Experiences of patient violence in Swedish intensive care units

Introduction: In the intensive care unit (ICU), every second patient develops acute brain dysfunction and delirium, because of severe illness and/or medical treatment (1). ICU patients may have delusions and even believe that the healthcare personnel try to infict harm upon them (2). This belief in combination with psychomotor agitation may lead to violent incidents in intense resistance (3). Except for debilitating consequences for patients, violent incidents are major problems in healthcare causing physical and psychological harm to healthcare workers (4–6). However, systematic approaches to describe healthcare workers’ experiences and management of aggressive ICU patients are needed. Objectives: To explore ICU healthcare workers’ experiences and perceptions of violent behaviors in patients with acute brain dysfunction. Methods: A qualitative descriptive design including focus group interviews with 36 ICU healthcare workers (physicians, nurses, nurse assistants and physiotherapists) in 4 Swedish ICUs who had experience of managing aggressive patients with acute brain dysfunction. A six-step refective thematic analysis was used to analyse data. Results: Nurses and assistant nurses were perceived to be at a nincreased risk of being exposed to violence, while physicians were mostly exposed to verbal assaults and threats from relatives. Delusions were perceived to be associated with a higher risk of violence in bedside work. The healthcare workers stated that incidents were under-reported, where only serious threats or physical assaults were reported. Most violent situations were experienced as unavoidable due to the patients’ illness. Conclusions: This study contributes an understanding of workplace violence in the ICU and may serve as a basis for development of violence prevention strategies useful in care and treatment of delirious patients.