Research Doctorate - Doctor of Philosophy (PhD) / Swearing is a subject largely ignored in academic circles but impossible to ignore in the health workplace. Despite its prevalence there has been little academic research into swearing, and certainly none on its impact on nursing staff. Nurses are, of all health workers, most likely to be targets of verbal aggression with up to 100% of nurses in mental health settings reporting verbal abuse. Nurses encounter swearing from patients and their carers, staff, and managers, and use swearwords in communication with each other, but there is no reference in the literature to the effects on nurses of exposure to swearing. This study set out to rectify that lack of research into swearing by answering three main questions: 1. What is the extent of swearing /verbal aggression in a health care setting? 2. What are the implications of swearing for a therapeutic encounter? 3. What is the impact of swearing on nurses? A mixed methods approach was employed. Phase one of the study explored the context of care, utilising the Overt Aggression Scale to describe the nature and extent of swearing and verbal aggression across a range of acute and long-term inpatient mental health settings. Data were derived from 9,623 reports spanning a 10-year period. The sample comprised 384 (72.1%) males and 148 (27.9%) females aged between 9.5 years and 93.3, mean age 45.6, SD=21.00 years. Most frequently reported over the 10-year period was verbal aggression; incidents involving females occurred mainly in connection with the more severe levels of verbal aggression. “Psychosis” was recorded as the main perceived cause of verbal aggression, in itself an insufficient explanation. A rising tendency to cite psychosis emerged as the level of aggression rose and, on average, 1.9 interventions were recorded for each aggressive incident. Phase two surveyed 107 nurses across three health care settings paediatrics, adult mental health, and child and adolescent mental health – by means of a questionnaire designed to elicit a combination of both qualitative and quantitative data, the Nursing Swearing Impact Questionnaire, which included three standardised instruments. The quantitative data were subjected to descriptive and inferential statistical analysis. High levels of swearing were reported, 29% of nurses being sworn at 1 to 5 times per week and 7% “continuously.” A similar incidence occurred within the nursing team, but being sworn at in anger by another staff member was rare and the major use was in jest or in conversation. The study failed to find significant differences between mental health and paediatric settings in the frequency of swearing but did find gender-based differences. High levels of distress caused by being subjected to swearing were evident, particularly when the aggressor was a relative or carer of a patient. Moreover, the respondents appeared to have only a limited range of interventions for use in dealing with the experience of being sworn at. However, what emerges strongly from the data is the extent to which swearing is culture- and context-bound, and the fact that nurses share many of the views and attitudes about swearing held by society at large. The culmination of the findings suggests that swearing is both widespread and underreported in a range of health contexts. The implications of swearing are poorly understood by nurses. These, and the magnitude of their distress in being subjected to it, render them ill-equipped to deal with the experience. The concomitant negative effects on empathy result in the nurses’ distancing themselves from the patient when confronted and implementing only a restricted range of interventions and detrimental effects on the quality of the therapeutic relationship will have negative effects on patient outcomes. Given the levels of swearing reported and its consequences on the therapeutic relationship, further research is warranted.

Thesis (Ph.D.) -- McMaster University, 2002. / Includes bibliographical references (leaves 168-178). Also available via World Wide Web.

Thesis (Ph. D.)--Georgia Institute of Technology, 2007. / Includes bibliographical references (leaves 129-137).

Thesis (doctoral)--Friedrich-Alexander-Universität zu Erlangen.

Thesis (M. Phil.)--University of Hong Kong, 1997. / Includes bibliographical references (leaf 151-152).

Thesis (M.S.)--Brigham Young University, 1999. / Includes bibliographical references (p. 141-145).

Thesis (Ph. D.)--Washington State University, August 2009. / Title from PDF title page (viewed on Sept. 9, 2009). "School of Mechanical and Materials Engineering." Includes bibliographical references (p. 180-188).

Honors Project--Smith College, Northampton, Mass., 2010. / Includes bibliographical references (p. 108-112).

Thesis (Ph. D.)--University of Wisconsin--Madison, 1984. / Typescript. Vita. eContent provider-neutral record in process. Description based on print version record. Includes bibliographical references (leaves 129-137).

Thesis (M.S.)--University of Wisconsin--Madison, 1970. / eContent provider-neutral record in process. Description based on print version record. Includes bibliographical references.