MA, EH, Z\u0026Ccedil;; methodology, MA; software, MA; validation, MA, Z\u0026Ccedil;; formal analysis, MA; data curation, EH, and Z\u0026Ccedil;; writing\u0026mdash;original draft preparation, EH, Z\u0026Ccedil;, and MA; writing\u0026mdash;review and editing, MA. All authors have read and agreed to the published version of the manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements:\u0026nbsp;\u003c/strong\u003eThis study was conducted collaboratively by the listed authors, without the involvement of any unacknowledged third-party individuals or services. The authors gratefully acknowledge the use of AI-assisted tools for language support during manuscript preparation. Specifically, DeepL was used to translate select portions of the literature review and methodological discussion from Turkish into English, and Grammarly was employed to improve grammar, sentence clarity, and overall consistency. All content produced or assisted by these tools was thoroughly reviewed and edited by the authors and verified using Turnitin to ensure accuracy and originality. No content was fully generated by AI. The authors confirm that all contributions have been appropriately acknowledged and that no additional contributors were involved beyond those listed as authors.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eSpector, P. E., Zhou, Z. E., \u0026amp; Che, X. X. (2014). Nurse exposure to physical and nonphysical violence, bullying, and sexual harassment: A quantitative review. \u003cem\u003eInternational Journal of Nursing Studies, 51\u003c/em\u003e(1), 72\u0026ndash;84. https://doi.org/10.1016/j.ijnurstu.2013.01.010\u003c/li\u003e\n\u003cli\u003eMagnavita, N. (2014). Workplace Violence and Occupational Stress in Healthcare Workers: A Chicken-and-Egg Situation\u0026mdash;Results of a 6-Year Follow-up Study. \u003cem\u003eJournal of Nursing Scholarship, 46\u003c/em\u003e(5), 366\u0026ndash;376. https://doi.org/10.1111/jnu.12088\u003c/li\u003e\n\u003cli\u003eDuğan, \u0026Ouml;. (2024). Sağlıkta şiddet: Youtube izleyicilerinin duyguları \u0026uuml;zerinden bir analiz [Violence in Healthcare: An Analysis Based on the Emotions of YouTube Viewers]. \u003cem\u003eKıbrıs T\u0026uuml;rk Psikiyatri ve Psikoloji Dergisi, 6\u003c/em\u003e(3), 249\u0026ndash;254. https://doi.org/10.35365/ctjpp.24.3.06\u003c/li\u003e\n\u003cli\u003eG\u0026uuml;len, S., \u0026amp; Ormankaya, T. (2025). COVID-19 Pandemi s\u0026uuml;recinde sağlıkta şiddet: Beyaz Kod verileri ile retrospektif bir değerlendirme [Violence in Healthcare During the COVID-19 Pandemic: A Retrospective Analysis Using White Code Data]. \u003cem\u003eSağlık Bilimlerinde Değer, 15\u003c/em\u003e(2), 275\u0026ndash;281. https://doi.org/10.33631/sabd.1563535\u003c/li\u003e\n\u003cli\u003eHills, D., \u0026amp; Joyce, C. (2013). A review of research on the prevalence, antecedents, consequences and prevention of workplace aggression in clinical medical practice. \u003cem\u003eAggression and Violent Behavior, 18\u003c/em\u003e(5), 554\u0026ndash;569. https://doi.org/10.1016/j.avb.2013.07.014\u003c/li\u003e\n\u003cli\u003eYang, H. L., Tai, J. C., Wang, C. H., Shyu, Y. K., Chou, K. R., \u0026amp; Pien, L. C. (2025). Workplace violence, work characteristics, and seniority levels among nurses: a cross-sectional study. \u003cem\u003eBMC Nursing, 24,\u003c/em\u003e 281. https://doi.org/10.1186/s12912-025-02887-3\u003c/li\u003e\n\u003cli\u003eAslan, B. B., \u0026amp; Durmuş, S. B. (2024). Sağlık \u0026ccedil;alışanlarına y\u0026ouml;nelik şiddetin \u0026ccedil;\u0026ouml;z\u0026uuml;m\u0026uuml;nde kriz iletişimi ve iletişim becerilerinin \u0026ouml;nemi: bir kamu hastanesi \u0026ouml;rneği [The Importance of Crisis Communication and Communication Skills in Addressing Violence Against Healthcare Workers: A Public Hospital Case Study]. \u003cem\u003eYeni Y\u0026uuml;zyıl\u0026rsquo;da İletişim \u0026Ccedil;alışmaları, 2\u003c/em\u003e(9), 44\u0026ndash;54.\u003c/li\u003e\n\u003cli\u003eKwak, Y., \u0026amp; Han, Y. (2020). Impact of emotional labour and workplace violence on professional quality of life among clinical nurses. \u003cem\u003eInternational Journal of Nursing Practice, 26\u003c/em\u003e(1), e12792. https://doi.org/10.1111/ijn.12792\u003c/li\u003e\n\u003cli\u003eColasanti, A., Natoli, A., Moliterno, D., Rossattini, M., De Gaspari, I. F., \u0026amp; Mauri, M. C. (2008). Psychiatric diagnosis and aggression before acute hospitalisation. \u003cem\u003eEuropean Psychiatry, 23,\u003c/em\u003e 441\u0026ndash;448. https://doi.org/10.1016/j.eurpsy.2007.09.005 \u003c/li\u003e\n\u003cli\u003eD\u0026apos;Ettorre, G., \u0026amp; Pellicani, V. (2017). Workplace Violence Toward Mental Healthcare Workers Employed in Psychiatric Wards. \u003cem\u003eSafety and Health at Work, 8\u003c/em\u003e(4), 337\u0026ndash;342. https://doi.org/10.1016/j.shaw.2017.01.004\u003c/li\u003e\n\u003cli\u003eAkbolat, M., Sezer, C., \u0026Uuml;nal, \u0026Ouml;., Amarat, M., \u0026amp; Durmuş, A. (2021). The effects of direct violence and witnessed violence on the future fear of violence and turnover intention: a study of health employees. \u003cem\u003eCurrent Psychology, 40,\u003c/em\u003e 4684\u0026ndash;4690. https://doi.org/10.1007/s12144-019-00410-x \u003c/li\u003e\n\u003cli\u003eAyhan, C. H., Aktaş, M. C., \u0026amp; Karan, E. (2025). Psychiatric nurses\u0026apos; experiences of patient violence on acute psychiatric units in Turkey: a qualitative study. \u003cem\u003eBMC Nursing, 24,\u003c/em\u003e 363. https://doi.org/10.1186/s12912-025-03030-y\u003c/li\u003e\n\u003cli\u003eFernandes, C. M. B., Bouthillette, F., Raboud, J. M., Bullock, L., Moore, C. F., Christenson, J. M., Grafstein, E., Rae, S., Ouellet, L., Gillrie, C., \u0026amp; Way, M. (1999). Violence in the emergency department: A survey of health care workers. \u003cem\u003eCMAJ, 161,\u003c/em\u003e 1245\u0026ndash;1248.\u003c/li\u003e\n\u003cli\u003eWang, J., Liu, M., Zheng, H., \u0026amp; Xiang, M. (2025). Workplace violence experiences of intensive care unit healthcare providers: a qualitative systematic review and meta-synthesis. \u003cem\u003eBMC Health Services Research, 25\u003c/em\u003e(1), 399. https://doi.org/10.1186/s12913-025-12446-w \u003c/li\u003e\n\u003cli\u003eAnnag\u0026uuml;r, B. (2010). Sağlık \u0026ccedil;alışanlarına y\u0026ouml;nelik şiddet: risk fakt\u0026ouml;rleri, etkileri, değerlendirilmesi ve \u0026ouml;nlenmesi [Violence Against Healthcare Workers: Risk Factors, Consequences, Assessment, and Prevention]. \u003cem\u003ePsikiyatride G\u0026uuml;ncel Yaklaşımlar, 2\u003c/em\u003e(2), 161\u0026ndash;173.\u003c/li\u003e\n\u003cli\u003eCamerino, D., Fry, C., Le Nezet, O., Conway, P. M., \u0026amp; Hasselhorn, H. (2008). Violence risks in nursing\u0026mdash;Results from the European \u0026apos;NEXT\u0026apos; Study. \u003cem\u003eOccupational Medicine, 58\u003c/em\u003e(2), 107\u0026ndash;114. https://doi.org/10.1093/occmed/kqm142 \u003c/li\u003e\n\u003cli\u003eDemiroğlu, T., Kılın\u0026ccedil;, E., \u0026amp; Atay, E. (2015). Sağlık \u0026ccedil;alışanlarına uygulanan şiddet: Kilis ili \u0026ouml;rneği [Violence Against Healthcare Workers: The Case of Kilis Province]. \u003cem\u003eSağlık Bilimleri Dergisi, 24\u003c/em\u003e(1), 49\u0026ndash;55.\u003c/li\u003e\n\u003cli\u003eMagnavita, N., \u0026amp; Heponiemi, T. (2011). Workplace Violence Against Nursing Students and Nurses: An Italian Experience. \u003cem\u003eJournal of Nursing Scholarship, 43\u003c/em\u003e(2), 203\u0026ndash;210. https://doi.org/10.1111/j.1547-5069.2011.01392.x\u003c/li\u003e\n\u003cli\u003ePortoghese, I., Galletta, M., Leiter, M. P., Cocco, P., D\u0026rsquo;Aloja, E., \u0026amp; Campagna, M. (2017). Fear of future violence at work and job burnout: A diary study. \u003cem\u003eBurnout Research, 7,\u003c/em\u003e 36\u0026ndash;46. https://doi.org/10.1016/j.burn.2017.11.003 \u003c/li\u003e\n\u003cli\u003eAla\u0026ccedil;am, B., \u0026amp; Baykal, \u0026Uuml;. (2025). Opinions of nurse managers on impact of domestic violence on work life: a qualitative study. \u003cem\u003eBMC Nursing, 24,\u003c/em\u003e 1153. https://doi.org/10.1186/s12912-025-03735-0\u003c/li\u003e\n\u003cli\u003eFu, C., Ren, Y., Wang, G., Shi, X., \u0026amp; Cao, F. (2021). Fear of future workplace violence and its influencing factors among nurses in Shandong, China: a cross-sectional study. \u003cem\u003eBMC Nursing, 20,\u003c/em\u003e 1\u0026ndash;10. https://doi.org/10.1186/s12912-021-00644-w \u003c/li\u003e\n\u003cli\u003eFu, C., Lv, X., Cui, X., Huang, M., \u0026amp; Cao, F. (2023). The association between fear of future workplace violence and depressive symptoms among nurses. \u003cem\u003eBMC Nursing, 22,\u003c/em\u003e 123. https://doi.org/10.1186/s12912-023-01265-1 \u003c/li\u003e\n\u003cli\u003eLanct\u0026ocirc;t, N., \u0026amp; Guay, S. (2014). The aftermath of workplace violence among healthcare workers: A systematic literature review. \u003cem\u003eAggression and Violent Behavior, 19\u003c/em\u003e(5), 492\u0026ndash;501. https://doi.org/10.1016/j.avb.2014.07.010 \u003c/li\u003e\n\u003cli\u003eLazarus, R. S., \u0026amp; Folkman, S. (1984). \u003cem\u003eStress, appraisal, and coping.\u003c/em\u003e Springer Publishing Company.\u003c/li\u003e\n\u003cli\u003eSchaufeli, W. B., \u0026amp; Bakker, A. B. (2004). Job demands, job resources, and burnout. \u003cem\u003eJournal of Organizational Behavior, 25\u003c/em\u003e(3), 293\u0026ndash;315. https://doi.org/10.1002/job.248 \u003c/li\u003e\n\u003cli\u003eAkyavuz, E. K. (2017). \u0026Ouml;ğretmenlerin \u0026ouml;rg\u0026uuml;tsel adalet ve \u0026ouml;rg\u0026uuml;tsel g\u0026uuml;ven algıları arasındaki ilişkinin incelenmesi [An Examination of the Relationship Between Teachers\u0026apos; Perceptions of Organizational Justice and Organizational Trust]. \u003cem\u003eUludağ \u0026Uuml;niversitesi Eğitim Fak\u0026uuml;ltesi Dergisi, 30\u003c/em\u003e(2), 805\u0026ndash;831.\u003c/li\u003e\n\u003cli\u003eAkgerman, A. (2018). \u003cem\u003eHemşirelerin y\u0026ouml;neticilerine g\u0026uuml;ven d\u0026uuml;zeylerinin \u0026ouml;rg\u0026uuml;tsel bağlılıklarına etkisi [The Effect of Nurses\u0026apos; Trust Levels in Their Managers on Their Organizational Commitment]\u003c/em\u003e. Unpublished MSc Thesis. Istanbul University.\u003c/li\u003e\n\u003cli\u003eYou, Q., Bai, D., Wu, C., Gao, J., \u0026amp; Hou, C. (2022). Status of work alienation among nurses in China: A systematic review. \u003cem\u003eFrontiers in Psychiatry, 13,\u003c/em\u003e 986139. https://doi.org/10.3389/fpsyt.2022.986139 \u003c/li\u003e\n\u003cli\u003eChiaburu, D. S., Thundiyil, T., \u0026amp; Wang, J. (2014). Alienation and its correlates: A meta-analysis. \u003cem\u003eEuropean Management Journal, 32\u003c/em\u003e(1), 24\u0026ndash;36. https://doi.org/10.1016/j.emj.2013.06.003 \u003c/li\u003e\n\u003cli\u003eG\u0026uuml;m\u0026uuml;ş, E., Alan, H., Eskici, G. T., \u0026amp; Bacaksız, F. E. (2021). Relationship between professional quality of life and work alienation among healthcare professionals. \u003cem\u003eFlorence Nightingale Journal of Nursing, 29\u003c/em\u003e(3), 342. https://doi.org/10.5152/FNJN.2021.20095 \u003c/li\u003e\n\u003cli\u003eSemiz, E., \u0026amp; S\u0026ouml;y\u0026uuml;k, S. (2023). The relationship between work alienation behavior and cyberloafing. \u003cem\u003e\u0026Ccedil;ankırı Karatekin \u0026Uuml;niversitesi İİBF Dergisi, 13\u003c/em\u003e(4), 1381\u0026ndash;1411. https://doi.org/10.18074/ckuiibfd.1261920\u003c/li\u003e\n\u003cli\u003eSeeman, M. (1959). On the Meaning of Alienation. \u003cem\u003eAmerican Sociological Review, 24\u003c/em\u003e(6), 783\u0026ndash;791. https://doi.org/10.2307/2088565 \u003c/li\u003e\n\u003cli\u003eShi, Y., Mao, F., \u0026amp; Zhang, X. (2025). Association between fear of future workplace violence and burnout among pediatricians. \u003cem\u003eJournal of Occupational Health, 67\u003c/em\u003e(1), uiaf029. https://doi.org/10.1093/joccuh/uiaf029\u003c/li\u003e\n\u003cli\u003eYalım, M. K. (2024). \u003cem\u003eSağlık end\u0026uuml;strisinde şiddet korkusunun \u0026ouml;rg\u0026uuml;tsel bağlılığa etkisi [The Effect of Fear of Violence on Organizational Commitment in the Healthcare Industry]\u003c/em\u003e. Unpublished MSc Thesis. Afyon Kocatepe University.\u003c/li\u003e\n\u003cli\u003eLi, N., Li, Y., Wang, J., Kong, C., Qin, Y., \u0026amp; Liu, J. (2023). Job stress mediates between climate and alienation. \u003cem\u003eWestern Journal of Nursing Research, 45\u003c/em\u003e(10), 878\u0026ndash;884. https://doi.org/10.1177/01939459231189926 \u003c/li\u003e\n\u003cli\u003eXia, B., Wang, X., Li, Q., He, Y., \u0026amp; Wang, W. (2022). How workplace incivility leads to work alienation. \u003cem\u003eFrontiers in Psychology, 13,\u003c/em\u003e 921161. https://doi.org/10.3389/fpsyg.2022.921161\u003c/li\u003e\n\u003cli\u003eRogers, A. K. (1994). \u003cem\u003eViolence at work: Personal and organizational outcomes\u003c/em\u003e. Unpublished MSc Thesis. University of Guelph.\u003c/li\u003e\n\u003cli\u003eDe Bruin, G. P. (2006). The dimensionality of the general work stress scale. \u003cem\u003eSA Journal of Industrial Psychology, 32\u003c/em\u003e(4), 68\u0026ndash;75. https://hdl.handle.net/10520/EJC89108\u003c/li\u003e\n\u003cli\u003eTeleş, M. (2021). Validity and reliability of the Turkish version of the General Work Stress Scale. \u003cem\u003eJournal of Nursing Management, 29\u003c/em\u003e(4), 710\u0026ndash;720. https://doi.org/10.1111/jonm.13211 \u003c/li\u003e\n\u003cli\u003eHirschfeld, R. R., Feild, H. S., \u0026amp; Bedeian, A. G. (2000). Work alienation as an individual‐difference construct. \u003cem\u003eJournal of Applied Social Psychology, 30\u003c/em\u003e(9), 1880\u0026ndash;1902. https://doi.org/10.1111/j.1559-1816.2000.tb02473.x \u003c/li\u003e\n\u003cli\u003eKanten, P., \u0026amp; \u0026Uuml;lker, F. (2014). Y\u0026ouml;netim tarzının \u0026uuml;retkenlik karşıtı iş davranışlarına etkisinde işe yabancılaşmanın aracılık rol\u0026uuml;. \u003cem\u003eMSK\u0026Uuml; Sosyal Bilimler Dergisi, 32,\u003c/em\u003e 16\u0026ndash;40.\u003c/li\u003e\n\u003cli\u003eRepublic of T\u0026uuml;rkiye Ministry of Health (2025). \u003cem\u003eHealth Statistics Yearbook \u0026ndash; 2023\u003c/em\u003e. https://dosyasb.saglik.gov.tr/Eklenti/50208/0/siy2023ingilizce31012025pdf.pdf \u003c/li\u003e\n\u003cli\u003eIstanbul Chamber of Commerce (2025). \u003cem\u003eHemşire Sayısı [Number of Nurses]. \u003c/em\u003ehttps://www.itosam.org.tr/veri-istanbul/saglik-istatistikleri/hemsire-sayisi\u003cem\u003e \u003c/em\u003e\u003c/li\u003e\n\u003cli\u003eCochran, W. G. (1977). \u003cem\u003eSampling techniques.\u003c/em\u003e John Wiley \u0026amp; Sons.\u003c/li\u003e\n\u003cli\u003eHair, J. F., Tomas, G., Hult, M., Ringle, C. M., \u0026amp; Sarstedt, M. (2014). \u003cem\u003eA primer on partial least square structural equations modeling (PLS-SEM).\u003c/em\u003e SAGE.\u003c/li\u003e\n\u003cli\u003eHair, J. F., Risher, J. J., Sarstedt, M., \u0026amp; Ringle, C. M. (2019). When to use and how to report the results of PLS-SEM. \u003cem\u003eEuropean Business Review, 31\u003c/em\u003e(1), 2\u0026ndash;24. https://doi.org/10.1108/EBR-11-2018-0203 \u003c/li\u003e\n\u003cli\u003eHenseler, J., Ringle, C. M., \u0026amp; Sarstedt, M. (2015). A new criterion for assessing discriminant validity. \u003cem\u003eJournal of the Academy of Marketing Science, 43\u003c/em\u003e(1), 115\u0026ndash;135. https://doi.org/10.1007/s11747-014-0403-8\u003c/li\u003e\n\u003cli\u003eRahman, O., Wong, K. K., \u0026amp; Yu, H. (2016). The effects of mall personality and fashion orientation on shopping value and mall patronage intension. \u003cem\u003eJournal of Retailing and Consumer Services, 28,\u003c/em\u003e 155\u0026ndash;164. https://doi.org/10.1016/j.jretconser.2015.09.008 \u003c/li\u003e\n\u003cli\u003eFalk, R. F., \u0026amp; Miller, N. B. (1992). \u003cem\u003eA primer for soft modeling.\u003c/em\u003e University of Akron Press.\u003c/li\u003e\n\u003cli\u003eRingle, C., Wende, S., \u0026amp; Becker, J. M. (2016). \u003cem\u003eSmartPLS 3. \u003c/em\u003ehttps://www.smartpls.com \u003c/li\u003e\n\u003cli\u003eHenseler, J., Hubona, G., \u0026amp; Ray, P. A. (2016). Using PLS path modeling in new technology research. \u003cem\u003eIndustrial Management \u0026amp; Data Systems, 116\u003c/em\u003e(1), 2\u0026ndash;20. https://doi.org/10.1108/IMDS-09-2015-0382 \u003c/li\u003e\n\u003cli\u003eBentler, P. M., \u0026amp; Bonett, D. G. (1980). Significance tests and goodness of fit in the analysis of covariance structures. \u003cem\u003ePsychological Bulletin, 88\u003c/em\u003e(3), 588\u0026ndash;606. https://doi.org/10.1037/0033-2909.88.3.588 \u003c/li\u003e\n\u003cli\u003eSmartPLS (n.d.). \u003cem\u003eModel Fit\u003c/em\u003e. https://www.smartpls.com/documentation/algorithms-and-techniques/model-fit\u003c/li\u003e\n\u003cli\u003eGates, D. M., Gillespie, G. L., \u0026amp; Succop, P. (2011). Violence against nurses and its impact. \u003cem\u003eNursing Economics, 29\u003c/em\u003e(2), 59\u0026ndash;66. http://ldihealtheconomist.com/media/nv01.pdf \u003c/li\u003e\n\u003cli\u003eGalanis, P., Moisoglou, I., Katsiroumpa, A., \u0026amp; Mastrogianni, M. (2024). Workplace bullying and job stress. \u003cem\u003eHealthcare, 12\u003c/em\u003e(6), 623. https://doi.org/10.3390/healthcare12060623 \u003c/li\u003e\n\u003cli\u003eBoyle, D. A. (2011). Countering compassion fatigue. \u003cem\u003eOJIN, 16\u003c/em\u003e(1), Manuscript 2. https://doi.org/10.3912/OJIN.Vol16No01Man02 \u003c/li\u003e\n\u003cli\u003eBrondolo, E., Eftekharzadeh, P., Clifton, C., Schwartz, J. E., \u0026amp; Delahanty, D. (2018). Work-related trauma, alienation, and posttraumatic and depressive symptoms in medical. \u003cem\u003ePsychological Trauma, 10\u003c/em\u003e(6), 689.\u003c/li\u003e\n\u003cli\u003eKim S, Mayer C, Jones CB. Relationships between nurses\u0026apos; experiences of workplace violence, emotional exhaustion and patient safety. \u003cem\u003eJournal of Research in Nursing\u003c/em\u003e. 2020;26(1-2):35-46. https://doi.org/10.1177/1744987120960200 \u003c/li\u003e\n\u003cli\u003eHavaei, F., Astivia, O. L. O., \u0026amp; MacPhee, M. (2020). Workplace violence and health outcomes. \u003cem\u003eInternational Journal of Nursing Studies, 109,\u003c/em\u003e 103666. https://doi.org/10.1016/j.ijnurstu.2020.103666\u003c/li\u003e\n\u003cli\u003eCampione, A., \u0026amp; Henschke, C. (2025). Impact of violence on emotional exhaustion risk. \u003cem\u003eBMC Nursing, 24,\u003c/em\u003e 1080. https://doi.org/10.1186/s12912-025-03745-y\u003c/li\u003e\n\u003cli\u003eSun, X., Qiao, M., Deng, J., Zhang, J., Pan, J., Zhang, X., \u0026amp; Liu, D. (2021). Mediating Effect of Work Stress on the Associations Between Psychological Job Demands, Social Approval, and Workplace Violence Among Health Care Workers in Sichuan Province of China. \u003cem\u003eFrontiers in Public Health, 9\u003c/em\u003e, 743626. https://doi.org/10.3389/fpubh.2021.743626 \u003c/li\u003e\n\u003cli\u003eItzhaki, M., Bluvstein, I., Peles Bortz, A., Kostistky, H., Bar Noy, D., Filshtinsky, V., \u0026amp; Theilla, M. (2018). Mental Health Nurse\u0026apos;s Exposure to Workplace Violence Leads to Job Stress, Which Leads to Reduced Professional Quality of Life. \u003cem\u003eFrontiers in Psychiatry, 9\u003c/em\u003e, 346955. https://doi.org/10.3389/fpsyt.2018.00059 \u003c/li\u003e\n\u003cli\u003eHobfoll, S. E. (1989). Conservation of resources: A new attempt at conceptualizing stress. \u003cem\u003eAmerican Psychologist, 44\u003c/em\u003e(3), 513\u0026ndash;524.\u003c/li\u003e\n\u003cli\u003eBahadır, M., \u0026amp; Ercan, A. (2018). \u003cem\u003eSağlık \u0026ccedil;alışanlarında iş stresi ve yabancılaşma [Job Stress and Alienation Among Healthcare Workers]\u003c/em\u003e. \u003cem\u003eII. Uluslararası Multidisipliner \u0026Ccedil;alışmaları Kongresi [\u003c/em\u003e2nd International Congress on Multidisciplinary Studies]\u003cem\u003e.\u003c/em\u003e\u003c/li\u003e\n\u003cli\u003eMagdy, A., \u0026amp; Salem, I. E. (2024). Understanding the impact of work environment. \u003cem\u003eTourism and Hospitality Management, 30\u003c/em\u003e(4), 531\u0026ndash;542. https://hrcak.srce.hr/file/465475 \u003c/li\u003e\n\u003cli\u003eGoudarzian, A. H., Nikbakht Nasrabadi, A., Farhadi, B., \u0026amp; Navab, E. (2024). Exploring the concept and management strategies of caring stress among clinical nurses: A scoping review. \u003cem\u003eFrontiers in Psychiatry, 15\u003c/em\u003e, 1337938. https://doi.org/10.3389/fpsyt.2024.1337938 \u003c/li\u003e\n\u003cli\u003eLaz\u0026aacute;nyi, K. (2010). Emotional labour and its consequences. \u003cem\u003eFIKUSZ\u0026apos;10 Symposium Proceedings,\u003c/em\u003e 149\u0026ndash;156.\u003c/li\u003e\n\u003cli\u003eLaeeque, S. H., Bilal, A., Babar, S., Khan, Z., \u0026amp; Ul Rahman, S. (2017). How Patient-Perpetrated Workplace Violence Leads to Turnover Intention Among Nurses: The Mediating Mechanism of Occupational Stress and Burnout. \u003cem\u003eJournal of Aggression, Maltreatment \u0026amp; Trauma, 27\u003c/em\u003e(1), 96\u0026ndash;118. https://doi.org/10.1080/10926771.2017.1410751 \u003c/li\u003e\n\u003cli\u003eDurmuş, A., \u0026Uuml;nal, \u0026Ouml;., T\u0026uuml;rktemiz, H., \u0026amp; \u0026Ouml;zt\u0026uuml;rk, Y. E. (2024). The effect of nurses\u0026apos; perceived workplace incivility on their presenteeism and turnover intention: The mediating role of work stress and psychological resilience. \u003cem\u003eInternational Nursing Review, 71\u003c/em\u003e(4), 960-968. https://doi.org/10.1111/inr.12950 \u003c/li\u003e\n\u003cli\u003eArnetz, J. E., Baker, N., Arble, E., \u0026amp; Arnetz, B. B. (2024). Workplace violence, work-related exhaustion, and workplace cognitive failure among nurses: A cross-sectional study. \u003cem\u003eJournal of Advanced Nursing, 81\u003c/em\u003e(1), 271-285. https://doi.org/10.1111/jan.16217 \u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Fear of violence, work stress of nurses, work alienation of nurses, workplace violence","lastPublishedDoi":"10.21203/rs.3.rs-7574420/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7574420/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e\u003cp\u003eViolence against healthcare workers has been investigated in many aspects, but the effects of the fear of violence have remained limited. This study examines the role of perceived work stress in the effect of fear of violence on work alienation among nurses.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e\u003cp\u003eThe sample of the study consists of 392 nurses working in fully fledged hospitals in Istanbul, T\u0026uuml;rkiye. The data were collected by using the Fear of Violence Scale, the General Work Stress Scale, and the Work Alienation Scale. Confirmatory composite analysis was conducted for reliability and validity testing of the scales. Structural equation modeling was employed with SmartPLS 3.2.9, and multi-group analyses were carried out with SPSS 26 according to age, tenure, education level, gender, and history of exposure to violence.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e\u003cp\u003eThe results revealed that fear of violence has a positive and significant effect on perceived work stress and work alienation, both directly and indirectly through work stress. Work stress was found to have a strong positive effect on work alienation. Multi-group analyses showed that there were significant differences in fear of violence, work stress, and work alienation in terms of age, tenure, gender, and exposure to violence, while education level was not significant.\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e\u003cp\u003eThis study shows that fear of violence is not only an emotional response but also a systematic and enduring threat that reduces psychological resources and creates conditions for alienation. The results expand the stressor\u0026ndash;strain\u0026ndash;outcome framework and the Conservation of Resources Theory by revealing that the anticipation of violence functions as a primary stressor with long-term consequences.\u003c/p\u003e","manuscriptTitle":"Fear of Violence and Work Alienation Among Nurses: The Mediating Role of Work Stress","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-10-23 10:44:34","doi":"10.21203/rs.3.rs-7574420/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"e35b58fc-0539-41aa-8f65-084a102bca91","owner":[],"postedDate":"October 23rd, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2026-03-04T11:12:14+00:00","versionOfRecord":[],"versionCreatedAt":"2025-10-23 10:44:34","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7574420","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7574420","identity":"rs-7574420","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}