Aim: This study explores nurse managers' experiences in dealing with patient/family violence toward their staff. Background: Studies and guidelines have emphasised the responsibility of nurse managers to manage violence directed at their staff. Although studies on nursing staff have highlighted the ineffectiveness of strategies used by nurse managers, few have explored their perspectives on dealing with violence. Methods: This qualitative study adopted a grounded theory approach to explore the experiences of 26 Japanese nurse managers. Results: The nurse managers made decisions using internalised ethical values, which included maintaining organisational functioning, keeping staff safe, advocating for the patient/family and avoiding moral transgressions. They resolved internal conflicts among their ethical values by repeating a holistic assessment and simultaneous approach consisting of damage control and dialogue. They facilitated the involved persons' understanding, acceptance and sensemaking of the incident, which contributed to a resolution of the internal conflicts among their ethical values. Conclusions: Nurse managers adhere to their ethical values when dealing with patient violence toward nurses. Their ethical decision-making process should be acknowledged as an effective strategy to manage violence. Implications for nursing management: Organisational strategies that support and incorporate managers' ethical decision-making are needed to prevent and manage violence toward nurses.
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