De-escalating verbal aggression in primary care settings.

Violence in society is reflected in aggressive acts within health care delivery systems. As health care reform continues to emphasize preventive health, primary health care settings will increasingly be used to deliver preventive care and may experience an increase in episodes of aggressive behaviors. Verbal abuse is the most common form of aggression, with nurses being one of the most likely targets of all health care providers. Verbal abuse is communication through words, tone, or manner that disparages, humiliates, intimidates, patronizes, threatens, accuses, or is disrespectful toward another. Verbally aggressive behaviors are generally not isolated acts, but a part of a cycle involving a sequence of escalating behaviors. Through verbal and nonverbal interventions, health care providers can interrupt the cycle and de-escalate a situation. The etiology of verbal aggression, populations at risk, behavioral cues, the verbal aggression cycle, and interventions are discussed.