Development of the Nurses' Attitudes Toward Violence by Patients and Patients' Relatives Scale: A Methodological...

Violence against nurses is a global occupational health and safety issue, yet instruments that assess nurses' attitudes towards violence from patients and their relatives are limited. This methodological study involved the development and evaluation of the Nurses' Attitudes Towards Violence by Patients and Patients' Relatives Scale. In the qualitative phase, 39 nurses were interviewed in depth until data saturation was reached, generating a pool of 61 items. Content validity with 15 experts (CVI = 0.90) yielded a draft of 57 items. The original quantitative sample (N = 608) was randomly divided into exploratory (n = 304) and confirmatory (n = 304) subsamples. Principal axis factoring with ProMax rotation supported a 36-item, three-factor solution that explained 52.3% of the common variance. This solution comprised the following factors: perception and causes of violence (20 items); effects of violence (13 items); and response to violence (3 items). In the original confirmatory subsample, the final model with six theory-based residual covariances was subjected to WLSMV confirmatory factor analysis, showing an overall acceptable fit (χ²(585) = 1297.5, χ²/df = 2.22, CFI = 0.900, TLI = 0.892, RMSEA = 0.063 [90% CI 0.059-0.068], SRMR = 0.093). A robustness wave involving 45 additional nurses, conducted between 27 August and 2 September 2026, produced almost identical results when combined with the confirmatory subsample (n = 349). Supplementary analyses supported composite reliability and discriminant validity, and found that measurement invariance was supported across institution type, whereas findings regarding sex invariance were interpreted as preliminary. In the original sample of N = 608, Cronbach's α was 0.943, 0.930 and 0.842 for the three factors, and 0.950 for the total scale. Two-week test-retest reliability was r = 0.976. The scale provides a multidimensional measure of nurses' evaluative-attributional beliefs, perceived effects and responses to violence from patients and relatives.