• Fredric Sjöberg, Martin Salzmann-Erikson, Eva Åkerman, Eva Joelsson-Alm, and Anna Schandl.
• Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Sjukhusbacken 10, SE-118 83, Stockholm, Sweden. fredric.sjoberg@ki.se.
• Crit Care. 2024 Jul 11; 28 (1): 232232.

BackgroundConflicts with patients and relatives occur frequently in intensive care units (ICUs), driven by factors that are intensified by critical illness and its treatments. A majority of ICU healthcare professionals have experienced verbal and/or physical violence. There is a need to understand how healthcare professionals in ICUs experience and manage this workplace violence.MethodsA qualitative descriptive analysis of four hospitals in Sweden was conducted using semi-structured focus-group interviews with ICU healthcare professionals.ResultsA total of 34 participants (14 nurses, 6 physicians and 14 other staff) were interviewed across the four hospitals. The overarching theme: "The paradox of violence in healthcare" illustrated a normalisation of violence in ICU care and indicated a complex association between healthcare professionals regarding violence as an integral aspect of caregiving, while simultaneously identifying themselves as victims of this violence. The healthcare professionals described being poorly prepared and lacking appropriate tools to manage violent situations. The management of violence was therefore mostly based on self-taught skills.ConclusionsThis study contributes to understanding the normalisation of violence in ICU care and gives a possible explanation for its origins. The paradox involves a multifaceted approach that acknowledges and confronts the structural and cultural dimensions of violence in healthcare. Such an approach will lay the foundations for a more sustainable healthcare system.© 2024. The Author(s).

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