Hospital violence, which includes verbal and physical violence, physical threats, sexual violence, harassment, and bullying, poses a significant threat to the safety and well-being of staff in all work-related situations [1]. The high expectations for quality service in healthcare, coupled with patient anxiety and concerns about illnesses, as well as dissatisfaction with treatment outcomes, can often lead to expressions of anger and frustration from patients and their families. Nurses, who are tasked with maintaining therapeutic relationships, frequently find themselves on the receiving end of such violence [2, 3]. Moreover, nurses' interactions with various hospital staff members can also lead to conflicts due to excessive workloads and the constant state of readiness for emergencies, resulting in different forms of violence [4]. A staggering 95.5% of clinical nurses in South Korea have reported experiencing verbal violence, physical threats, and physical violence across various departments. The main instigators of this violence were identified as patients (83.5%) and their families (90.8%). However, physicians and fellow nurses also contributed significantly to these incidents, accounting for 78.2% and 62.3% respectively [5].

Nurses who have been subjected to violence often display emotional reactions such as anger, irritation, and depression. They may also experience physical symptoms including headaches, insomnia, and general tension. These individuals may find it challenging to attend work, notice changes in their relationships with colleagues, and even develop a fear of patients [6]. As these violence responses accumulate, they can lead to increased stress levels, which in turn can contribute to nurse burnout [7]. Furthermore, this burnout can extend to other nurses, resulting in decreased job satisfaction, diminished enthusiasm for work, a heightened intention to leave the job, reduced organizational productivity, and widespread organizational burnout [1, 3, 7, 8]. This situation has serious implications for the management of the nursing workforce and the quality of nursing care. It can lead to an increase in patient safety errors and negatively impact the patients who are receiving nursing services [1, 7]. As such, interventions are necessary to mitigate nurse burnout caused by violence responses and to improve the quality of nursing care.

Various strategies are employed to prevent hospital violence, including the development of violence prevention policies, training for violence prevention and response, and enhancements to the work environment [3]. However, these strategies may not fully alleviate the negative reactions and burnout that individuals experience when violence occurs. Even with rigorous implementation of violence prevention measures, unexpected violence can still occur, potentially intensifying negative reactions [8]. To prevent and reduce burnout, it is important to consider both external factors, such as the nursing work environment, social support, and salary satisfaction, and internal factors, such as self-efficacy, resilience, professional self-concept, and interpersonal skills. However, research suggests that internal factors may have a more positive effect on reducing burnout than external factors [7]. Therefore, it is crucial to identify and strengthen nurses' internal resources.

Positive psychological capital, an internal resource of an individual, comprises four interconnected positive psychological states: self-efficacy, hope, optimism, and resilience [9]. This form of capital positively influences job stress, anxiety, and turnover intention by reducing them, while simultaneously enhancing organizational commitment, job satisfaction, and job performance [10]. Furthermore, positive psychological capital can be enhanced through development and training [9], which can serve as a crucial strategy for mitigating nurse burnout, decreasing turnover rates, and sustaining a proficient nursing workforce [11]. A meta-analysis [12] revealed that positive psychological capital had the most substantial effect on reducing nurse burnout. It encourages nurses to fulfill their nursing responsibilities, assists them in overcoming challenges, and fosters positive perceptions, thereby diminishing negative attitudes and burnout towards patients. Consequently, positive psychological capital can serve as a factor in enabling nurses to effectively manage negative violence responses, foster positive perceptions of patients, and motivate them to carry out their nursing duties, ultimately reducing burnout.

Prior studies focused on nurses have noted that an elevated level of positive psychological capital correlates with a decrease in burnout [13]. Additionally, increased resilience is associated with diminished negative responses to violence and a reduction in burnout [14]. Resilience also moderates the effects of post-traumatic stress disorder [15], while self-efficacy influences the regulation of burnout [16]. Both resilience and self-efficacy are subcomponents of positive psychological capital [9]. Given that post-traumatic stress is a contributing factor to burnout [7], it can be inferred that positive psychological capital may moderate nurse burnout. Moreover, research [17] investigating the correlation between customer misbehavior and burnout suggests that positive psychological capital can help manage burnout. This supports the notion that positive psychological capital can assist nurses in controlling burnout that may arise in situations where they encounter violence. Consequently, it is crucial to evaluate the emotional, physical, and social responses to violence, as well as the levels of positive psychological capital and burnout in clinical nurses. This evaluation will provide the foundation for the development of nurse burnout reduction programs that leverage positive psychological capital, by elucidating the moderating effect of positive psychological capital on the relationship between responses to violence and burnout.

The aim of this study was to investigate the responses of clinical nurses to violence and burnout, as well as their levels of positive psychological capital. Additionally, we aimed to verify the moderating role of positive psychological capital in the relationship between responses to violence and burnout.

This study investigated the responses of clinical nurses to emotional, physical, and social violence. It also aimed to assess their levels of positive psychological capital and burnout. Furthermore, the study aimed to comprehend the moderating effects of positive psychological capital on the relationship between each type of violence response and burnout.

In this study, clinical nurses reported the highest scores for emotional violence responses (3.34 points), followed by physical violence responses (2.64 points) and social violence responses (1.97 points). These findings align with previous studies that used the same measurement tool with emergency room nurses [23, 24]. Those studies reported scores for emotional violence responses between 3.19 and 3.57 points, physical violence responses between 2.39 and 2.75 points, and social violence responses between 1.72 and 2.28 points. However, our results differ from those of Hwang and Han's study [14] with emergency room nurses, where the highest scores were reported for social violence responses. This discrepancy suggests that violence responses among nurses may vary based on factors such as the healthcare institution's characteristics, the department of work, and individual factors. This underscores the need for ongoing studies on nurses' violence responses. While most previous research on nurses' violence responses has focused on emergency room nurses due to their increased risk of exposure to violence, our study found no significant differences in violence responses between clinical nurses and emergency room nurses. Therefore, it is important to consider and manage violence responses among nurses across various departments.

The mean burnout level among clinical nurses in this study was 3.07 points. This aligns closely with the findings of Ju et al. [24], which utilized the same measurement tool and focused on emergency room nurses, yielding a score of 2.99 points. However, our results were higher than those reported by Kim [13], which centered on psychiatric ward nurses and reported a score of 2.75 points. Despite these differences, our study found no significant variation in burnout levels based on the nurses' department of work. This suggests that predicting nurse burnout levels based solely on their department may not be feasible due to the influence of various complex factors. According to the criteria established by Stamm [21], the nurses in our study, as well as those in the studies by Kim [13] and Ju et al. [24], experienced moderate levels of burnout. Consequently, it is crucial to devise strategies to prevent and mitigate burnout among nurses.

The relationships between responses to violence, burnout, and positive psychological capital were examined. It was found that emotional, physical, and social responses to violence were positively correlated with burnout. Conversely, positive psychological capital was negatively correlated with burnout. These findings are consistent with previous research, such as the studies conducted by Hwang and Han [14] and Ju et al. [24], which identified a positive correlation between responses to violence and burnout among emergency room nurses. Similarly, research by Kim [13], focusing on psychiatric ward nurses, and Cho [25], focusing on nurses in small-sized hospitals, both reported a negative correlation between positive psychological capital and burnout. These findings suggest a significant interrelationship between burnout, responses to violence, and positive psychological capital in the nursing profession. It can be inferred that nurses with high responses to violence and low positive psychological capital are at an increased risk of experiencing burnout.

Job satisfaction and experiences of verbal violence were identified general characteristics and factors related to experiences of violence in hospitals that contribute to burnout among clinical nurses. This aligns with the findings of Lim and Shin's study [26], which focused on operating room nurses and identified job satisfaction and verbal violence as significant contributors to burnout. In our study, we found that lower job satisfaction correlated with higher levels of burnout. This underscores the importance of identifying and enhancing various factors that can improve nurses' job satisfaction in order to mitigate burnout. Furthermore, we found that experiences of verbal violence were associated with increased burnout. Nurses reported that they most frequently experienced verbal violence from patients, family members, and various medical staff. This is consistent with previous studies conducted on clinical nurses in South Korea [5, 6]. Given that verbal violence often occurs without the perpetrator recognizing it as such [6], healthcare organizations should implement institutional measures to address this issue. Such measures could include fostering a culture of mutual respect and empathy among healthcare professionals, and providing training on effective communication and violence prevention.

This study's analysis of the relationship between violence responses and burnout showed that social violence responses significantly contributed to burnout. This aligns with the results of a study on emergency room nurses, which also identified violence responses as key factors in burnout [14]. Interestingly, while emotional violence responses scored highest among the sub-factors of violence responses, it was social violence responses that had the greatest effect on burnout. This means that while nurses perceived the intensity of emotional violence responses, which reflect their feelings and emotional reactions postviolence, as the most severe, it was social violence responses (i.e., changes in their behavior and relationships post-violence) that were perceived as less severe but had the most significant impact on burnout. In light of previous research suggesting that increased social support leads to better violence coping mechanisms and lower burnout levels [27, 28], reducing social violence responses could be a crucial strategy in mitigating burnout among nurses. Furthermore, an organizational culture that views violence as an inevitable consequence of nurses' inadequate performance and the high-pressure nature of patient care, rather than addressing the emotional difficulties stemming from violence, may result in unresolved negative emotions post-violence. This could ultimately lead to changes in social responses, impacting relationships with colleagues, family, and friends, and thereby influencing burnout [18]. Indeed, a study by Kang and Park [6] found that nurses who experienced violence most often adopted a passive coping strategy, reacting as if nothing had happened when violence occurred. Therefore, it is vital to accurately identify the sources of violence, develop proactive coping strategies, and cultivate an organizational culture that encourages immediate emotional support and empathy from colleagues and superiors. Proactive management and intervention at the hospital level are necessary to decrease violence responses among clinical nurses.

The moderating role of positive psychological capital in the effect of violence responses on burnout was examined. It was determined that positive psychological capital does indeed moderate the relationship between social violence responses and burnout. Positive psychological capital is a positive internal resource of an individual, comprising four elements: self-efficacy, hope, resilience, and optimism. These elements work together synergistically, creating a more significant combined effect [9, 10]. Individuals with high levels of positive psychological capital tend to view situations optimistically, have confidence in their ability to overcome obstacles, and actively problem-solve to achieve their objectives [22]. Moreover, positive psychological capital is seen as a crucial factor in mitigating burnout [12] and can be improved through training and development [9]. As such, nursing organizations should strive to implement interventions and efforts to boost the positive psychological capital of clinical nurses, thereby maintaining a high-quality nursing staff.

Cho's study [25] the importance of an organizational culture that promotes active interaction, trust, and creativity among its members. Such a culture can bolster positive psychological capital, thereby motivating individuals to problem-solve and boosting their self-esteem. Furthermore, positive psychological capital can be enhanced through high social support from various sources [29], the provision of educational programs designed to improve individual capabilities [30], and the regular offering of mentoring programs where experienced employees share their knowledge and experience [31]. In this study, an analysis of the differences in positive psychological capital based on general characteristics revealed that individuals who were older, more satisfied with their job, had higher social support, were married, or had a master's degree or higher education level, exhibited higher positive psychological capital. This aligns with the findings of previous research [13, 29, 32]. Kim's study [13] and Kang and Kwon's study [32] discovered that as career experience and job positions increased, so did positive psychological capital. When considering both age and job satisfaction, it was found that nurses with more clinical experience and higher job positions tend to possess increased competence and problem-solving abilities in clinical practice. This results in higher self-confidence, increased job satisfaction, and ultimately, higher positive psychological capital. Moreover, being married may contribute to higher positive psychological capital due to the emotional support received from a supportive spouse. Therefore, nursing organizations should implement strategies at the organizational level to assess the level of positive psychological capital among nurses. For those nurses with low positive psychological capital, interventions should be aimed at enhancing individual positivity and fostering a supportive social environment to reduce social violence responses.

In conclusion, this study found a positive correlation between burnout in clinical nurses and their responses to emotional, physical, and social violence. Conversely, a negative correlation was observed with positive psychological capital. Notably, among the various dimensions of violence responses, social violence responses significantly influenced burnout. Positive psychological capital was found to moderate the relationship between social violence responses and burnout. This implies that positive psychological capital can lessen the detrimental effects of social violence responses, making it a key factor to consider when developing programs to support nurses in effectively managing violent situations and preventing future burnout. Consequently, organizations should offer violence prevention education, accurately identify violence causes, and promptly address them when they occur. They should also establish institutional mechanisms to minimize negative violence responses. Moreover, efforts should be made to identify accessible support methods for nurses who have experienced violence. To boost positive psychological capital and empower individuals to positively tackle challenges when problems or difficulties arise, nursing managers should cultivate a work environment and atmosphere that promotes individual positivity based on trust among organizational members. They should also foster and support innovative ideas and regularly offer various programs to enhance individual capabilities.

The significance of this study lies in its provision of foundational data for the creation of intervention programs aimed at reducing nurse burnout, based on its findings regarding the moderating role of positive psychological capital in the relationship between responses to violence and burnout. However, it is important to acknowledge that the instrument used in this study to gauge responses to violence was somewhat limited. It consisted of only three items pertaining to social violence responses and restricted the assessment of these responses by confining the item format based on the presence or absence of changes in social relationships. Consequently, there is a need for further research to develop a more comprehensive tool that can accurately measure nurses' responses to social violence. This improved tool should then be utilized in future studies.

This study's findings indicate that responses to social violence significantly influence burnout, and that positive psychological capital can moderate the relationship between these responses and burnout. Therefore, to prevent and mitigate burnout among nurses, it is vital to strategically promote the reduction of responses to social violence and the enhancement of positive psychological capital. This can be achieved by establishing a support system that fosters a culture within organizations that acknowledges and addresses negative social responses following violent experiences. Furthermore, burnout prevention programs for nurses should incorporate strategies that minimize threats to positive psychological capital and maximize factors that bolster it, thereby fostering individual positivity at an organizational level.

Building upon the results of this study, the following recommendations are made. First, a tool should be developed that can classify and measure social violence responses in a more detailed and specific manner. Subsequent research should then utilize this tool for more comprehensive investigations. Second, it would be advisable to develop programs aimed at enhancing nurses' positive psychological capital and conduct research to validate their effectiveness.