Identity and Emotional Labor in Resisting Violence in Care Work

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We work on understanding the discourses on daily practices related to workplace violence and professional identity, and, in analyzing the associations between emotional demands and psychological distress (PD), investigating the mediating role of job satisfaction (JS) in care work for people living with a disability and/or social vulnerability. Methods: This research was empirically analytical, cross-sectional, and partially mixed, composed of two studies (qualitative and quantitative). Participants were workers from two Chilean organizations that assist elderly people or patients with intellectual or mental disabilities. Results: Care work exposes workers to high psychological and emotional demands that are associated with PD. Likewise, JS as a dimension related to the identity component is negatively related to PD. Thus, JS is a mediating variable between emotional and psychological demands. The meaning of work and the “vocation of service” allows workers to elaborate positive narratives about their daily work experiences despite exposure to aggression. Conclusions: Professional identity of care workers is strongly linked to their vocational character, which implies risks for those who perform it due to the impossibility of dissociating tasks from relational aspects. Workplace violence is usually trivialized, and the negative emotional correlate is hidden in this work. workplace violence identity emotional labor psychological distress Figures Figure 1 Introduction In a changing world with growing populations, aging societies, and evolving family structures, care work is crucial to society [1]. In this context, it is relevant to unveil the working conditions and their effects on care workers to address the urgent action needed on the organization of care work from governments, employers, trade unions, and individual citizens. This type of paid work is characterized by having as its objective the search for physical, mental, social, and/or emotional well-being of the users, with whom face-to-face interactions are maintained, and multiple times, and it cannot be carried out adequately without public investment that allows financing it [2]. Moreover, care work involves not only the maintenance or preservation of another’s life but also implies the performance of psychological work. Care denotes the affective dimension mobilized in the development of activities that require "tenderness" or "sympathy," which are present in domestic work and the care of others, whether they are sick people, children, or others [3] This kind of job is performed in contexts with excessive restrictions [4] and without a secure physical environment [5,6], with organizational cultures that usually normalize workplace violence and favor the absence of consequences [6–8]. Care work has also been linked with high psychological and emotional demands [6,9,10], which, together with other psychosocial work factors, have been associated with workplace violence [11]. Professional Identity and Care Work The characteristics of care work have important implications for professional identities. Social identity is conceived as the representations individuals construct about themselves based on belonging to different groups or social categories [12]. These representations are elaborated in the interaction with others, involving the incorporation of cultural mediators that articulate social relations [13]. Identity operates as a dynamic system that allows one to organize and signify the environment, regulating behavior and guiding action. Therefore, when people act, they obtain feedback about their capabilities, both from their appreciation and recognition, which impacts their self-esteem and self-efficacy [13,14]. Professional identity is a type of social identity that can be understood as a set of beliefs and values that guide how employees produce meanings in work situations about others based on their representations of their professional role [15]. These identities are shaped by professional training processes, past experiences, and organizational cultures [16]. Professional identities involve processes of continuity and change, as they are modified according to the relationships sustained at work and within the framework of social and institutional conditions and structures [17]. Several authors have described the particular characteristics of the identities that are built around care work, highlighting factors such as “the ethic of care” which subordinates the needs of caregivers to those of care recipients [15,18], and emphasizes the commitment to values such as empathy, compassion, selfness and dedication towards patients or users [19–22]. Another element that characterizes this professional identity means that the motivation for work is sustained by altruism rather than remuneration, which is usually low in the case of these professionals, who also tend to perceive a lack of social recognition due to the low status of their occupations (e.g., educators, social workers, health technicians) [23,24]. So, self-sacrifice's value seems particularly relevant to care workers’ motivation. Users’ well-being tends to be more important than material rewards for this kind of worker, representing a major source of job satisfaction [25]. The enactment of these professional identities provides positive emotions and allows workers to represent themselves as valuable and self-effective by contributing to users’ well-being [15,26,27]. In fact, in the case of health workers, high levels of compassionate behavior are associated with stress decrease and general health improvement [28]. Also, positive emotions towards users, commitment to public interest, and self-sacrifice have been linked to higher job satisfaction [29]. In turn, studies in this population have suggested that job satisfaction can have an important effect on mental health, even in contexts of high demands and in the presence of multiple stressors [30]. Professional Identity and trivialization of violence Although care workers’ professional identities have been recognized as facilitators of well-being, the literature [15,31] also reports their impact on the meanings constructed about user violence and how it is managed. This is relevant because their patients often attack health workers more than their colleagues or team leaders [32]. To be the target of violence exerted by users means facing a permanent tension that arises from the need to care but, at the same time, to control. The dissonance between identity representations associated with empathy and compassion versus the need to carry out punitive actions that organizations often prescribe in these situations can be an important source of psychological distress [33,34]. The workers’ need to protect the positive attributes of their professional identities can activate defensive strategies such as minimization, trivialization, or normalization of violence. This has been observed mainly in health and social services, where violence is often seen as “part of the job” [31,33]. These ways of signifying aggression protect identity by focusing on users’ characteristics and avoiding perceiving themselves as victims. Besides, since violence involves subversion of power in the relationship between users and workers, it can lead to feelings of humiliation, vulnerability, guilt, and low efficacy in the caring role [35]. In the case of these workers, the trivialization of users’ violence has been associated with negative psychological outcomes, such as post-traumatic stress syndrome. Nevertheless, colleagues and employers’ social support seems to decrease the negative effects of violence on mental health [33]. Consequently, a comprehensive approach to workplace violence should consider different work organization phenomena, such as emotional demands and psychological distress [8,11,36]. It also requires a deeper understanding of the meanings that care workers produce about their professional practices and how these affect their professional identities’ construction. Thus, assuming that important tensions and contradictions cross-care work, this study aims to understand care workers’ discourses on daily practices related to workplace violence experiences and their relations with their professional identity. Also, this research seeks to analyze the associations between emotional demands and psychological distress, investigating the mediating role of job satisfaction in care workers who assist disabled or socially vulnerable users. Methods Design This research was empirically analytical, cross-sectional, and partially mixed. It comprised two concurrent studies, with the qualitative study (study 1) dominating the quantitative study (study 2). Both studies used different samples from three workplaces. Study 1 The qualitative study aimed to reconstruct workers' practices and meanings about their experiences [37] using a dense description of the phenomena [38]. Thus, a semi-structured interview addressed participants regarding violence in their work contexts, how it was managed, and the meanings that they constructed about themselves as care workers. Participants and procedure The participants were selected using convenience sampling [39]. They were contacted via email through three long-term care centers. Two of these centers assisted patients with mental or intellectual disabilities, and one of them assisted elderly people with physical and/or cognitive impairments. The interviews included 26 workers from different hierarchical levels in the institution, balanced by gender (Women=14, Men=12). Qualitative data analysis strategy The qualitative data analysis was conducted using the content analysis technique following deductive categories [40]. Content analysis is an analysis of communications using systematic and objective procedures to describe the content of messages [41]. Categories were first constructed based on the reviewed literature and then contrasted with the obtained data to elaborate the results presented in this paper. Study 2 A quantitative study of a non-experimental, cross-sectional, ex post facto cross-sectional nature was carried out. As a hypothesis, it was expected to find a positive and significant relationship between psychological and emotional demands and psychological distress, a negative and significant relationship between psychological and emotional demands and job satisfaction, and a negative and significant relationship between job satisfaction and psychological distress. It was also expected that job satisfaction plays a mediating role in the relationship between psychological and emotional demands and psychological distress. Participants and procedure The sample, established through non-probabilistic convenience sampling, comprised 139 female care workers, concentrated in the young and middle age range (66.2% between 18 and 45 years); only 10.8% had complete university education, and 17.3% had incomplete secondary education or technical studies; 70% were dedicated to operational tasks, and a third had been with the institution for more than five years. Instruments Psychological and emotional demands . Psychological demands refer to the way of working and the organization's restrictions to complete tasks (speed, amount of work, time for tasks, receiving conflicting demands, mentally demanding work) [42]. They were measured through 5 Likert-type items of the Job Content Questionnaire (JQC) by Karasek et al. [42], validated in Chile by Ansoleaga [43] with four answer options (Always =4, Almost Never=1). Emotional demands refer to staying emotionally distant and hiding emotions [43]. They were measured using 4 Likert-type items [44], with four answer options (Always to Never). The psychological demands indicator (in advance PSDI) was constructed from the emotional and psychological demands. Job satisfaction refers to the level of satisfaction in the current job, enthusiasm for it, and enjoyment of its realization. It was measured with the Job Satisfaction Scale [45], which consists of 5 Likert-type items ranging from strongly disagree to strongly agree. Psychological distress . The measure is composed of symptoms of depression, restlessness, fatigue, feelings of guilt, and anxiety. It was measured with the Kessler Scale (K6) [34], which consists of six Likert-type items with five response alternatives (Never=0, Always=4). Quantitative Data Analysis Strategy First, the Harman test estimated the possible effect of the common method variance of all the scales' items. Then, the psychometric properties of the instruments were tested by the internal consistency through Cronbach Alpha (α) y McDonald Omega (ω) and the internal validity (factorial structure) of the instruments by confirmatory factor analysis (CFA). Later, a descriptive analysis of the data was performed, which involved the analysis of the sociodemographic characteristics of the participants the central variables of the study and, the bivariate correlation analysis procedure was implemented to determine the strength and directionality of the relationships between the variables, to finish with the empirical mediation contrast, through a simple mediation analysis through the macro Process of Hayes [46] in the IBM SPSS software. IBM SPSS Statistics 24.0 and JASP 0.162 were used. Results Qualitative Study Violence, role paradox, and emotional demands Participants revealed that one of the most relevant and frequent challenges they face is dealing with users’ violent behaviors, including verbal and physical aggressions directed at workers, other residents, and the infrastructure of the centers : “These aggressions range from punches, pushes, bites, spits, some throw excrement (…) Others throw blunt objects such as stones, sticks” (Mental disability center worker) . These attacks generate significant stress due to the difficulties in managing users. On the one hand, the simultaneous exercise of control and care functions requires a permanent state of vigilance in monitoring users’ emotional and behavioral disturbance indicators. This tends to allow the deployment of prevention strategies, such as distracting users who show signs of agitation and avoiding stimuli that may alter them. Despite these efforts and due to the mental disorders presented by the users, the episodes of violence turn out to be highly unpredictable and difficult to manage: A lot of them don’t show even the slightest signs — like, you don’t see it coming — and suddenly they get upset and lash out. And we don’t realize it until they've already gone after a fellow resident or a staff member." (Mental disability center worker) Consequently, the work context appears to be perceived as uncontrollable, generating anxiety because of the expectation of violent episodes: “Sometimes it's like seven or eight in the evening, and all sudden things get tense in no time. Other times, nothing happens, and you start feeling uneasy just because you're so used to something going wrong …" (Mental disability center worker ) . Additionally, this also seems to produce an ambivalent perception of the users as simultaneously vulnerable and threatening people : “You look at them and think, ‘These sweet old folks…’ and then, all of a sudden, they change completely — sometimes out of nowhere" (Senior center worker ) The difficulty in preventing and controlling these situations and the physical consequences of violence tend to be assumed by these workers as a product of their own mistakes or lack of capacity to avoid these episodes: “A girl pulled my hair for about two hours outside… the headache stayed with me for several days, but it was my mistake anyway because my hair was not taken” (Mental disability center worker) On the other hand, institutional action protocols establish that employees must protect themselves in these incidents, taking physical distance from the agitated user and keeping other residents away. These indications are difficult for workers to follow because they understand that their role is to care for and protect the most vulnerable users, preventing them from attacking themselves or attacking other residents and even staff. The emotional relevance of exercising this role has the consequence that they often become the target of aggression, giving priority to preserving others’ well-being to the detriment of their safety: “We cannot do physical containment because it is a residence, in the end, it is to take care of you, take care of him because we have users who self-harmed and take care of the rest, so you are a shield, a caregiver and everything at once, and you get scared” (Mental disability center worker) At the same time, being unable to defend themselves or being defended by their coworkers also generates feelings of vulnerability, fear, and helplessness. These emotions must be regulated or hidden to regain control of the situation and, in some cases, quickly reintegrate into the work routine after the attack. This also happens with aggressions that, although they do not generate physical damage, do have a negative emotional impact: “A physical aggression from a user is terrible because we cannot yell at him, we cannot do verbal or mechanical restraint, we must wait for them to hit us; and if a user gives us a bad hit, who responds for us?” (Senior center worker) “Apart from the pain you may feel because of the aggression, psychologically you feel bad because if you punch me, I will punch you back, but with them, it is not the same… we have always tried to fight for a place where we can go to cry. Because we cannot do it in front of the user” (Mental disability center worker) Professional identity: empathy, compassion and self-sacrifice. Coping with stress, fear, and feelings of helplessness while positively valuing their work experiences in a threatening context seems possible because care work is represented as a vocation, which emerges as a core element of their professional identity. This vocation is closely related to values such as empathy, compassion, and self-sacrifice, allowing them to prioritize the care of users even when this implies risking their own physical and psychological integrity. “When we have been beaten, our rights are violated… and there one has to question whether one has the vocation, to think first about who I am acting in front of, to put oneself in the place of the user” (Mental disability center worker) “They need conversation and love, they only need that, and for that, you have to have a vocation. And the person who does not have it is better not to work at the center” (Senior center worker) Enacting these attributes of their professional identities provides participants with positive emotional experiences. The feedback they receive from users, through gestures of recognition and affection, confirms the way in which they represent themselves as care workers. This is reflected in the value they place on the bonds they establish with users and the affective retribution they obtain from these relationships, which seem to positively affect their own sense of personal worth and professional capacity. These positive emotions seem to have a greater impact on their work and psychological well-being than the negative ones they experience because of violence, making it easier for them to continue working in these scenarios. “I know that many times we have been attacked, we have been insulted by them, but after a while, they are giving you affection, they are hugging you, they are giving you unconditional affection, and that is gratifying, that is why I continue” (Mental disability center worker) “The guys use violence, more than violence it is often the force that one does not know how to interpret, and they are decompensated for different situations. Sometimes we are bad or moody, but they also have good and bad days, and the guy who attacked you today will give you a kiss tomorrow. So you have to understand and study them, be empathetic and put yourself in the place of the other” (Mental disability center worker) Trivialization of violence as a strategy for protecting professional identity Besides, professional identity seems to be preserved through the trivialization and normalization of violence at work, minimizing its severity and consequences. This is reflected, for example, in prevention strategies such as working in pairs so that some workers can cushion the impact of a blow. “We also have guys who bite, who kick you… which is still violence, maybe not of the same caliber as a stick or an iron, but from a version as small as a bite or a push” (Mental disability center worker) “(The caregivers) ended up with bruises, broken fingers, etc. They have to report their incident and have a witness. On the part of the organization, we try to avoid violence, knowing that there will be another colleague who may be attentive to put her hand so that the first does not reach the colleague so hard, to contain as appropriate to avoid a kick, that kind of things” (Senior center worker) There is also some resistance on the part of employees to seek medical attention in case of injuries, even when their managers consider it necessary. This could be playing a dual function. On the one hand, it could serve to avoid visualizing themselves as victims of violence, with the consequent loss of power that this entails. On the other hand, this could facilitate the maintenance of the feeling of control, psychological strength, and professional capacity, as well as the sense of self-sacrifice: “(a user) threw me here, and I got to feel how my scalp peeled off my head… we managed to release the hair, I had to put ice on, and I was in a lot of pain, and we managed to put the user to bed. Then went for coffee, and the boss wanted to send me to the medical center… I did not consider it necessary because, in the end, what would they do to me? And my colleagues were going to be alone, and one less weighs. And then we just laughed, if, in the end, we have no choice” (Senior center worker) “As we are old, we never go to a medical center, we are already used to it. I have been beaten up, but if it is a fracture, we have to go. Years ago, that happened to me, but it has been more than seven years since I went, I think I already handle it better” (Mental disability center) Likewise, another possible cause of the trivialization of violence may be related to the attributions they constructed concerning its origins. Participants perceive that violence is largely caused by mental illness or disability and also by other aspects, such as centers’ deficient infrastructure and work organization. However, the participants with leadership positions in their organizations emphasize the responsibility of employees in these episodes. The lack of training, poor management of their emotional problems, and carelessness in interacting with the users are considered by them as important antecedents of violence in the residences. This could also be posing a threat to worker’s professional identities: “They are constantly training them in emotional and environmental containment to be able to work with these users when they are decompensated, to be able to lower those aggressive behaviors they have… although they are trained, they do not react when the user is decompensated, because many times they are called attention to them, and they get more altered” (Leadership of Mental disability center) “We usually get people without training… They have a lot of desire, a lot of love, but they have no idea how to deal with a psychomotor agitation, they have no idea how to deal with a user” (Leadership of Mental disability center) The violence normalization is even transmitted to new workers and trainees, who are taught to dismiss the relevance of these episodes and consider them as part of the nature of the work they do: “It depends a lot on the attitude of the people who are working, and that is emphasized to the people who are arriving, for example, “Be careful with him, he can suddenly send you a punch,” “If he tells you something does not take it personally.” It depends a lot on how one welcomes the people who are arriving” (Senior center worker) “We are used to verbal violence, we take it with humor. There are some who know perfectly well what they are doing, but we are already used to this type of high-caliber vocabulary, so it no longer complicates us. To new people, yes, many times they are not accustomed, but with the time we guide them regarding that they must get used to it” (Senior center worker) Together, these ways of trivializing aggression would make it possible to face highly emotionally demanding work contexts and protect professional identity from the negative effects of violence. In this sense, it is possible to hypothesize that its normalization could facilitate greater job satisfaction and better well-being and mental health results. Quantitative Study Descriptives and analysis of the effect of variance of the common method Table 1 shows the descriptive statistics. The Harman Test was applied to estimate the effect of the variance of the common method. Thus, all the items of the scales were subjected to an exploratory factor analysis with the principal component’s method and varimax rotation, forcing the extraction to a single factor. The results showed that this factor explained 32.94% of the common variance, so it can be argued that the effect of the common variance does not seem to affect the relationship between the variables studied significantly. Table 1 Descriptive statistics of the main variables of the study . Media Standard derivation Minimal Maximum Psychological emotional demands 2.38 .56 1.22 3.78 Job satisfaction 2.90 .89 1 4 Psychological distress .64 .77 0 4 Note . n=139 Analysis of the instrument´s psychometric properties A confirmatory factor analysis was applied to estimate the fit of the factorial structure of the instruments of PSDI, job satisfaction, and psychological distress. All the goodness-of-fit indices are within the expected parameters, indicating a good fit of the data concerning the factorial structure of the instruments: PSDI ( x²/df ratio=1.67, SRMR=.06, RMSEA=.07, CFI=.96, TLI=.94), job satisfaction ( x²/df ratio=1.83, SRMR=.04, RMSEA=.07, CFI=.98, TLI=.97), and psychological distress ( x²/df ratio=1.73, SRMR=.03, RMSEA=.07, CFI=.98, TLI=.96). McDonald´s Omega and Cronbach´s Alpha internal consistency internal consistency indices were calculated for the three scales. The values obtained are shown in the diagonal of Table 2, all adequate because they are above .70. Analysis of bivariate correlations Table 2 shows the results of Pearson’s bivariate correlation between study variables. Table 2 Pearson´s matrix of bivariate correlations between the main variables of the study, and reliability indices. 1 2 3 1. Psychological and emotional demands (.75, .77) 2. Job satisfaction -.52*** (.83, .79) 3. Psychological distress .44*** -.50*** (.85, .84) Note . n=139; *** p < .001. On the diagonal are the McDonald´s Omega and Cronbach´s Alpha indices of the instruments, respectively. The expected relationships between the variables have been reproduced in the data. There is a statistically significant and positive relationship between PSDI and psychological distress ( r = .44, p < .001). In turn, a statically significant and negative relationship can be observed between PSDI and job satisfaction ( r = -.52, p < .001), and a negative and significant relationship of the same nature between job satisfaction and psychological distress ( r = -.50, p < .001). Mediation analysis A mediation model was performed based on correlation analyses’ results to test if job satisfaction mediated the relation between PSDI and psychological distress. PSDI had a significant positive effect on psychological distress ( β =.39; t =5.244; p =.000). PSDI had a negative influence on job satisfaction ( β =-.44; t =-7.084; p =.000). In turn, job satisfaction had a negative impact on psychological distress ( β =-.42; t =-4.372; p =.000). The indirect effect of PSDI on psychological distress through job satisfaction was significant ( β =.18, SE=.06, CI 95% [0.77, 0.322]). The direct effect of PSDI on psychological distress was still significant when all the variables were in the model ( β =.20, t =-2.51, p =.013). This indicates that job satisfaction partially mediates the relation between PSDI on psychological distress. The model explained 17% of psychological distress’s variability (See Figure 1). Consequently, given these results, the mediation hypothesis has empirical support, so it is maintained. Discussion Care work is characterized by important tensions and contradictions that need a more complete scientific understanding because of its various implications for the lives of those who dedicate themselves to it. This led us to carry out the present research, whose purpose has been double: on the one hand, to understand the discourses on daily practices related to workplace violence and professional identity in this field of work and, on the other hand, to analyze the relationship between PSDI and psychological distress, investigating the mediating role of job satisfaction. The results of study 2 show that care work exposes workers to high PSDI that is associated with psychological distress, which is a precursor to mental health problems. Also, job satisfaction is a mediating variable between the PSDI -typical of care work- and psychological distress. On the other hand, study 1 shows that the meaning of work and the “vocation of service” allows workers to elaborate positive narratives about their daily work experiences despite exposure to aggression. Considering the results of both studies, we can understand job satisfaction as a dimension related to the identity component of care work is negatively related to psychological distress. This explains the mediating role of job satisfaction between psychological and emotional demands and psychological distress. Zapf and Holz [ 47 ] indicate that emotional labor has an ambivalent character, with positive consequences such as job satisfaction, feelings of personal achievement, and a sense of self-efficacy and negative consequences such as emotional exhaustion, depersonalization, or psychosomatic aliments. In the same sense, some occupations in the service sector involve a high vocational commitment of workers. This entails an emotional commitment that brings negative consequences for health, according to Ansoleaga and Toro [ 48 ]. This research reveals a high exposure to workplace violence and its naturalization [ 6 , 7 , 9 ] exerted by users who are particularly complex and contributes to understanding how care workers resist these situations by applying the trivialization of violence as a mechanism for the protection of their professional identity, being trapped in a paradox. In particular, the narrative of the role and the professional identity of the care worker is associated with values and attributes such as empathy, compassion, and caring. However, care institutions produce, maintain, and count the efforts that workers deploy for the sacrificial culture. The sacrificial culture alludes to certain patterns of behavior that are part of the socialization in and for care work, in which work is conceived as a socially valued activity and sustained mainly by a personal commitment to such values. Thus, fulfilling the institutional mission is privileged beyond what could be a reasonable commitment at work, often transgressing labor rights. This culture is present in work contexts where it is practically impossible to establish limits in the face of a constantly high demand for work and is difficult to disconnect even during free moments [ 48 ]. The resistance attempts of the workers in the face of this extreme and unpredictable demand risk them being questioned by their peers and the institution since the emotional and work demand is crossed by a social value discourse that appeals to vocation, good values, humanitarian aid, compassion, and empathy -among others-, forcing them to meet the constant and overloaded demands of their work [ 48 , 49 ]. Thus, certain heroic and humanistic qualities are overvalued, especially in times of crisis [ 50 ], and regulating emotions is prescribed to respond to work and help purposes. A high commitment to work has been associated with the perception of well-being, which has been widely described in studies on “engagement” and service capacity that promotes meaning, the feeling of usefulness, and motivation [ 51 ]. However, particularly in precarious work contexts of high demands and low control of workers, this can encourage the intensification of this sacrificial culture [ 48 ]. In this way, care workers constitute a population at risk for the emergence of health problems. If we assume that professional identity is built in the dynamics between the representations that workers elaborate about themselves and their contexts, how they conceive their role guides and gives meaning to their actions and relationships with others at work. At the same time, the effects of the exercise of their work, in terms of their emotional experiences and the results of their actions, feedback these identities that they have built for themselves [ 13 ]. In this case, we observe that the centrality of a care ethic, which subordinates the needs of care workers to those of care receivers [ 33 ] and which develops in the context of a sacrificial culture of work, can contribute to the elaboration of a stressed or fragmented work identity by ambivalent feelings. These discordances are linked to the insuperable simultaneous roles of care and control, which have correlated emotional states that may contradict each other. This can result in a high risk of mental health problems. Fulfilling the task of protecting the most vulnerable often places workers in a position of vulnerability where they even become real “human shields,” narrated from an epic discourse that leaves little space for recognizing the place of victims or the lack of protection they are subjected to. There is around this position the concealment of negative emotions, including the prescription that being a victim of aggression is part of the work, and it is reproduced in the processes of socialization at work. In this way, the narratives around the daily experiences of violence at work, the emotions experienced, and the practices of coping with violence are functional to the preservation of the professional identity of care workers, integrating a robust vocational component. In turn, these identity narratives are functional in maintaining an organizational system often precarious in their objective but also symbolic and subjective conditions, such as the lack of recognition and legitimation. However, the institutions show concern about the consequences of this work reality from operational and procedural rationality (more training, instructive protocols) that neglects and ignores the power of cultural and subjective factors in the behavior of people in organizations and where the professional identity of care workers occupies a fundamental place. This operational rationality succumbs because it assumes that work contexts are static and care work has no relational components, especially because the activity and task are inseparable from the emotional and relational components of the person who deploys them. This contributes to the failure of a more “objective” response from the institutions to the problem of violence in care work and, at the same time, produces high amounts of anxiety and distress and constitutes a threat to the sense of professional efficacy. Sustaining the identity narrative of care work with older adults or people with intellectual or mental disabilities, neglecting the effects that workplace violence has on workers can be very costly for people and organizations since the evidence shows consequences on the mental health of workers such as symptomatology of post-traumatic stress disorder [ 5 , 7 , 52 ], depressive symptomatology [ 4 ], anxiety and problems like subjective discomfort, poorer quality of sleep and instability in sleep hours [ 53 ] It has also been reported as an effect the decrease in quality of care when there is workplace violence has also been reported, which is manifested in the deterioration of relationships with users [ 54 ] and in the face of the occurrence of an episode of workplace violence, this can have consequences in the long term (approximately for two years) [ 8 ]. Furthermore, the implications at the level of physical health are widespread physical discomfort and stress [ 10 , 55 ]. Thus also, workplace violence has been associated with decreased productivity, injury or sick leave, and absence periods of eight or more consecutive weeks [ 56 , 57 ], which have an increase in costs for the organization and the state due to medical leave and disability pensions [ 58 ]. Finally, analyzing work in care services requires incorporating a gender perspective. Gender refers to the historical-social construction of the feminine and the masculine and how these constructions are articulated in power relations [ 59 ]. Gender elements strongly cross work in care services; it is feminized work; employment patterns, social structures, and biological differences contribute to specific patterns of gender risks and occupational risks [ 60 ] since gender inequalities and discrimination in general society are reproduced within the organization [ 61 ]. According to Matamala et al. [ 59 ] gender constructs subjectivities where the feminine is related to “being for others,” which generates that women tune in differently with the suffering of others; according to Boniol et al. [ 62 ], the health sector has a traditional division of labor of gender roles where women are in subordinate positions, perform tasks associated with direct care, while men perform management tasks or are in higher hierarchical positions; this could contribute to making subtle discriminations appear as nonexistent or as part of the work due to care of others that they exercise [ 63 ]. Care work is often “mothernalized”, localized, and naturalized as women´s work [ 49 ]. Limitations Among the limitations of the quantitative study, it is worth mentioning that we used a convenience sample within the framework of a cross-sectional design that does not make it possible to observe the relationships between the variables studied over time. In addition, although occupational health research highlights the importance of working separately with samples of men and women to incorporate the gender dimension, we think that future studies should include men to study the effect of this variable on the relationship between psychological and emotional demands, job satisfaction and distress in care work. Concerning the results of the qualitative study, it would be important to carry out studies that address the construction processes of these professional identities throughout the workers' work trajectories. These studies should also delve into the role of gender in how workers incorporate the ethic of care and the culture of sacrifice and the meanings they produce about violence. Projections of the study The results reveal the need for a state policy on care work, its recognition at the private level, the professionalization of its exercise in formal work settings, and the training of people who perform this work in a paid and unpaid manner. Regarding control and prevention against workplace violence in care work, research points to the need to move from individual strategies to organizational strategies [ 64 , 65 ], that these be made known to workers and that workers be educated to recognize episodes of workplace violence [ 66 ]. Thus, the studies assign a fundamental role to organizational social support (instrumental and informational) to moderate the adverse effects of violence [ 67 ]. Conclusions The professional identity of care workers is strongly linked to their vocational character and their expression of empathy and commitment to the users of the institutions. - Care work implies risks for those who perform it due to the impossibility of dissociating tasks or activities from relational aspects and the emotions they produce. Although it has little social recognition, it is a work that has a strong vocational component, which is reproduced in the identity narrative of care workers. Work implies risks for those who perform it due to the impossibility of dissociating tasks or activities from relational aspects and the emotions they produce. Although it has little social recognition, workers' identity narratives reproduce a solid vocational component. - Workplace violence is usually trivialized, and the negative emotional correlate is hidden in the care work. In these dynamics, the bond becomes ambivalent because whoever is the subject of care is and must be subject to control; it is vulnerable but also threatens female workers. Declarations Funding: This research was selected in the Call for Research and Innovation Projects in Prevention of Occupational Accidents and Diseases ("2020") of the Superintendence of Social Security (Chile) and funded by the Asociación Chilena de Seguridad with resources from the Social Security of Law No. 16,744 on Occupational Accidents and Diseases. Ethical Approval and accordance: The project was approved by the Ethics Committee for Scientific Research of the Asociación Chilena de Seguridad (CEC/29/2020). The procedures used in this study adhere to the tenets of the Declaration of Helsinki. Consent to Participate: Informed consent was obtained from all subjects involved in the study. Conflict of interest: All authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest or non-financial interest in the subject matter or materials discussed in this manuscript. Clinical trial number: not applicable. Author Contribution M.A., E.A., M.J.M-L., and R.R-V. contributed to the conceptualization of the study. M.A., M.J.M-L., and R.R-V curated the data. Formal analysis and methodology were carried out by M.A., E.A., M.J.M.-L., and R.R.-V. Acquired the funding; Investigation; Project administration and Supervision were conducted by E.A.. All authors reviewed and approved the final manuscript. Data Availability The datasets generated during and/or analysed during the current study are not publicly available due to the sensitive nature of the interview material, which addresses experiences of workplace violence and mental health, but are available from the corresponding author on reasonable request. 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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-7160043","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":491684875,"identity":"b9fb2582-6c0a-4503-9459-c52a7de17c7b","order_by":0,"name":"Elisa Ansoleaga","email":"","orcid":"","institution":"Diego Portales University","correspondingAuthor":false,"prefix":"","firstName":"Elisa","middleName":"","lastName":"Ansoleaga","suffix":""},{"id":491684876,"identity":"3a97971d-ba42-441f-a104-c62789d6b9e0","order_by":1,"name":"María José Mera-Lemp","email":"","orcid":"","institution":"Viña del Mar University","correspondingAuthor":false,"prefix":"","firstName":"María","middleName":"José","lastName":"Mera-Lemp","suffix":""},{"id":491684877,"identity":"672ad58c-b2af-4240-b856-ce32c7ab792e","order_by":2,"name":"Magdalena Ahumada","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA5ElEQVRIiWNgGAWjYFACHhDBzMDA3gAiQSABiAuI0cJzAKxFAqLFgBgtEglEatFtP3tM6kaNtbzuzDeGnwvb7tXxtycfYPiBR4vZmbw06Zxj6YbbbucYS89sK5aQOPMsgbEHn5YDOWbSOWyHGYFaDKR52xIkGG7kGDDjc5jZ+TdALf8O22+7ecb4N0iLPEEtN4C25LYdTtx2g8cMbIsBYS1vjK1z+9KTt51JK7PmOZcguRHol4N4/XI+x/B2zjdr223HD2++zVOWwC93PPnggx8VuLVgBwdI1TAKRsEoGAWjABUAAKVkUPTqn3sGAAAAAElFTkSuQmCC","orcid":"","institution":"Alberto Hurtado University","correspondingAuthor":true,"prefix":"","firstName":"Magdalena","middleName":"","lastName":"Ahumada","suffix":""},{"id":491684878,"identity":"2f47c980-6f20-40fb-b34a-af1b40725e65","order_by":3,"name":"Raúl Ramírez-Vielma","email":"","orcid":"","institution":"University of Concepción","correspondingAuthor":false,"prefix":"","firstName":"Raúl","middleName":"","lastName":"Ramírez-Vielma","suffix":""}],"badges":[],"createdAt":"2025-07-18 18:23:08","currentVersionCode":1,"declarations":{"humanSubjects":false,"vertebrateSubjects":false,"conflictsOfInterestStatement":false,"humanSubjectEthicalGuidelines":false,"humanSubjectConsent":false,"humanSubjectClinicalTrial":false,"humanSubjectCaseReport":false,"vertebrateSubjectEthicalGuidelines":false},"doi":"10.21203/rs.3.rs-7160043/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-7160043/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":87884859,"identity":"028c372f-9257-4b7a-88e1-a731e5ec7ce9","added_by":"auto","created_at":"2025-07-30 05:01:35","extension":"jpeg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":20600,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cem\u003eModel of mediation of job satisfaction in the relationship between psychological and emotional demands and psychological distress.\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eNote\u003c/em\u003e. n=139\u003c/p\u003e","description":"","filename":"groupimage1.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-7160043/v1/123318843ac2f9c134bd8b29.jpeg"},{"id":92091359,"identity":"2952e747-e3c6-43b8-878a-0e3baf785676","added_by":"auto","created_at":"2025-09-24 13:39:46","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":600394,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7160043/v1/44905d17-7f7b-4c17-8b2d-9828decd33ef.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Identity and Emotional Labor in Resisting Violence in Care Work","fulltext":[{"header":"Introduction","content":"\u003cp\u003eIn a changing world with growing populations, aging societies, and evolving family structures, care work is crucial to society [1]. In this context, it is relevant to unveil the working conditions and their effects on care workers to address the urgent action needed on the organization of care work from governments, employers, trade unions, and individual citizens. This type of paid work is characterized by having as its objective the search for physical, mental, social, and/or emotional well-being of the users, with whom face-to-face interactions are maintained, and multiple times, and it cannot be carried out adequately without public investment that allows financing it [2]. Moreover, care work involves not only the maintenance or preservation of another’s life but also implies the performance of psychological work. Care denotes the affective dimension mobilized in the development of activities that require \"tenderness\" or \"sympathy,\" which are present in domestic work and the care of others, whether they are sick people, children, or others [3]\u003c/p\u003e\n\u003cp\u003eThis kind of job is performed in contexts with excessive restrictions [4] and without a secure physical environment [5,6], with organizational cultures that usually normalize workplace violence and favor the absence of consequences [6–8]. Care work has also been linked with high psychological and emotional demands [6,9,10], which, together with other psychosocial work factors, have been associated with workplace violence [11].\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eProfessional Identity and Care Work\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe characteristics of care work have important implications for professional identities. Social identity is conceived as the representations individuals construct about themselves based on belonging to different groups or social categories [12]. These representations are elaborated in the interaction with others, involving the incorporation of cultural mediators that articulate social relations [13]. Identity operates as a dynamic system that allows one to organize and signify the environment, regulating behavior and guiding action. Therefore, when people act, they obtain feedback about their capabilities, both from their appreciation and recognition, which impacts their self-esteem and self-efficacy [13,14].\u003c/p\u003e\n\u003cp\u003eProfessional identity is a type of social identity that can be understood as a set of beliefs and values that guide how employees produce meanings in work situations about others based on their representations of their professional role [15]. These identities are shaped by professional training processes, past experiences, and organizational cultures [16]. Professional identities involve processes of continuity and change, as they are modified according to the relationships sustained at work and within the framework of social and institutional conditions and structures [17].\u003c/p\u003e\n\u003cp\u003eSeveral authors have described the particular characteristics of the identities that are built around care work, highlighting factors such as “the ethic of care” which subordinates the needs of caregivers to those of care recipients [15,18], and emphasizes the commitment to values such as empathy, compassion, selfness and dedication towards patients or users [19–22].\u003c/p\u003e\n\u003cp\u003eAnother element that characterizes this professional identity means that the motivation for work is sustained by altruism rather than remuneration, which is usually low in the case of these professionals, who also tend to perceive a lack of social recognition due to the low status of their occupations (e.g., educators, social workers, health technicians) [23,24]. So, self-sacrifice's value seems particularly relevant to care workers’ motivation. Users’ well-being tends to be more important than material rewards for this kind of worker, representing a major source of job satisfaction [25].\u003c/p\u003e\n\u003cp\u003eThe enactment of these professional identities provides positive emotions and allows workers to represent themselves as valuable and self-effective by contributing to users’ well-being [15,26,27]. In fact, in the case of health workers, high levels of compassionate behavior are associated with stress decrease and general health improvement [28]. Also, positive emotions towards users, commitment to public interest, and self-sacrifice have been linked to higher job satisfaction [29]. In turn, studies in this population have suggested that job satisfaction can have an important effect on mental health, even in contexts of high demands and in the presence of multiple stressors [30].\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eProfessional Identity and trivialization of violence\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAlthough care workers’ professional identities have been recognized as facilitators of well-being, the literature [15,31] also reports their impact on the meanings constructed about user violence and how it is managed. This is relevant because their patients often attack health workers more than their colleagues or team leaders [32]. To be the target of violence exerted by users means facing a permanent tension that arises from the need to care but, at the same time, to control. The dissonance between identity representations associated with empathy and compassion versus the need to carry out punitive actions that organizations often prescribe in these situations can be an important source of psychological distress [33,34].\u003c/p\u003e\n\u003cp\u003eThe workers’ need to protect the positive attributes of their professional identities can activate defensive strategies such as minimization, trivialization, or normalization of violence. This has been observed mainly in health and social services, where violence is often seen as “part of the job” [31,33]. These ways of signifying aggression protect identity by focusing on users’ characteristics and avoiding perceiving themselves as victims. Besides, since violence involves subversion of power in the relationship between users and workers, it can lead to feelings of humiliation, vulnerability, guilt, and low efficacy in the caring role [35]. In the case of these workers, the trivialization of users’ violence has been associated with negative psychological outcomes, such as post-traumatic stress syndrome. Nevertheless, colleagues and employers’ social support seems to decrease the negative effects of violence on mental health [33].\u003c/p\u003e\n\u003cp\u003eConsequently, a comprehensive approach to workplace violence should consider different work organization phenomena, such as emotional demands and psychological distress [8,11,36]. It also requires a deeper understanding of the meanings that care workers produce about their professional practices and how these affect their professional identities’ construction. Thus, assuming that important tensions and contradictions cross-care work, this study aims to understand care workers’ discourses on daily practices related to workplace violence experiences and their relations with their professional identity. Also, this research seeks to analyze the associations between emotional demands and psychological distress, investigating the mediating role of job satisfaction in care workers who assist disabled or socially vulnerable users.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003e\u003cstrong\u003eDesign\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis research was empirically analytical, cross-sectional, and partially mixed. It comprised two concurrent studies, with the qualitative study (study 1) dominating the quantitative study (study 2). Both studies used different samples from three workplaces.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStudy 1\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe qualitative study aimed to reconstruct workers' practices and meanings about their experiences [37] using a dense description of the phenomena [38]. Thus, a semi-structured interview addressed participants regarding violence in their work contexts, how it was managed, and the meanings that they constructed about themselves as care workers.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eParticipants and procedure\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eThe participants were selected using convenience sampling [39]. They were contacted via email through three long-term care centers. Two of these centers assisted patients with mental or intellectual disabilities, and one of them assisted elderly people with physical and/or cognitive impairments. The interviews included 26 workers from different hierarchical levels in the institution, balanced by gender (Women=14, Men=12).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eQualitative data analysis strategy\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eThe qualitative data analysis was conducted using the content analysis technique following deductive categories [40]. Content analysis is an analysis of communications using systematic and objective procedures to describe the content of messages [41]. Categories were first constructed based on the reviewed literature and then contrasted with the obtained data to elaborate the results presented in this paper.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStudy 2\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA quantitative study of a non-experimental, cross-sectional, ex post facto cross-sectional nature was carried out. As a hypothesis, it was expected to find a positive and significant relationship between psychological and emotional demands and psychological distress, a negative and significant relationship between psychological and emotional demands and job satisfaction, and a negative and significant relationship between job satisfaction and psychological distress. It was also expected that job satisfaction plays a mediating role in the relationship between psychological and emotional demands and psychological distress.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eParticipants and procedure\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eThe sample, established through non-probabilistic convenience sampling, comprised 139 female care workers, concentrated in the young and middle age range (66.2% between 18 and 45 years); only 10.8% had complete university education, and 17.3% had incomplete secondary education or technical studies; 70% were dedicated to operational tasks, and a third had been with the institution for more than five years. \u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eInstruments\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003ePsychological and emotional demands\u003c/em\u003e\u003c/strong\u003e. \u003cem\u003ePsychological demands\u003c/em\u003e refer to the way of working and the organization's restrictions to complete tasks (speed, amount of work, time for tasks, receiving conflicting demands, mentally demanding work) [42]. They were measured through 5 Likert-type items of the Job Content Questionnaire (JQC) by Karasek et al. [42], validated in Chile by Ansoleaga [43] with four answer options (Always =4, Almost Never=1). \u003cem\u003eEmotional demands\u003c/em\u003e refer to staying emotionally distant and hiding emotions [43]. They were measured using 4 Likert-type items [44], with four answer options (Always to Never). The psychological demands indicator (in advance PSDI) was constructed from the emotional and psychological demands.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eJob satisfaction\u003c/em\u003e\u003c/strong\u003e refers to the level of satisfaction in the current job, enthusiasm for it, and enjoyment of its realization. It was measured with the Job Satisfaction Scale [45], which consists of 5 Likert-type items ranging from strongly disagree to strongly agree.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003ePsychological distress\u003c/em\u003e\u003c/strong\u003e. The measure is composed of symptoms of depression, restlessness, fatigue, feelings of guilt, and anxiety. It was measured with the Kessler Scale (K6) [34], which consists of six Likert-type items with five response alternatives (Never=0, Always=4).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eQuantitative Data Analysis Strategy\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eFirst, the Harman test estimated the possible effect of the common method variance of all the scales' items. Then, the psychometric properties of the instruments were tested by the internal consistency through Cronbach Alpha (α) y McDonald Omega (ω) and the internal validity (factorial structure) of the instruments by confirmatory factor analysis (CFA). Later, a descriptive analysis of the data was performed, which involved the analysis of the sociodemographic characteristics of the participants the central variables of the study and, the bivariate correlation analysis procedure was implemented to determine the strength and directionality of the relationships between the variables, to finish with the empirical mediation contrast, through a simple mediation analysis through the macro Process of Hayes [46] in the IBM SPSS software. IBM SPSS Statistics 24.0 and JASP 0.162 were used.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003e\u003cstrong\u003eQualitative Study\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eViolence, role paradox, and emotional demands\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eParticipants revealed that one of the most relevant and frequent challenges they face is dealing with users\u0026rsquo; violent behaviors, including verbal and physical aggressions directed at workers, other residents, and the infrastructure of the centers\u003cem\u003e: \u0026ldquo;These aggressions range from punches, pushes, bites, spits, some throw excrement (\u0026hellip;) Others throw blunt objects such as stones, sticks\u0026rdquo; (Mental disability center worker)\u003c/em\u003e. These attacks generate significant stress due to the difficulties in managing users.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eOn the one hand, the simultaneous exercise of control and care functions requires a permanent state of vigilance in monitoring users\u0026rsquo; emotional and behavioral disturbance indicators. This tends to allow the deployment of prevention strategies, such as distracting users who show signs of agitation and avoiding stimuli that may alter them. Despite these efforts and due to the mental disorders presented by the users, the episodes of violence turn out to be highly unpredictable and difficult to manage: \u003cem\u003eA lot of them don\u0026rsquo;t show even the slightest signs \u0026mdash; like, you don\u0026rsquo;t see it coming \u0026mdash; and suddenly they get upset and lash out. And we don\u0026rsquo;t realize it until they\u0026apos;ve already gone after a fellow resident or a staff member.\u0026quot; (Mental disability center worker)\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;Consequently, the work context appears to be perceived as uncontrollable, generating anxiety because of the expectation of violent episodes: \u003cem\u003e\u0026ldquo;Sometimes it\u0026apos;s like seven or eight in the evening, and all sudden things get tense in no time. Other times, nothing happens, and you start feeling uneasy just because you\u0026apos;re so used to something going wrong\u003c/em\u003e\u0026hellip;\u0026quot; \u003cem\u003e(Mental disability center worker\u003c/em\u003e\u003cem\u003e)\u003c/em\u003e. Additionally, this also seems to produce an ambivalent perception of the users as simultaneously vulnerable and threatening people\u003cem\u003e: \u0026ldquo;You look at them and think, \u0026lsquo;These sweet old folks\u0026hellip;\u0026rsquo; and then, all of a sudden, they change completely \u0026mdash; sometimes out of nowhere\u0026quot; (Senior center worker\u003c/em\u003e) The difficulty in preventing and controlling these situations and the physical consequences of violence tend to be assumed by these workers as a product of their own mistakes or lack of capacity to avoid these episodes:\u003cem\u003e\u0026nbsp;\u0026ldquo;A girl pulled my hair for about two hours outside\u0026hellip; the headache stayed with me for several days, but it was my mistake anyway because my hair was not taken\u0026rdquo; (Mental disability center worker)\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eOn the other hand, institutional action protocols establish that employees must protect themselves in these incidents, taking physical distance from the agitated user and keeping other residents away. These indications are difficult for workers to follow because they understand that their role is to care for and protect the most vulnerable users, preventing them from attacking themselves or attacking other residents and even staff. The emotional relevance of exercising this role has the consequence that they often become the target of aggression, giving priority to preserving others\u0026rsquo; well-being to the detriment of their safety:\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;We cannot do physical containment because it is a residence, in the end, it is to take care of you, take care of him because we have users who self-harmed and take care of the rest, so you are a shield, a caregiver and everything at once, and you get scared\u0026rdquo; (Mental disability center worker)\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eAt the same time, being unable to defend themselves or being defended by their coworkers also generates feelings of vulnerability, fear, and helplessness. These emotions must be regulated or hidden to regain control of the situation and, in some cases, quickly reintegrate into the work routine after the attack. This also happens with aggressions that, although they do not generate physical damage, do have a negative emotional impact:\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;A physical aggression from a user is terrible because we cannot yell at him, we cannot do verbal or mechanical restraint, we must wait for them to hit us; and if a user gives us a bad hit, who responds for us?\u0026rdquo; (Senior center worker)\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;Apart from the pain you may feel because of the aggression, psychologically you feel bad because if you punch me, I will punch you back, but with them, it is not the same\u0026hellip; we have always tried to fight for a place where we can go to cry. Because we cannot do it in front of the user\u0026rdquo; (Mental disability center worker)\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eProfessional identity: empathy, compassion and self-sacrifice.\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eCoping with stress, fear, and feelings of helplessness while positively valuing their work experiences in a threatening context seems possible because care work is represented as a vocation, which emerges as a core element of their professional identity. This vocation is closely related to values such as empathy, compassion, and self-sacrifice, allowing them to prioritize the care of users even when this implies risking their own physical and psychological integrity.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;When we have been beaten, our rights are violated\u0026hellip; and there one has to question whether one has the vocation, to think first about who I am acting in front of, to put oneself in the place of the user\u0026rdquo; (Mental disability center worker)\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;They need conversation and love, they only need that, and for that, you have to have a vocation. And the person who does not have it is better not to work at the center\u0026rdquo; (Senior center worker)\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eEnacting these attributes of their professional identities provides participants with positive emotional experiences. The feedback they receive from users, through gestures of recognition and affection, confirms the way in which they represent themselves as care workers.\u003c/p\u003e\n\u003cp\u003eThis is reflected in the value they place on the bonds they establish with users and the affective retribution they obtain from these relationships, which seem to positively affect their own sense of personal worth and professional capacity. These positive emotions seem to have a greater impact on their work and psychological well-being than the negative ones they experience because of violence, making it easier for them to continue working in these scenarios.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;I know that many times we have been attacked, we have been insulted by them, but after a while, they are giving you affection, they are hugging you, they are giving you unconditional affection, and that is gratifying, that is why I continue\u0026rdquo; (Mental disability center worker)\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;The guys use violence, more than violence it is often the force that one does not know how to interpret, and they are decompensated for different situations. Sometimes we are bad or moody, but they also have good and bad days, and the guy who attacked you today will give you a kiss tomorrow. So you have to understand and study them, be empathetic and put yourself in the place of the other\u0026rdquo; (Mental disability center worker)\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eTrivialization of violence as a strategy for protecting professional identity\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eBesides, professional identity seems to be preserved through the trivialization and normalization of violence at work, minimizing its severity and consequences. This is reflected, for example, in prevention strategies such as working in pairs so that some workers can cushion the impact of a blow.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;We also have guys who bite, who kick you\u0026hellip; which is still violence, maybe not of the same caliber as a stick or an iron, but from a version as small as a bite or a push\u0026rdquo; (Mental disability center worker)\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;(The caregivers) ended up with bruises, broken fingers, etc. They have to report their incident and have a witness. On the part of the organization, we try to avoid violence, knowing that there will be another colleague who may be attentive to put her hand so that the first does not reach the colleague so hard, to contain as appropriate to avoid a kick, that kind of things\u0026rdquo; (Senior center worker)\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eThere is also some resistance on the part of employees to seek medical attention in case of injuries, even when their managers consider it necessary. This could be playing a dual function. On the one hand, it could serve to avoid visualizing themselves as victims of violence, with the consequent loss of power that this entails. On the other hand, this could facilitate the maintenance of the feeling of control, psychological strength, and professional capacity, as well as the sense of self-sacrifice:\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;(a user) threw me here, and I got to feel how my scalp peeled off my head\u0026hellip; we managed to release the hair, I had to put ice on, and I was in a lot of pain, and we managed to put the user to bed. Then went for coffee, and the boss wanted to send me to the medical center\u0026hellip; I did not consider it necessary because, in the end, what would they do to me? And my colleagues were going to be alone, and one less weighs. And then we just laughed, if, in the end, we have no choice\u0026rdquo; (Senior center worker)\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;As we are old, we never go to a medical center, we are already used to it. I have been beaten up, but if it is a fracture, we have to go. Years ago, that happened to me, but it has been more than seven years since I went, I think I already handle it better\u0026rdquo; (Mental disability center)\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eLikewise, another possible cause of the trivialization of violence may be related to the attributions they constructed concerning its origins. Participants perceive that violence is largely caused by mental illness or disability and also by other aspects, such as centers\u0026rsquo; deficient infrastructure and work organization. However, the participants with leadership positions in their organizations emphasize the responsibility of employees in these episodes. The lack of training, poor management of their emotional problems, and carelessness in interacting with the users are considered by them as important antecedents of violence in the residences. This could also be posing a threat to worker\u0026rsquo;s professional identities:\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;They are constantly training them in emotional and environmental containment to be able to work with these users when they are decompensated, to be able to lower those aggressive behaviors they have\u0026hellip; although they are trained, they do not react when the user is decompensated, because many times they are called attention to them, and they get more altered\u0026rdquo; (Leadership of Mental disability center)\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;We usually get people without training\u0026hellip; They have a lot of desire, a lot of love, but they have no idea how to deal with a psychomotor agitation, they have no idea how to deal with a user\u0026rdquo; (Leadership of Mental disability center)\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eThe violence normalization is even transmitted to new workers and trainees, who are taught to dismiss the relevance of these episodes and consider them as part of the nature of the work they do:\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;It depends a lot on the attitude of the people who are working, and that is emphasized to the people who are arriving, for example, \u0026ldquo;Be careful with him, he can suddenly send you a punch,\u0026rdquo; \u0026ldquo;If he tells you something does not take it personally.\u0026rdquo; It depends a lot on how one welcomes the people who are arriving\u0026rdquo; (Senior center worker)\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;We are used to verbal violence, we take it with humor. There are some who know perfectly well what they are doing, but we are already used to this type of high-caliber vocabulary, so it no longer complicates us. To new people, yes, many times they are not accustomed, but with the time we guide them regarding that they must get used to it\u0026rdquo; (Senior center worker)\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eTogether, these ways of trivializing aggression would make it possible to face highly emotionally demanding work contexts and protect professional identity from the negative effects of violence. In this sense, it is possible to hypothesize that its normalization could facilitate greater job satisfaction and better well-being and mental health results.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eQuantitative Study\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eDescriptives and analysis of the effect of variance of the common method\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eTable 1 shows the descriptive statistics. The Harman Test was applied to estimate the effect of the variance of the common method. Thus, all the items of the scales were subjected to an exploratory factor analysis with the principal component\u0026rsquo;s method and varimax rotation, forcing the extraction to a single factor. The results showed that this factor explained 32.94% of the common variance, so it can be argued that the effect of the common variance does not seem to affect the relationship between the variables studied significantly.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003cstrong\u003eTable\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003e1\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eDescriptive statistics of the main variables of the study\u003c/em\u003e\u003cem\u003e.\u003c/em\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"601\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 236px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003eMedia\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003eStandard derivation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003eMinimal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003eMaximum\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 236px;\"\u003e\n \u003cp\u003ePsychological emotional demands\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003e2.38\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003e.56\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003e1.22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003e3.78\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 236px;\"\u003e\n \u003cp\u003eJob satisfaction\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003e2.90\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003e.89\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 236px;\"\u003e\n \u003cp\u003ePsychological distress\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003e.64\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003e.77\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cem\u003eNote\u003c/em\u003e. n=139\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eAnalysis of the instrument\u0026acute;s psychometric properties\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eA confirmatory factor analysis was applied to estimate the fit of the factorial structure of the instruments of PSDI, job satisfaction, and psychological distress. All the\u0026nbsp;goodness-of-fit indices are within the expected parameters, indicating a good fit of the data concerning the factorial structure of the instruments: PSDI (\u003cem\u003ex\u0026sup2;/df\u003c/em\u003e ratio=1.67, SRMR=.06, RMSEA=.07, CFI=.96, TLI=.94), job satisfaction (\u003cem\u003ex\u0026sup2;/df\u003c/em\u003e ratio=1.83, SRMR=.04, RMSEA=.07, CFI=.98, TLI=.97), and psychological distress (\u003cem\u003ex\u0026sup2;/df\u003c/em\u003e ratio=1.73, SRMR=.03, RMSEA=.07, CFI=.98, TLI=.96). McDonald\u0026acute;s Omega and Cronbach\u0026acute;s Alpha internal consistency internal consistency indices were calculated for the three scales. The values obtained are shown in the diagonal of Table 2, all adequate because they are above .70.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eAnalysis of bivariate correlations\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eTable 2 shows the results\u0026nbsp;of Pearson\u0026rsquo;s bivariate correlation between study variables.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003e2\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003ePearson\u0026acute;s matrix of bivariate correlations between the main variables of the study, and reliability indices.\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"605\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 265px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 44.4215%;\"\u003e\n \u003cp\u003e1. Psychological and emotional demands\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17.8925%;\"\u003e\n \u003cp\u003e(.75, .77)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 44.4215%;\"\u003e\n \u003cp\u003e2. Job satisfaction\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17.8925%;\"\u003e\n \u003cp\u003e-.52***\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e(.83, .79)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 44.4215%;\"\u003e\n \u003cp\u003e3. Psychological distress\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17.8925%;\"\u003e\n \u003cp\u003e.44***\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e-.50***\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e(.85, .84)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cem\u003eNote\u003c/em\u003e. n=139; ***\u003cem\u003ep\u003c/em\u003e \u0026lt; .001. On the diagonal are the McDonald\u0026acute;s Omega and Cronbach\u0026acute;s Alpha indices of the instruments, respectively.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n\u003cp\u003eThe expected relationships between the variables have been reproduced in the data. There is a statistically significant and positive relationship between PSDI and psychological distress (\u003cem\u003er\u003c/em\u003e = .44, \u003cem\u003ep\u003c/em\u003e \u0026lt; .001). In turn, a statically significant and negative relationship can be observed between PSDI and job satisfaction (\u003cem\u003er\u003c/em\u003e = -.52, \u003cem\u003ep\u003c/em\u003e \u0026lt; .001), and a negative and significant relationship of the same nature between job satisfaction and psychological distress (\u003cem\u003er\u003c/em\u003e = -.50, \u003cem\u003ep\u003c/em\u003e \u0026lt; .001).\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eMediation analysis\u003c/em\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA mediation model was performed based on correlation analyses\u0026rsquo; results to test if job satisfaction mediated the relation between PSDI\u0026nbsp;and psychological distress. PSDI had a significant positive effect on psychological distress (\u003cem\u003e\u0026beta;\u003c/em\u003e=.39; \u003cem\u003et\u003c/em\u003e=5.244; \u003cem\u003ep\u003c/em\u003e=.000). PSDI had a negative influence on job satisfaction (\u003cem\u003e\u0026beta;\u003c/em\u003e=-.44; \u003cem\u003et\u003c/em\u003e=-7.084; \u003cem\u003ep\u003c/em\u003e=.000). In turn, job satisfaction had a negative impact on psychological distress (\u003cem\u003e\u0026beta;\u003c/em\u003e=-.42; \u003cem\u003et\u003c/em\u003e=-4.372; \u003cem\u003ep\u003c/em\u003e=.000). The indirect effect of PSDI\u0026nbsp;on psychological distress through job satisfaction was significant (\u003cem\u003e\u0026beta;\u003c/em\u003e =.18, SE=.06, CI 95% [0.77, 0.322]). The direct effect of PSDI\u0026nbsp;on psychological distress was still significant when all the variables were in the model (\u003cem\u003e\u0026beta;\u003c/em\u003e=.20, \u003cem\u003et\u003c/em\u003e=-2.51, \u003cem\u003ep\u003c/em\u003e=.013). This indicates that job satisfaction partially mediates the relation between PSDI on psychological distress. The model explained 17% of psychological distress\u0026rsquo;s variability (See Figure 1). Consequently, given these results, the mediation hypothesis has empirical support, so it is maintained.\u0026nbsp;\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eCare work is characterized by important tensions and contradictions that need a more complete scientific understanding because of its various implications for the lives of those who dedicate themselves to it. This led us to carry out the present research, whose purpose has been double: on the one hand, to understand the discourses on daily practices related to workplace violence and professional identity in this field of work and, on the other hand, to analyze the relationship between PSDI and psychological distress, investigating the mediating role of job satisfaction.\u003c/p\u003e\u003cp\u003eThe results of study 2 show that care work exposes workers to high PSDI that is associated with psychological distress, which is a precursor to mental health problems. Also, job satisfaction is a mediating variable between the PSDI -typical of care work- and psychological distress. On the other hand, study 1 shows that the meaning of work and the \u0026ldquo;vocation of service\u0026rdquo; allows workers to elaborate positive narratives about their daily work experiences despite exposure to aggression. Considering the results of both studies, we can understand job satisfaction as a dimension related to the identity component of care work is negatively related to psychological distress. This explains the mediating role of job satisfaction between psychological and emotional demands and psychological distress.\u003c/p\u003e\u003cp\u003eZapf and Holz [\u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e47\u003c/span\u003e] indicate that emotional labor has an ambivalent character, with positive consequences such as job satisfaction, feelings of personal achievement, and a sense of self-efficacy and negative consequences such as emotional exhaustion, depersonalization, or psychosomatic aliments. In the same sense, some occupations in the service sector involve a high vocational commitment of workers. This entails an emotional commitment that brings negative consequences for health, according to Ansoleaga and Toro [\u003cspan citationid=\"CR48\" class=\"CitationRef\"\u003e48\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eThis research reveals a high exposure to workplace violence and its naturalization [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e] exerted by users who are particularly complex and contributes to understanding how care workers resist these situations by applying the trivialization of violence as a mechanism for the protection of their professional identity, being trapped in a paradox. In particular, the narrative of the role and the professional identity of the care worker is associated with values and attributes such as empathy, compassion, and caring. However, care institutions produce, maintain, and count the efforts that workers deploy for the sacrificial culture. The sacrificial culture alludes to certain patterns of behavior that are part of the socialization in and for care work, in which work is conceived as a socially valued activity and sustained mainly by a personal commitment to such values. Thus, fulfilling the institutional mission is privileged beyond what could be a reasonable commitment at work, often transgressing labor rights. This culture is present in work contexts where it is practically impossible to establish limits in the face of a constantly high demand for work and is difficult to disconnect even during free moments [\u003cspan citationid=\"CR48\" class=\"CitationRef\"\u003e48\u003c/span\u003e]. The resistance attempts of the workers in the face of this extreme and unpredictable demand risk them being questioned by their peers and the institution since the emotional and work demand is crossed by a social value discourse that appeals to vocation, good values, humanitarian aid, compassion, and empathy -among others-, forcing them to meet the constant and overloaded demands of their work [\u003cspan citationid=\"CR48\" class=\"CitationRef\"\u003e48\u003c/span\u003e, \u003cspan citationid=\"CR49\" class=\"CitationRef\"\u003e49\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eThus, certain heroic and humanistic qualities are overvalued, especially in times of crisis [\u003cspan citationid=\"CR50\" class=\"CitationRef\"\u003e50\u003c/span\u003e], and regulating emotions is prescribed to respond to work and help purposes. A high commitment to work has been associated with the perception of well-being, which has been widely described in studies on \u0026ldquo;engagement\u0026rdquo; and service capacity that promotes meaning, the feeling of usefulness, and motivation [\u003cspan citationid=\"CR51\" class=\"CitationRef\"\u003e51\u003c/span\u003e]. However, particularly in precarious work contexts of high demands and low control of workers, this can encourage the intensification of this sacrificial culture [\u003cspan citationid=\"CR48\" class=\"CitationRef\"\u003e48\u003c/span\u003e]. In this way, care workers constitute a population at risk for the emergence of health problems.\u003c/p\u003e\u003cp\u003eIf we assume that professional identity is built in the dynamics between the representations that workers elaborate about themselves and their contexts, how they conceive their role guides and gives meaning to their actions and relationships with others at work. At the same time, the effects of the exercise of their work, in terms of their emotional experiences and the results of their actions, feedback these identities that they have built for themselves [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. In this case, we observe that the centrality of a care ethic, which subordinates the needs of care workers to those of care receivers [\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e] and which develops in the context of a sacrificial culture of work, can contribute to the elaboration of a stressed or fragmented work identity by ambivalent feelings. These discordances are linked to the insuperable simultaneous roles of care and control, which have correlated emotional states that may contradict each other. This can result in a high risk of mental health problems.\u003c/p\u003e\u003cp\u003eFulfilling the task of protecting the most vulnerable often places workers in a position of vulnerability where they even become real \u0026ldquo;human shields,\u0026rdquo; narrated from an epic discourse that leaves little space for recognizing the place of victims or the lack of protection they are subjected to. There is around this position the concealment of negative emotions, including the prescription that being a victim of aggression is part of the work, and it is reproduced in the processes of socialization at work. In this way, the narratives around the daily experiences of violence at work, the emotions experienced, and the practices of coping with violence are functional to the preservation of the professional identity of care workers, integrating a robust vocational component. In turn, these identity narratives are functional in maintaining an organizational system often precarious in their objective but also symbolic and subjective conditions, such as the lack of recognition and legitimation.\u003c/p\u003e\u003cp\u003eHowever, the institutions show concern about the consequences of this work reality from operational and procedural rationality (more training, instructive protocols) that neglects and ignores the power of cultural and subjective factors in the behavior of people in organizations and where the professional identity of care workers occupies a fundamental place. This operational rationality succumbs because it assumes that work contexts are static and care work has no relational components, especially because the activity and task are inseparable from the emotional and relational components of the person who deploys them. This contributes to the failure of a more \u0026ldquo;objective\u0026rdquo; response from the institutions to the problem of violence in care work and, at the same time, produces high amounts of anxiety and distress and constitutes a threat to the sense of professional efficacy.\u003c/p\u003e\u003cp\u003eSustaining the identity narrative of care work with older adults or people with intellectual or mental disabilities, neglecting the effects that workplace violence has on workers can be very costly for people and organizations since the evidence shows consequences on the mental health of workers such as symptomatology of post-traumatic stress disorder [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR52\" class=\"CitationRef\"\u003e52\u003c/span\u003e], depressive symptomatology [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e], anxiety and problems like subjective discomfort, poorer quality of sleep and instability in sleep hours [\u003cspan citationid=\"CR53\" class=\"CitationRef\"\u003e53\u003c/span\u003e] It has also been reported as an effect the decrease in quality of care when there is workplace violence has also been reported, which is manifested in the deterioration of relationships with users [\u003cspan citationid=\"CR54\" class=\"CitationRef\"\u003e54\u003c/span\u003e] and in the face of the occurrence of an episode of workplace violence, this can have consequences in the long term (approximately for two years) [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. Furthermore, the implications at the level of physical health are widespread physical discomfort and stress [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR55\" class=\"CitationRef\"\u003e55\u003c/span\u003e]. Thus also, workplace violence has been associated with decreased productivity, injury or sick leave, and absence periods of eight or more consecutive weeks [\u003cspan citationid=\"CR56\" class=\"CitationRef\"\u003e56\u003c/span\u003e, \u003cspan citationid=\"CR57\" class=\"CitationRef\"\u003e57\u003c/span\u003e], which have an increase in costs for the organization and the state due to medical leave and disability pensions [\u003cspan citationid=\"CR58\" class=\"CitationRef\"\u003e58\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eFinally, analyzing work in care services requires incorporating a gender perspective. Gender refers to the historical-social construction of the feminine and the masculine and how these constructions are articulated in power relations [\u003cspan citationid=\"CR59\" class=\"CitationRef\"\u003e59\u003c/span\u003e]. Gender elements strongly cross work in care services; it is feminized work; employment patterns, social structures, and biological differences contribute to specific patterns of gender risks and occupational risks [\u003cspan citationid=\"CR60\" class=\"CitationRef\"\u003e60\u003c/span\u003e] since gender inequalities and discrimination in general society are reproduced within the organization [\u003cspan citationid=\"CR61\" class=\"CitationRef\"\u003e61\u003c/span\u003e]. According to Matamala et al. [\u003cspan citationid=\"CR59\" class=\"CitationRef\"\u003e59\u003c/span\u003e] gender constructs subjectivities where the feminine is related to \u0026ldquo;being for others,\u0026rdquo; which generates that women tune in differently with the suffering of others; according to Boniol et al. [\u003cspan citationid=\"CR62\" class=\"CitationRef\"\u003e62\u003c/span\u003e], the health sector has a traditional division of labor of gender roles where women are in subordinate positions, perform tasks associated with direct care, while men perform management tasks or are in higher hierarchical positions; this could contribute to making subtle discriminations appear as nonexistent or as part of the work due to care of others that they exercise [\u003cspan citationid=\"CR63\" class=\"CitationRef\"\u003e63\u003c/span\u003e]. Care work is often \u0026ldquo;mothernalized\u0026rdquo;, localized, and naturalized as women\u0026acute;s work [\u003cspan citationid=\"CR49\" class=\"CitationRef\"\u003e49\u003c/span\u003e].\u003c/p\u003e\u003cp\u003e\u003cb\u003eLimitations\u003c/b\u003e\u003c/p\u003e\u003cp\u003eAmong the limitations of the quantitative study, it is worth mentioning that we used a convenience sample within the framework of a cross-sectional design that does not make it possible to observe the relationships between the variables studied over time. In addition, although occupational health research highlights the importance of working separately with samples of men and women to incorporate the gender dimension, we think that future studies should include men to study the effect of this variable on the relationship between psychological and emotional demands, job satisfaction and distress in care work.\u003c/p\u003e\u003cp\u003eConcerning the results of the qualitative study, it would be important to carry out studies that address the construction processes of these professional identities throughout the workers' work trajectories. These studies should also delve into the role of gender in how workers incorporate the ethic of care and the culture of sacrifice and the meanings they produce about violence.\u003c/p\u003e\u003cp\u003e\u003cb\u003eProjections of the study\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThe results reveal the need for a state policy on care work, its recognition at the private level, the professionalization of its exercise in formal work settings, and the training of people who perform this work in a paid and unpaid manner.\u003c/p\u003e\u003cp\u003eRegarding control and prevention against workplace violence in care work, research points to the need to move from individual strategies to organizational strategies [\u003cspan citationid=\"CR64\" class=\"CitationRef\"\u003e64\u003c/span\u003e, \u003cspan citationid=\"CR65\" class=\"CitationRef\"\u003e65\u003c/span\u003e], that these be made known to workers and that workers be educated to recognize episodes of workplace violence [\u003cspan citationid=\"CR66\" class=\"CitationRef\"\u003e66\u003c/span\u003e]. Thus, the studies assign a fundamental role to organizational social support (instrumental and informational) to moderate the adverse effects of violence [\u003cspan citationid=\"CR67\" class=\"CitationRef\"\u003e67\u003c/span\u003e].\u003c/p\u003e"},{"header":"Conclusions","content":"\u003cp\u003eThe professional identity of care workers is strongly linked to their vocational character and their expression of empathy and commitment to the users of the institutions.\u003c/p\u003e\u003cp\u003e\u003cul\u003e\u003cli\u003e\u003cp\u003e- Care work implies risks for those who perform it due to the impossibility of dissociating tasks or activities from relational aspects and the emotions they produce. Although it has little social recognition, it is a work that has a strong vocational component, which is reproduced in the identity narrative of care workers. Work implies risks for those who perform it due to the impossibility of dissociating tasks or activities from relational aspects and the emotions they produce. Although it has little social recognition, workers' identity narratives reproduce a solid vocational component.\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003e- Workplace violence is usually trivialized, and the negative emotional correlate is hidden in the care work. In these dynamics, the bond becomes ambivalent because whoever is the subject of care is and must be subject to control; it is vulnerable but also threatens female workers.\u003c/p\u003e\u003c/li\u003e\u003c/ul\u003e\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eFunding:\u0026nbsp;\u003c/strong\u003eThis research was selected in the Call for Research and Innovation Projects in Prevention of Occupational Accidents and Diseases (\u0026quot;2020\u0026quot;) of the Superintendence of Social Security (Chile) and funded by the Asociaci\u0026oacute;n Chilena de Seguridad with resources from the Social Security of Law No. 16,744 on Occupational Accidents and Diseases.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthical Approval and accordance:\u003c/strong\u003e The project was approved by the Ethics Committee for Scientific Research of the Asociaci\u0026oacute;n Chilena de Seguridad (CEC/29/2020). The procedures used in this study adhere to the tenets of the Declaration of Helsinki.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent to Participate:\u003c/strong\u003e Informed consent was obtained from all subjects involved in the study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflict of interest:\u0026nbsp;\u003c/strong\u003eAll authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest or non-financial interest in the subject matter or materials discussed in this manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eClinical trial number:\u0026nbsp;\u003c/strong\u003enot applicable.\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eM.A., E.A., M.J.M-L., and R.R-V. contributed to the conceptualization of the study. M.A., M.J.M-L., and R.R-V curated the data. Formal analysis and methodology were carried out by M.A., E.A., M.J.M.-L., and R.R.-V. Acquired the funding; Investigation; Project administration and Supervision were conducted by E.A.. All authors reviewed and approved the final manuscript.\u003c/p\u003e\u003ch2\u003eData Availability\u003c/h2\u003e\u003cp\u003eThe datasets generated during and/or analysed during the current study are not publicly available due to the sensitive nature of the interview material, which addresses experiences of workplace violence and mental health, but are available from the corresponding author on reasonable request.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eInternational Labour Organization. Care work and care jobs for the future of decent work | International Labour Organization [Internet]. 2018 [cited 2025 Jul 18]. 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J Occup Health Psychol. 2003;8(2):110\u0026ndash;22.\u003c/span\u003e\u003c/li\u003e\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":true,"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":"workplace violence, identity, emotional labor, psychological distress","lastPublishedDoi":"10.21203/rs.3.rs-7160043/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7160043/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eCare work is crossed by important contradictions. We work on understanding the discourses on daily practices related to workplace violence and professional identity, and, in analyzing the associations between emotional demands and psychological distress (PD), investigating the mediating role of job satisfaction (JS) in care work for people living with a disability and/or social vulnerability.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eMethods: This research was empirically analytical, cross-sectional, and partially mixed, composed of two studies (qualitative and quantitative). Participants were workers from two Chilean organizations that assist elderly people or patients with intellectual or mental disabilities.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eResults: Care work exposes workers to high psychological and emotional demands that are associated with PD. Likewise, JS as a dimension related to the identity component is negatively related to PD. Thus, JS is a mediating variable between emotional and psychological demands. The meaning of work and the “vocation of service” allows workers to elaborate positive narratives about their daily work experiences despite exposure to aggression.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eConclusions: Professional identity of care workers is strongly linked to their vocational character, which implies risks for those who perform it due to the impossibility of dissociating tasks from relational aspects. Workplace violence is usually trivialized, and the negative emotional correlate is hidden in this work.\u003c/p\u003e","manuscriptTitle":"Identity and Emotional Labor in Resisting Violence in Care Work","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-07-30 05:01:30","doi":"10.21203/rs.3.rs-7160043/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":"870b5d21-8007-4adc-b39a-19e67fb7f088","owner":[],"postedDate":"July 30th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-09-24T13:39:34+00:00","versionOfRecord":[],"versionCreatedAt":"2025-07-30 05:01:30","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7160043","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7160043","identity":"rs-7160043","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}