Verbal Aggression Against Health Care Staff – Mixed Methods Study

Clinical staff in various settings has to cope with aggressive behavior from patients and visitors. In recent years, physical aggression has received a lot of attention and many prevention programs are available throughout Western societies. However, verbal aggression against health care staff is much more prevalent than physical aggression.

This paper reports on a mixed methods study which was conducted in in the following settings in Germany: mental hospitals, forensic hospitals, acute care hospitals, nursing homes and residential homes for mentally ill residents. Eight focus group interviews were conducted with a total of 74 staff members (nurses, physicians, social workers, psychologists and nursing assistants). The interview guide contained questions about any kind of verbal aggression which had been experienced, about the differences between physical and verbal aggression and about the coping strategies of health care staff. Subsequently, 1,053 staff members from the various settings participated in a survey which focused on the frequency of verbal aggression and on the severity of aggressive acts.

The results revealed that verbal aggression is a very common phenomenon among health care staff. The following types of verbal aggression were identified:  threats, verbal abuse, use of rude/sexual language, continual loud vocalizations (e.g., shouting, questioning), remarks which questioned the competency of the staff, refusal of cooperation and the ridiculing of staff. 16 percent of staff reported having experienced verbal aggression on a daily basis during the six months prior to the survey data collection date. Threats were experienced as being the most severe form of verbal aggression, followed by refusal of cooperation. On average, verbal aggression is rated to be more severe than physical aggression.

Currently, prevention programs in healthcare institutions are focusing mainly on physical aggression. This focus needs to be altered by teaching staff how to cope better with verbal aggression.