Attribution, risk perception, and response to workplace violence: a scenario-based study of triage nurses

Workplace violence (WPV) against nurses is a persistent challenge in emergency care, yet little is known about how frontline nurses cognitively interpret aggressive patient or family behavior and how these interpretations influence their risk perception and coping strategies. Drawing on attribution theory, we examined how nurses assign causality in different WPV scenarios and how these attributions relate to behavioral responses. A cross-sectional, scenario-based online survey was conducted among 230 emergency nurses using the Wenjuanxing platform. Six vignettes representing common WPV encounters were designed to systematically vary along three attributional dimensions: consensus, distinctiveness, and consistency. Participants identified the likely cause of the behavior (actor, situation, or stimulus), rated perceived risk, and indicated preferred coping strategies. Attribution patterns aligned with scenario cues, suggesting nurses were sensitive to contextual features when interpreting aggression. Situation attributions were consistently linked to lower perceived risk and fewer negative coping responses. In contrast, stimulus attributions, especially in personalized or ambiguous situations, corresponded with higher risk scores and increased likelihood of passive coping. Prior WPV experience was associated with greater use of actor attributions and heightened avoidant behavior, even in less threatening contexts. Nurses' interpretations of patient aggression are shaped by both clinical context and personal experience, with meaningful consequences for their emotional responses and behavioral choices. Interventions such as simulation-based education and attributional reframing may enhance nurses' cognitive flexibility and preparedness in managing WPV more effectively.