The Unseen Wounds of Intensive Care: A Mixed Methods Study of Nurses' Exposure to Violence

Intensive care units constitute one of the most stressful working environments for healthcare workers, and workplace violence represents a significant occupational risk in these units. Violence is not limited to physical harm alone; it negatively impacts nurses' psychosocial well-being, performance and the quality of care.

This study aims to examine experiences of workplace violence conceptualised as 'invisible wounds' in intensive care units using a mixed methods approach with a sample of intensive care nurses.

This study used a mixed methods design, combining a cross-sectional survey with qualitative content analysis. The research was designed as a mixed methods study and was conducted between 15 February and 5 April 2026. In the qualitative phase, semi-structured interviews were conducted with 13 nurses; in the quantitative phase, the Demographic Characteristics Form and The Multidimensional Presenteeism in Nurses Scale were administered to 130 nurses. Data were analysed using IBM SPSS 27 and MAXQDA 2022.

Of the total sample (N = 130), 64.6% of nurses reported exposure to workplace violence at least once in their professional practice (n = 84/130); the most common type of violence was verbal violence (91.7%). The rate of physical violence was 32.1%, and the most significant source of violence was patients' relatives (67.9%). Only 46.4% of nurses who had been exposed to violence reported the incident. The mean scores on the 'Experience of Presenteeism at Work' scale were 19.13 ± 8.57 for the experience dimension, 43.64 ± 11.44 for the reasons dimension, and 69.52 ± 18.86 for the consequences dimension. Qualitative findings revealed that the experience of violence was described using the metaphor of an 'invisible wound', that violence became normalised over time, and that nurses predominantly turned to individual coping strategies.

Workplace violence among intensive care nurses is a widespread, multidimensional and largely normalised problem. Low reporting rates and the normalisation of violence create a vicious cycle in which opportunities for learning and improvement are lost. To break this cycle, it is necessary to strengthen a culture of reporting, develop institutional support mechanisms and implement holistic strategies that prioritise staff safety.

Identifying the prevalence, under-reporting and normalisation of workplace violence in intensive care units enables targeted interventions that reduce exposure to violence, improve nurses' well-being and performance and promote a safety culture through effective reporting systems.