Academic Journal
Critical Care Aggression and Violence Events (CAVE) Against Nurses in the ICU: Epidemiology and Risk Factors for Recurrence.
| Τίτλος: | Critical Care Aggression and Violence Events (CAVE) Against Nurses in the ICU: Epidemiology and Risk Factors for Recurrence. |
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| Συγγραφείς: | Frei AI; Clinic for Intensive Care, Department of Acute Medicine, University Hospital Basel, Basel, Switzerland., Berger S; Interdepartmental Division of Critical Care, University Health Network, Toronto, ON, Canada., Grzonka P; Clinic for Intensive Care, Department of Acute Medicine, University Hospital Basel, Basel, Switzerland., Amacher SA; Clinic for Intensive Care, Department of Acute Medicine, University Hospital Basel, Basel, Switzerland.; Department of Anesthesiology and Intensive Care Medicine, Medical Centre-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg im Breisgau, Germany., Kliem P; Clinic for Intensive Care, Department of Acute Medicine, University Hospital Basel, Basel, Switzerland., Gebhard CE; Clinic for Intensive Care, Department of Acute Medicine, University Hospital Basel, Basel, Switzerland.; Medical Faculty, University of Basel, Basel, Switzerland.; Institute for Intensive Care Medicine, Stadtspital Zürich, Zürich, Switzerland., Hunziker S; Medical Faculty, University of Basel, Basel, Switzerland.; Medical Communication and Psychosomatic Medicine, University Hospital Basel, Basel, Switzerland., Sutter R; Clinic for Intensive Care, Department of Acute Medicine, University Hospital Basel, Basel, Switzerland.; Medical Faculty, University of Basel, Basel, Switzerland.; Department of Clinical Research, University of Basel, Basel, Switzerland. |
| Πηγή: | Critical care medicine [Crit Care Med] 2026 Oct 01; Vol. 54 (10), pp. 2728-2740. Date of Electronic Publication: 2026 Jul 24. |
| Τύπος έκδοσης: | Journal Article |
| Γλώσσα: | English |
| Στοιχεία περιοδικού: | Publisher: Lippincott Williams & Wilkins Country of Publication: United States NLM ID: 0355501 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1530-0293 (Electronic) Linking ISSN: 00903493 NLM ISO Abbreviation: Crit Care Med Subsets: MEDLINE |
| Imprint Name(s): | Publication: Philadelphia, PA : Lippincott Williams & Wilkins Original Publication: New York, Kolen. |
| Ιατρικοί όροι (MeSH): | Intensive Care Units*/statistics & numerical data , Workplace Violence*/statistics & numerical data , Nursing Staff, Hospital*/statistics & numerical data , Nursing Staff, Hospital*/psychology , Aggression*, Switzerland/epidemiology ; Humans ; Retrospective Studies ; Risk Factors ; Male ; Female ; Adult ; Middle Aged ; Recurrence ; Incidence |
| Περίληψη: | Objectives: To quantify and characterize aggression and violence against nurses, identify associated clinical characteristics, evaluate measures in response, and explore predictors of recurrent incidents in the ICU. Design: Retrospective single-center study. Incidence and characteristics of aggression and violence against ICU nurses were the primary outcomes. Aggression was defined as hostile behavior or resistance to care without intent to harm. Violence comprised verbal, physical, or sexual acts to threaten or inflict harm. Secondary outcomes included risk factors for recurrent incidents, defined as multiple episodes of aggression/violence separated by greater than or equal to 24 hours. Multivariable analyses were performed to identify potential independent associations. Setting: Data were collected from 2023 to 2024 at the tertiary medical-surgical ICU with up to 35 beds at the University Hospital Basel. Nursing operations followed a three-shift system: day (07:00-15:00), late (15:00-23:00), and night (23:30-07:00). Subjects: Clinical reports from ICU nurses were screened. Interventions: None. Measurements and Main Results: During 2190 shifts, 308 aggressive or violence incidents (14% of shifts) were reported. Most occurred during late (37%) or night (34%) shifts; 75% involved violence. Violent incidents were combined in nature (79% physical, 43% verbal, and 3% sexual). Patients were mainly involved (97%) and predominantly male (71%; median age 67; 90% emergency admissions). Psychiatric comorbidities, drug, and alcohol abuse were found in 20-33%. Recurrent aggression/violence occurred in 27%, predicted by longer ICU stay (adjusted odds ratio [OR] = 1.05/every additional hour), aggression as the first incident (adjusted OR = 6.9), and verbal violence as the first incident (adjusted OR = 4.3). Nurses (89%, two-thirds female, median 7 yr' experience) rarely documented harm (1.3%), but patients were reported to suffer complications in 60% of incidents, mainly from oversedation and physical harm from restraints. Conclusions: Violence in the ICU is frequent and almost always caused by patients. Recurring violence was independently associated with longer ICU stay, initial aggression, and verbal violence. Staff harm was rare, but incidents were frequently associated with complications in patients. (Copyright © 2026 The Author(s). Published by Wolters Kluwer Health, LLC. on behalf of the Society of Critical Care Medicine and Wolters Kluwer Health, LLC.) |
| Competing Interests: | The authors have disclosed that they do not have any potential conflicts of interest. |
| References: | Al-Qadi MM: Workplace violence in nursing: A concept analysis. J Occup Health 2021; 63:e12226. Centers for Disease Control and Prevention: Violence Occupational Hazards in Hospitals. 2002. Available at: https://www.cdc.gov/niosh/docs/2002-101/#What%20is%20workplace%20violence? Accessed February 15, 2026. International Labour Organization: Code of Practice on Workplace Violence in Services Sectors and Measures to Combat This Phenomenon. 2003. Available at: https://www.ilo.org/media/270791/download . Accessed February 15, 2026. Lanctôt N, Guay S: The aftermath of workplace violence among healthcare workers: A systematic literature review of the consequences. Aggress Violent Behav 2014; 19:492–501. Stahl-Gugger A, Hämmig O: Prevalence and health correlates of workplace violence and discrimination against hospital employees—a cross-sectional study in German-speaking Switzerland. BMC Health Serv Res 2022; 22:291. Duan X, Ni X, Shi L, et al.: The impact of workplace violence on job satisfaction, job burnout, and turnover intention: The mediating role of social support. Health Qual Life Outcomes 2019; 17:93. Chen Z, Peng K, Liu X, et al.: Association between high burn-out and workplace violence among healthcare workers in China: A WeChat-based survey. BMJ Open 2022; 12:e064729. O’Brien CJ, van Zundert AAJ, Barach PR: The growing burden of workplace violence against healthcare workers: Trends in prevalence, risk factors, consequences, and prevention—a narrative review. eClinicalMedicine 2024; 72:102641. Slack RJ, French C, McGain F, et al.; George Institute for Global Health and the Australian and New Zealand Intensive Care Society Clinical Trials Group (ANZICS CTG): Violence in intensive care: A point prevalence study. Crit Care Resusc 2022; 24:272–279. White DB, Ernecoff N, Buddadhumaruk P, et al.: Prevalence of and factors related to discordance about prognosis between physicians and surrogate decision makers of critically ill patients. JAMA 2016; 315:2086–2094. Berger S, Grzonka P, Frei A, et al.: Violence against healthcare professionals in intensive care units: A systematic review and meta-analysis of frequency, risk factors, interventions, and preventive measures. Crit Care 2024; 28:61. Berger S, Amacher SA, Lohri M, et al.: Risk stratification for violent behavior in critically ill patients: Current assessment tools. Intensive Crit Care Nurs 2025; 89:103957. von Elm E, Altman DG, Egger M, et al.: The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: Guidelines for reporting observational studies. Lancet 2007; 370:1453–1457. Hahn S, Muller M, Hantikainen V, et al.: Risk factors associated with patient and visitor violence in general hospitals: Results of a multiple regression analysis. Int J Nurs Stud 2013; 50:374–385. Berger S, Grzonka P, Frei AI, et al.: Violence against healthcare professionals in intensive care units: A systematic review and meta-analysis of frequency, risk factors, interventions, and preventive measures. Crit Care 2024; 28:61. Lynch J, Appelboam R, McQuillan PJ: Survey of abuse and violence by patients and relatives towards intensive care staff. Anaesthesia 2003; 58:893–899. Menyhart O, Weltz B, Gyorffy B: MultipleTesting.com: A tool for life science researchers for multiple hypothesis testing correction. PLoS One 2021; 16:e0245824. Menyhart O, Weltz B, Gyorffy B: Correction: MultipleTesting.com: A tool for life science researchers for multiple hypothesis testing correction. PLoS One 2022; 17:e0274662. Hosmer DW, Lemeshow S: A goodness of-fit test for the multiple logistic regression model. Commun Stat Theory Methods 1980; 10:1043–1069. Arnetz JE, Hamblin L, Ager J, et al.: Underreporting of workplace violence: Comparison of self-report and actual documentation of hospital incidents. Workplace Health Safety 2015; 63:200–210. Alfuqaha OA, Albawati NM, Alhiary SS, et al.: Workplace violence among healthcare providers during the COVID-19 health emergency: A cross-sectional study. Behav Sci (Basel) 2022; 12:106. Chen X, Lv M, Wang M, et al.: Incidence and risk factors of workplace violence against nurses in a Chinese top-level teaching hospital: A cross-sectional study. Appl Nurs Res 2018; 40:122–128. Parke R, Bates S, Carey M, et al.: Bullying, discrimination, and sexual harassment among intensive care unit nurses in Australia and New Zealand: An online survey. Aust Crit Care 2022; 36:10–18. Wei CY, Chiou ST, Chien LY, et al.: Workplace violence against nurses—prevalence and association with hospital organizational characteristics and health-promotion efforts: Cross-sectional study. Int J Nurs Stud 2015; 56:63–70. Duncan SM, Hyndman K, Estabrooks CA, et al.: Nurses’ experience of violence in Alberta and British Columbia hospitals. Can J Nurs Res 2001; 32:57–78. Ahmed AS: Verbal and physical abuse against Jordanian nurses in the work environment. East Mediterr Health J 2012; 18:318–324. Al-Nemari HHAM, Salem IMW: Workplace violence against healthcare workers at ministry of health hospitals, Holy Makkah City, Saudi Arabia, 2019: A cross-sectional study. Indian J Public Health Res Dev 2020; 11:341–350. Camerino D, Estryn-Behar M, Conway PM, et al.: Work-related factors and violence among nursing staff in the European NEXT study: A longitudinal cohort study. Int J Nurs Stud 2008; 45:35–50. Hwang YY, Park Y, Park S: Experience of workplace violence among intensive care unit nurses. Korean J Adult Nurs 2015; 27:548–558. Sharma S, Gautam PL, Sharma S, et al.: Questionnaire-based evaluation of factors leading to patient- physician distrust and violence against healthcare workers. Indian J Crit Care Med 2019; 23:302–309. Grover S, Dalton N, Avasthi A: Workplace violence against doctors in a tertiary care hospital. Ind Psychiatry J 2020; 29:38–46. Wang T, Abrantes ACM, Liu Y: Intensive care units nurses’ burnout, organizational commitment, turnover intention and hospital workplace violence: A cross-sectional study. Nurs Open 2022; 10:1102–1115. Yi X, Feng X: Study on the current status and influencing factors of workplace violence to medical staff in intensive care units. Emerg Med Int 2022; 2022:1–5. Jiao M, Ning N, Li Y, et al.: Workplace violence against nurses in Chinese hospitals: A cross-sectional survey. BMJ Open 2015; 5:e006719. Rodriguez-Acosta RL, Myers DJ, Richardson DB, et al.: Physical assault among nursing staff employed in acute care. Work 2010; 35:191–200. Thomas AN, Horner D, Taylor RJ: An analysis of patient safety incident reports describing injuries to staff working in critical care in the North West of England between 2009 and 2013. J Intensive Care Soc 2015; 16:208–214. Pandey M, Bhandari TR, Dangal G: Workplace violence and its associated factors among nurses. J Nepal Health Res Counc 2018; 15:235–241. van den Boogaard M, Slooter AJC: Delirium in critically ill patients: Current knowledge and future perspectives. BJA Educ 2019; 19:398–404. Li J, Cai S, Liu X, et al.: Circadian rhythm disturbance and delirium in ICU patients: A prospective cohort study. BMC Anesthesiol 2023; 23:203. Giusti EM, Veronesi G, Forest H, et al.: Role of turnover, downsizing, overtime and night shifts on workplace violence against healthcare workers: A seven-year ecological study. BMC Public Health 2024; 24:3371. Grover S, Avasthi A: Clinical practice guidelines for management of delirium in elderly. Indian J Psychiatry 2018; 60(Suppl 3):S329–S340. Aiello G, Cuocina M, La Via L, et al.: Melatonin or ramelteon for delirium prevention in the intensive care unit: A systematic review and meta-analysis of randomized controlled trials. J Clin Med 2023; 12:435. Kim S, Mayer C, Jones CB: Relationships between nurses’ experiences of workplace violence, emotional exhaustion and patient safety. J Res Nurs 2021; 26:35–46. Johnson GU, Towell-Barnard A, Ewens B: Predicting violence in the intensive care unit: Can artificial intelligence protect those who care? Intensive Crit Care Nurs 2025; 89:104054. |
| Contributed Indexing: | Keywords: aggression; critical care nursing; intensive care units; recurrence; workplace violence |
| Entry Date(s): | Date Created: 20260724 Date Completed: 20261006 Latest Revision: 20261006 |
| Update Code: | 20261007 |
| PubMed Central ID: | PMC13632810 |
| DOI: | 10.1097/CCM.0000000000007264 |
| PMID: | 42496194 |
| Βάση Δεδομένων: | MEDLINE |
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