Verbal Aggression in Healthcare Settings

This article discusses the prevalence and causes of verbal aggression in healthcare settings, particularly among nurses. It explores the factors contributing to verbal aggression and suggests strategies such as effective communication, education and training, clinical supervision, and medication management. The article emphasizes the need for healthcare leaders and managers to address this issue and create a safe working environment.

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Strategic Health Leadership and Management
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Strategic Health Leadership and Management
Table of Contents
Verbal Aggression...........................................................................................................................3
Issue/Case Study..............................................................................................................................4
Strategies..........................................................................................................................................6
Effective Communication............................................................................................................6
Education and Training................................................................................................................7
Clinical Supervision.....................................................................................................................7
Medications..................................................................................................................................7
Bibliography....................................................................................................................................9

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Verbal Aggression
Amongst nurses, the risk of facing aggression, particularly verbal aggression is
particularly relevant. Verbal aggression is a type of direct psychological violence, which
involves yelling at the nursing staff or making mocking or disgusting remarks, particularly to the
nursing staff in the healthcare settings. According to Edwards (2016), aggression towards nurses
can emanate from diverse sources: patient to nurse, patient relatives to nurse, nurse to nurse, as
well as physician to nurse (Edwards, 2016), Verbal aggression in the healthcare setting is the
most often experienced form of aggression and more nursing staff than the physicians are
experienced to aggression all through their profession. According to Viotti et al (2015), the
greater prevalence of verbal violence on nurses when contrasted with physicians can be
connected to factors that include duration of time spent with the patient or relatives, supposed
senior authority of doctors by patients when compared to nurses, misinformation and
communication style.
According to Stone, McMillan, Hazelton, & Clayton (2011), gender and professional
factors have been found to contribute to verbal aggression among nurses in the workplace.
Younger nurses and less knowledgeable nursing personnel are more at risk of aggression in the
place of work when contrasted senior nurses and more qualified registered nurses. Also, night-
shift nurses in addition to weekend nursing personnel are at more risk of workplace verbal
aggression. This can be associated with the comparative isolation where these nursing staff are
working plus lower staffing levels in “quieter” periods (Roche, Diers, Duffield & Catling-Paull,
2010). The nurse might also react to verbal aggression with non-attendance from job, changing

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jobs, or parting the nursing occupation in total. The prospective for place of work violence plus
violence towards healthcare staff resulting in occupational nervousness is a not novel incident; it
is been recorded as being relatively widespread and frequent.
The article highlights the fact that conflict resolution, as well as de-escalation are
suggested as first-choice strategies for violence and swearing in inpatient environments.
Moderation, as well as seclusion is normally considered as the last resorts for managing verbal
aggression in inpatient settings. There is the need for increased and effective communication
towards managing aggressive incidents, in which nurses often accentuate “medication plus
medical management” in regard to both cause and reaction to aggression.
Issue/Case Study
The article “Wounding Words: Swearing and Verbal Aggression in an Inpatient Setting”
by Stone, McMillan, Hazelton, and Clayton address the issue of swearing and aggression as
challenges that nurses face while working in inpatient environment. The purpose of the article
was to study swearing along with verbal aggression in Australian inpatient settings that comprise
frequency, gender, patient motivation, as well as nursing strategies (Stone, McMillan, Hazelton,
& Clayton, 2011). The authors highlight the fact that nurses have continued to face challenging
environment while providing care to their patients as they are exposed to violent. Nurses in
psychiatric inpatient facilities more often face violence and swearing/verbal aggression that has
been reported as a leading form of aggression. The same findings have been reported in the US
and European countries, such as Germany and Belgium where nurses face increased verbal
aggression.

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The article reports that there are three causes of verbal aggression that include patient
disease, comprising inadequate medication, as well as delusions; interpersonal differences; plus
limit setting, like being stopped from parting the healthcare facility. Stone et al. (2011) argue
that nurses in Australia have reported many instances of verbal aggression that has continued to
cause more stress and burnout while providing direct care to patients. In many instances, patients
in psychiatric section usually become more violent to nurses. In addition, nurses that have
experienced verbal aggression or violence in their lives increased the potential of experiencing
such acts in the workplace (Hogarth & Morphet, 2016). The mental state has been attributed to
the growing instances of verbal aggression/swearing. This is consistent with the previous studies
from severe mental wellbeing environments in the United States (US) and Germany. The US
Department of Labour estimates that more than 2 million workers experience verbal aggression
annually.
The article further provides valuable information regarding gender issue in the growing
cases of swearing and verbal aggression. Verbal violence at any level can be more likely to be
registered for male than women patients; nonetheless, more severe verbal aggression is more
probable to be reported for female as compared men nurses. The authors in the article emphasize
that there is a connection between swearing in addition to psychiatric states normally perceive in
psychiatric health units. Thus, the occurrence of verbal aggression and swearing among the
patients diagnosed with bipolar affective disorder (BAD) along with personality disorders
(Edward, Ousey, Warelow & Lui, 2014).
Additionally, in the article, it was evident that verbal aggression and swearing may be
linked to nurses to factors that are inherent to the patient in many parts of Australia and the

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United States. These include gender, diagnosis, as well as substance abuse. The external factors,
as well as interactions amid internal and external elements were less probable to be registered as
the inspiration for verbal aggression. Citrome and Volavka (2011) assert that the ascription of
inspiration to the internal framework can be derivative of the biomedical framework that offers
justification for the utilization of medical management for verbal violence or a defence
mechanism to free nurses with poor communication skills from personal participation plus
answerability. In order to manage swearing/verbal aggression there is the need to develop
effective interventions that will allow nurses to be productive and ensure that the delivery of care
is effective (Citrome &Volavka, 2011).
Strategies
Effective Communication
It is recommended that there is a need to develop effective communication in the
inpatient settings. The communication style of the nurses may be impacted by age, experience,
the level of stress and burnout, scope of practice and cultural context. The article highlighted the
fact that verbal aggression and swearing occurs because of miscommunication between the nurse
and patient or nurse and physicians. Therefore, it will be important to the leaders in the
healthcare setting in Australia to develop effective communication channels that will promote
collaboration and eliminate miscommunication that result in verbal aggression in the workplace.
Leaders and managers should in the forefront in motivating the patients and nurses to embrace
communication process that will ensure that they resolve potential conflicts in the inpatient
settings (Stewart & Bowers, 2012).

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Education and Training
Education and training should prioritized by managers and leaders towards ensuring that
nurses and patients will be able to manage incidents of verbal aggression and swearing that have
become prevalent in inpatient settings in Australia. This demands social support for the staff and
patients that increase the management capabilities to adequately manage the incidents of
aggression. Education and training will ensure that the knowledge of the staff plus patient on the
effective management of aggression towards creating safe environment. The training and
education must be designed by healthcare managers and leaders in inpatient settings through
workshops and conferences where the nurses will be trained on how to adequately manage
incidents that result in verbal aggression and swearing (Happell & Koehn, 2011).
Clinical Supervision
Clinical supervision has been found to be effective in assisting nurse deal with swearing
and verbal aggression. Clinical supervision should be designed in a manner that will ensure that
nurses respond efficiently to the challenge of verbal aggression. There is the need to revisit
individual and group forms of clinical supervision, with particular focus on working through
distress plus developing ways coping more effectively in situations in which nurses are probable
to be exposed to swearing and verbal aggression (Citrome & Volavka, 2011).
Medications
Proving appropriate medication to patients that are thought to display aggressive
behaviours should be prioritized. The nurses should develop medication to the patients that will
ensure that these patients do not become aggressive and that their aggressive behaviours are
managed through medications. Specifically, patients with disorders like schizophrenia and

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bipolar affective disorder (BAD) must be give the right medication since they always display
aggressive behaviours. Nurses should ensure that the patients with aggressive behaviours are
supervised to take their drugs on a regular basis to manage their condition (Joa & Morken, 2012).

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Bibliography
Citrome, Leslie. & Volavka, Jan. “Pharmacological management of acute and persistent
aggression in forensic psychiatry settings.” CNC Drugs. Vol.25, no 12. (2011)” 1009-
1076.
Edward, Karen-leigh. “A systematic review and meta-analysis of factors that relate to aggression
perpetrated against nurses by patients/relatives or staff.” Journal of clinical nursing. 25,
no 3-4. (2016): 289-299.
Edward, Karen-leigh., Ousey, Karen., Warelow, Philip. & Lui, Steve. Nursing and aggression in
the workplace: a systematic review. British journal of nursing. Vol. 23. No. 12.
(2014):653-659.
Happell, Brenda. & Koehn, Stefan. “Impacts of Seclusion and the Seclusion Room: Exploring
the Perceptions of MentalHealth Nurses in Australia.” Archives of Psychiatric Nursing.
Vol. 25. No. 2. (2011): 109-119.
Hogarth, Kathryn.M., Beattie, Julia. & Morphet, Jill. “Nurses’ attitude towards the reporting of
violence in the emergency department.” Australian Emergency Nursing Journal. Vol.19.
No. 2. (2016): 75-81.
Joa, Torill.Skibeli & Morken, Tone.“Violence towards personnel in out-of-hours primary care: a
cross-sectional study,” Scandinavian Journal of Primary Health Care. Vol. 30, No.
1:(2012): 55–60.

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Roche, Michael, A., Diers, Donna., Duffield, Christine. & Catling-Paull, Christine. “Violence
Toward Nurses, the Work Environment, and Patient Outcomes.” Journal of Nursing
Scholarship. Vol. 42. No. 1. (2010): 13-22.
Stewart, Duncan. & Bowers. Len. “Inpatient verbal aggression: contents, targets and patient
characteristics.” Psychiatric Mental Health Nurse. Vol.20, No 3. (2012): 236-243.
Stone, Teresa., McMillan, Margaret., Hazelton, Michael. & Clayton, Edward.”Wounding Words:
Swearing and Verbal Aggression in an Inpatient Setting.” Perspectives in Psychiatric
Care. Vol. 47, no 4. (2011): 194-203.
Viotti, Sarah., Gilardi, Silvia., Guglielmetti, Chiara., & Converson, Daniela. “Verbal Aggression
from Care Recipients as a Risk Factor among Nursing Staff: A Study on Burnout in the
JD-R Model Perspective”. BioMed Research International. Vol. 2015. No. 8. (2015):56-
67.