Verbal abuse of service users by professionals in social services: qualitative analysis of reported events in Finland

ABSTRACT

The verbal abuse research in social services is limited. This study aimed to describe verbal abuse of service users by professionals in social services. This cross-sectional descriptive study examined statutory reports of threats or risks in implementing social services in one city of Finland, from 2016 to 2020 (n = 1433). The case reports describing the verbal abuse (n = 34) were analysed using inductive content analysis. The perpetrators were registered and unregistered professionals. The types of abuse included inappropriate speaking style, oppression or dominance, and sometimes verbal abuse was accompanied by physical violence or threats of violence. The consequences affected the emotional well-being of service users, the fulfilment of their needs and the delivery of services. Actions implemented as a result of the reports consisted of monitoring, supporting, educating and alerting professionals about verbal abuse and raising awareness about the reporting. The findings suggest proactive training for professionals on behavioural boundaries and whistleblowing.

KEYWORDS:

• Social care
• social services
• verbal abuse
• maltreatment
• neglect
• service user safety

Introduction

This study focuses on cases of verbal abuse reported in social care services in one city of Finland. The definition of verbal abuse is broad and includes shouting at (Pazandeh et al., 2023; Phillips et al., 2013), name-calling (F. Alzyoud et al., 2018; Phillips et al., 2013), harsh, rude or vulgar words (F. Alzyoud et al., 2018; Madeiro et al., 2022; Mirzania et al., 2023), and threats against someone or threats of bad consequences (F. Alzyoud et al., 2018; Mirzania et al., 2023; Pazandeh et al., 2023; Phillips et al., 2013). Verbal abuse can also be insults, orders, accusations, humiliation (Pazandeh et al., 2023), swearing, frightening, belittling, intimidating (Phillips et al., 2013), and judgemental comments (Mayra et al., 2022; Mirzania et al., 2023). Sometimes, verbal abuse can take the form of an aggressive tone of voice (F. Alzyoud et al., 2018), undignified care (Brenes Monge et al., 2021), or dehumanising and joking while the patient is unconscious (Albina, 2016).

The Violence Prevention Alliance working group of WHO (2020b) has identified social services as a sector in need of violence prevention, as people who rely on social services are often vulnerable groups in conditions that increase the risk of abuse. It is also worth noting that in the related fields of study, vulnerable populations, such as older people, children, and people with intellectual disabilities or mental illness, are more prone to patient abuse (Goodman, 2020). Although the violence prevention and collaboration tool by WHO (2020b) focuses on interpersonal violence that occurs against people of all ages and in different life situations, further discussion is needed about the possibility that violent or abusive behaviour may be directed at patients or service users (from now on in this paper = clients) by social and health care professionals. Acts of violence may not always be intentional, but they can still affect an individual’s health and well-being and thus be abusive (Krug et al., 2002, pp. 5–7). However, the Global Patient Safety Action Plan 2021–2030 (WHO, 2021) only considers the protection of patients, while the discussion about the protection of social care clients is lacking in the action plan, although the main objectives can be applied also to social services. The action plan has, therefore, served as the basis for the Finnish Client and Patient Safety Strategy and Implementation Plan 2022–2026 (Ministry of Social Affairs and Health, 2022b).

In Finland, client safety has not been defined in legislation, although the term is mentioned in legislation on social services (710/1982, 812/2000, 817/2015). However, the National Supervisory Authority for Welfare and Health (Valvira, 2023) has defined the term to monitor the implementation of client safety measures. Valvira covers aspects of client safety in the organisation, provision and implementation of social care services that ensure that the client’s physical, psychological, social, or financial security is not compromised (Ministry of Social Affairs and Health, 2022b, p. 12; Pehkonen & Pohjola, 2022). Self-monitoring and interventions in observed risks or abuse cases are central to client safety and quality care work (Valvira, 2023).

The Finnish Act on the Status and Rights of Social Welfare Clients (812/2000: 1:1§) and Act on Social Welfare (710/1982/2014) protects a client’s right to be treated well in social services and to receive services that promote and maintain well-being and safety (1:1.1–4 §); these services must not violate human dignity (4:30.1 §). By law, social service professionals must provide high-quality social services to clients, and professionals are obliged to report any perceived or suspected wrongdoing, threat, or risk in social care services (710/1982: 5:48.1–2 §). However, reporting systems for client safety incidents in social services are quite new in Finland, whereas patient safety incidents are currently commonly reported worldwide (WHO, 2020a). In Finland, social and health care services of the city concerned have developed and used a web-based social care reporting system called SPro (‘Sosiaalihuoltolain mukaisten epäkohtien raportointijärjestelmä’ in Finnish) since 2016. It is developed for reporting risks or threats of risks to clients in social care services. Nationally widely collaborating information technology company Awanic Ltd (2023), which provides data on client safety incidents, has analysed SPro client safety reports, which describe verbal abuse potentially or actually endangering client’s well-being. Data from the SPro reporting system have previously been used to describe alleged abuse of social care clients by staff at a general level and to describe the actions that followed the abuse (Härkänen et al., 2023). Still, there is no analysis of cases of verbal abuse in SPro reports.

Little is known about the details of the verbal abuse of clients by professionals in social and health care services. In health care, patient abuse is described as more common than is often thought. Verbal abuse, which is a type of patient abuse (Goodman, 2020), is one of the most prevalent types of abuse experienced by patients when conducted by health care workers (Brenes Monge et al., 2021; Irinyenikan et al., 2022; Madeiro et al., 2022). The literature suggests that in long-term care, verbal abuse is identified in approximately one in five safety reports (Conti et al., 2022). Verbally abusive behaviour by health care professionals towards patients has been studied mainly in hospitals in relation to the treatment of women during childbirth (F. Alzyoud et al., 2018; Brenes Monge et al., 2021; Irinyenikan et al., 2022; Madeiro et al., 2022; Mayra et al., 2022; Mirzania et al., 2023; Pazandeh et al., 2023). In addition, these studies are from middle-income countries, leaving a gap in the knowledge of the incidence of verbal abuse in social and health care services worldwide.

The lack of information about verbal abuse in general in social services or by social and health care professionals towards clients or patients means that abuse easily goes undetected, in which case the abusive practice will continue. Evidence is needed on such verbal abuse overall and in the context of high-income countries.

Aims

This study aimed to describe verbal abuse of clients perpetrated and reported by professionals in social services.

The research questions were as follows

What types of verbal abuse towards clients are perpetrated by professionals in social services?

What are the consequences of verbal abuse for clients?

What measures are planned or implemented as a result of verbal abuse?

Materials and methods

Design and setting

The philosophical approach of this qualitative study was interpretivism, which focuses on the human experience within a given context and uses inductive analysis to interpret phenomena (Ryan, 2018). This was a cross-sectional, retrospective, and descriptive study of verbal abuse of clients when committed and reported by professionals through statutory reports in social services between 2016 and 2020 in one city of Finland. The reports included all social care units (i.e. family and social services, health care and substance abuse services, hospital rehabilitation, and care services) where social care services are provided. SPro reports can currently be submitted by over six hundred units (Härkänen et al., 2023).

Data collection

The social and health care services provider granted permission to use the data from the SPro system. The data for analysis were transferred to the research group as a spreadsheet by the SPro system administrator (Awanic Ltd, 2023).

Data and sample

Between 11 October 2016 and 31 December 2020, n = 1433 client safety reports were submitted through the SPro system. The reports comprised 15 sections (Table 1) of structured and free-text data. The SPro reports submitted by social service professionals included information about the reporter, the location wherein the incident occurred, the reporting time, the reporter’s occupation, the time and date of the event, the type of submission (threat or risk of threat), the type of abuse (to select from the structured alternatives e.g. inappropriate encounter, verbal abuse of the client), the reporter’s own observations of the event (free text) and their view of the action required (free text). The report’s handler (e.g. manager) documents the consequences for the client (unknown; no harm; mild harm; moderate harm; severe harm) and suggestions for action to prevent the recurrence of the threat (structured categories). In addition, the handler writes free-text descriptions of the suggested actions, explains why there is no need for action, or describes how the suggested actions were implemented.

Table 1. Background information on the reports classified as ‘abuse of client by words’.

	f	%
The division units to which the reports relate
Hospital, rehabilitation and care services	20	59
Family and social services	14	41
Total	34	100
Reporters’ occupations
Social advisers or other advisers of social work	10	29
Practical nurses or care workers	8	24
Registered nurses	5	15
Other	4	12
Social workers	4	12
Rehabilitation and therapy staff,	2	6
Students and trainees
Unknown	1	2
Total	34	100
Reporter’s perception of the consequences for the client
Risk	29	85
Threat of risk	5	15
A total	34	100
Other types of classifications used by reporters, in addition to verbal abuse
Lack of realisation of the client’s status and rights	2	50
Abuse of the client	1	25
Other	1	25
Total	4	100
Report handler’s perception of the severity of the event for the client
Mild harm	16	47
No harm	8	24
Unknown	5	15
Moderate harm	4	12
Serious harm	1	2
Total	34	100
Suggestion by the report’s handler to prevent a recurrence of the event (predefined options)
Inform/discuss what happened	24
Notify upper management	9
A developmental action is planned regarding the event	7
No action	1
Total	41

A total of n = 71 reports were initially classified as an ‘inappropriate encounter or verbal abuse of client’. These were extracted for detailed examination. After reading the free text of the reports, n = 12 reports were further excluded because they did not describe any verbal abuse or were duplicates. Fifty-nine reports contained information about some form of verbal abuse. Of these, only cases where verbal abuse was perpetrated by social service professionals or related services commissioned by social services (such as transport or cleaning services) were analysed. Thus, the final sample was n = 34 cases of verbal abuse, consisting of 3616 words regarding case descriptions and 993 words describing the actions taken as a result of the reported abuse.

Data analysis

Structured background information data were analysed quantitatively (f, %) using R software (version 3.6.1). The free text data were analysed qualitatively using inductive content analysis (Vaismoradi et al., 2013). The free texts of 34 case reports were read with the research questions in mind. The original information units of verbal abuse (n = 172) were identified and simplified into codes (n = 44). The codes were grouped based on similarities to form subcategories (n = 17), and the similar subcategories were further combined to form main categories (n = 3; Bengtsson, 2016). Each main category, subcategory, and code could be traced back to the citation excerpts of the original free text data in an Excel spreadsheet. In this paper, translated excerpts of the original texts are presented for all subcategories in the results section. The texts were translated by the first author.

The data were analysed by the first author, who has a background in nursing, quality management, and academic research. Other authors, including a professor representing the social and health sciences, provided critical comments and suggestions for revision. The group of authors included a registered social worker with a Master’s degree in social policy, and two registered nurses with Master’s degree in nursing science. Furthermore, in the author group were a Master’s degree candidate, a doctoral researcher, and an associate professor of health sciences, who all are registered nurses with experience of clinical nursing. All members had scientific research experience.

Ethics

The social and health care services granted the study permission. The identifying information of the reporting professionals and clients was removed from the data before they were allocated to the research group. According to the Finnish National Board on Research Integrity (TENK Guidelines, 2019), an official ethical review was not required for the study using anonymised register-based data. The principles of the Declaration of Helsinki (World Medical Association, 2013) were followed to protect the anonymity of social care clients, service providers, and professionals during data handling throughout the study process and reporting.

Results

Structured background information on the reports

Most of the reports were submitted by nurses, care workers, social advisers/social workers, or other social work advisers (n = 18; 53%). Most reports were of minor harm (n = 16; 47%). Common suggestions for preventing event recurrence were informing or discussing (within the team) what happened (n = 24; Table 1).

Verbal abuse described in the reports

The following main categories emerged from the inductive content analysis: 1) professionals involved in the abuse, 2) types of verbal abuse, 3) consequences of verbal abuse, and 4) actions taken in response to verbal abuse (Table 2 and Supplemental material 1).

Table 2. Verbal abuse of clients by professionals in social services (n = 34 cases).

	Subcategory (n = *)
ABUSING PROFESSIONALS	Non-registered professionals or unspecified professionals (n = 17)
	Registered health professionals (n = 17)
TYPE OF VERBAL ABUSE	Rude, abusive style of talking or documenting (n = 18)
	Oppression as the aim of abuse (n = 25)
	Dominance as the aim of abuse (n = 22)
	Verbal abuse in conjunction with the threat of physical abuse, carrying out physical abuse, or interfering with the fulfilment of the client’s needs (n = 13)
CONSEQUENCES OF VERBAL ABUSE	Consequences unknown (n = 8)
	Emotional or behavioural consequences (n = 21)
	Care and service-related consequences (n = 15)
	General safety-related consequences (n = 2)
PLANNED OR IMPLEMENTED ACTIONS DUE TO REPORTED VERBAL ABUSE	Monitoring professionals (n = 11)
	Supporting professionals and clients (n = 10)
	Educating professionals through discussion and review of guidelines (n = 27)
	Alerting and raising awareness of verbal abuse and reporting (n = 11)

*n = number of observations in 34 case reports.

Types of professionals involved in verbal abuse

Half of the mentioned perpetrators were registered professionals (n = 17), including nurses, social workers, or physicians. The other half were non-registered professionals (n = 17). The latter included foster parents, personal assistants, support workers and professionals from ancillary services such as transport or cleaning services who worked closely with social services on the same client. Two case reports did not specify the profession of the perpetrator (e.g. ‘staff’). Detailed information on all codes, subcategories and main categories can be found in Supplemental material 1.

Types of verbal abuse

Four types of verbal abuse were identified (Supplemental material 1). First, reports described a rude, abusive style of conversation or documentation. Specifically, the style of abuse was described as shouting at clients, for example (n = 10):

The children were frightened, and they said, for example, that (person) and (person) were shouting at the children. (R = report number 1095)

The reports also described berating and yelling at clients (n = 3):

[The] social care worker behaved inappropriately/verbally aggressively towards client. (R1288)

Some reports (n = 4) described perpetrators deliberately provoking clients into an argument, which one reporter perceived as increasing the risk of aggressive behaviour from clients:

Some of the support persons are provoking them by saying ‘hit me; you will lose your holidays’. (R631)

The second type of verbal abuse, oppression (n = 25) as a goal of abuse, was demonstrated by ignoring the client’s views or preferences and being unresponsive (n = 10), using scolding, name-calling, degrading, or talking or gossiping in a teasing manner (n = 8). Other methods of oppressive verbal abuse methods were dissing, mocking, and questioning (n = 6). In addition, sexual talk was identified once as an oppressive method of verbal abuse:

One female counsellor treats them harshly and degradingly, which is why the client perceives the behaviour as offensive … they experience the facial expressions, gestures, and speeches as contemptuous and oppressive. (R137)

The third verbal abuse type identified was the perpetrator’s aim to dominate clients (n = 23). It was used almost as often as oppression. The perpetrators used verbal threats and bullying (n = 7) to dominate. Other means used to dominate clients were reproach or command (n = 9) and blame (n = 6):

[They] took the resident to the bathroom in an angry and furious manner [and] shouted at them, ‘Why do you ring the bell constantly? I am tired/I do not have time to take you to the bathroom; do not ring again’. (R127)

The fourth type was verbal abuse combined with threats of physical abuse (n = 2) or actual physical abuse (n = 5), including sexual acts or threatening or compromising meeting the client’s needs (n = 5):

[The] nurse/carer has behaved in a threatening manner and kicked the floor because the client did not obey the nurse … [The] nurse has been angry and aggressive. The client said [they] feared the nurse/carer. (R592)

Verbal abuse combined with physical violence was rarely reported. It was perpetrated by service providers against clients (n = 4) through rough handling (n = 2) and compromising clients’ sexual autonomy (n = 2):

[They] told him to undress and threatened that the police would come and cut off his clothes if they refused to undress … [They] told them to lower [their] pants and peeked at the client’s bottom. (R269)

Consequences of verbal abuse for clients

The consequences of verbal abuse for clients were not described in eight reports out of 34 reported cases. When described, the consequences were most often emotional (n = 21; 61.76%), such as feeling frightened (n = 10; 29.41%), upset, and offended or humiliated (n = 6; 17.65%; Supplemental material 1):

The client says that they have been treated inappropriately … during the body check … says they haven’t been able to talk to anyone about it before … The incident still feels offensive. (R269)

Actions implemented for verbal abuse

The main categories of actions taken in response to verbal abuse were: (a) monitoring professionals, (b) supporting professionals or clients, (c) educating professionals through discussions, and (d) alerting professionals to verbal abuse and raising awareness of safety measures and the possibility of reporting about verbal abuse (Supplemental material 1).

For controlling service providers, there were sanctions (serious discussions, issuing notes or warnings, changing responsible persons or units, not employing the person in the future, terminating the service contract) or investigations (inspection visits, requesting declarations, reporting to the parliamentary ombudsman):

Requested written explanation from the family care home by (date). An inspection visit will be made to the unit in (month); the children will be heard; and discussions will be held with the staff. (R535)

Specialist appointments, such as psychologists or social care workers, were arranged to support the client as a target of abuse. Abusive professionals were supported through professional counselling, referral to occupational health or specialists such as psychology, or shift changes:

The (Spro) report has been reviewed in the occupational guidance meeting. Enhanced care services visited the resident. The responsible carer for the resident has been changed. In the occupational development discussion, the issues facilitating recovery from work have been discussed (holidays, work shift planning, and support from the occupational well-being staff). A joint meeting will be arranged with (name) and the colleagues. (R768)

Furthermore, the professionals were offered training on verbal abuse through discussions and guidelines (n = 23). Guidelines were revised and discussed, along with rules, professional behaviour and treating others with dignity and respect:

Will be discussed in a meeting about the client’s good encounters, values, and working procedures. Revision education about the new SPro reporting procedure will be conducted. The instructions for intervening in elder abuse in nursing homes. The results of Valvira’s (National Supervisory Authority for Welfare and Health) survey, self-monitoring instructions and the rules of the work community. (R24)

The reports served to alert and raise awareness of how to deal with verbal abuse. Professionals at all levels were encouraged to speak up and report verbal abuse (Spro report, notification of concern) to ensure reporting and safety:

[It was] agreed that once the client feels mistreated, they will immediately inform the employee … The employee will be mindful of their own way of interacting so as not to offend the client. We try to avoid and clear up misunderstandings in communication. (R137)

Discussion

This study described verbal abuse by professionals towards clients in social services, the consequences for clients and the actions taken as a result of reported verbal abuse. The emotional well-being of and the delivery of social services appeared to be affected by verbal abuse.

The proportion of verbal abuse reports among statutory client safety reports was much lower than in the previous systematic review and meta-analysis of 19 studies on violence perpetrated by health care workers in long-term care, where verbal abuse reports often accounted for a fifth of the reports (Conti et al., 2022). The reason for low reporting may be that verbal abuse is perceived as milder than physical violence and, therefore, underreported. The SPro reporting system is relatively new, and reporting may not be a part of professionals’ daily routines. Indeed, in the first five years, less than 1500 reports were submitted from over 600 units, and there were several non-reporting units (Härkänen et al., 2023). Thus, reminding about the responsibility and duty of reporting any risks or threats towards clients in social services can be recommended for continuous staff training.

In the earlier literature (Conti et al., 2022), the perpetrator types of professionals were essentially similar. Still, surprisingly, the results suggest that perpetrators were equally likely to be unregistered and registered professionals. However, there has been little research on the proportions of individuals with substance abuse issues and the types of verbal abuse (Conti et al., 2022). The high proportion of registered professionals among individuals with substance abuse issues in this study may be explained by the fact that the SPro system encourages professionals to report their colleagues who commit verbal abuse. In addition, the Finnish law Act on Supervision of Social and Healthcare (741/2023) requires professionals to report all observed risks or threats in social care services. The findings imply that attention should be paid to the training of registered and unregistered professionals in social services and cooperating service providers to minimise verbal abuse and to encourage whistleblowing and reporting in the case of verbal abuse. Whistleblowing is a measure to stop suspected wrongdoing in the workplace (Tiitinen, 2020). However, there is evidence in the literature that whistleblowing can lead to negative consequences for employees, which may hinder their willingness to report (Tiitinen, 2020), regardless, professionals are obliged to report according to the Statement of Ethical Principles of the International Federation of Social Workers (2018). This should be emphasised in the training of all types of professionals.

One reason for professionals’ abusive behaviour might be mental strain due to work overload (F. A. Alzyoud et al., 2023; Conti et al., 2022; Maffett et al., 2022). Encountering vulnerable clients who verbally or physically challenge their carer over time might also cause emotional stress for carers (Karlsson et al., 2019). Even if this kind of behaviour by social care clients is, in most cases, a result of limited health conditions, it can lead to cynical attitudes towards clients (Clompus & Albarran, 2016). Previous research has shown that defusing discussions in situations of verbal abuse is welcomed by professionals. Defusing could support professionals emotionally and reduce their risk of committing verbal abuse, although the effect of defusing sessions needs further study (Ericsson et al., 2021). Professionals also need guidance on how to defuse their own emotions when faced with verbal abuse from other clients or family members. Therefore, regardless of the challenges, professionals have the responsibility to always protect the health and well-being of clients. Thus, it is important to secure defusing and other emotional support for staff in case of repeated emotional strain during the work.

Interestingly, the SPro reports showed that verbal abuse in social care is also perpetrated by several actors other than social care professionals. However, these were not analysed in this study because the focus of this study was on verbal abuse perpetrated by professionals in social services. In addition, information about verbal abuse by persons other than professionals should be reported to other systems than SPro or by other means than digitally. This highlights the importance of giving clear instructions on where and how to report about abuse committed by other staff groups than staff of social services.

The types of verbal abuse accurately represented the concepts found in the literature (Conti et al., 2022). It was surprising that this small sample represented a wide range of types of verbal abuse. Within the reports was identified oppressive and dominant verbal abuse and inappropriate or rude speaking styles conducted by professionals. These kinds of actions are unacceptable and unprofessional behaviour. Verbal abuse was reported recurrently. It was sometimes combined with physical violence or the threat of it. Recurrent abusive situations should be prevented. The protection of vulnerable client groups (e.g. children or individuals with substance abuse issues) is one of the main responsibilities of social service staff. This is particularly true when clients are unable to care for themselves or protect themselves from harm or serious exploitation (Goodman, 2020; National Health Service, 2021). Thus, more emphasis is needed in clinical settings to prevent risks of recurrent abuse.

The professionals need guidance and support in maintaining respectful behaviour, in ethical encounters, in whistleblowing, and in dealing with challenging situations. There is a need to emphasise the responsibilities of managers to intervene and stop verbal abuse, for example through training and mentoring for staff and arranging support for staff. Measures are needed to identify and minimise risks to client well-being. The WHO’s Global Patient Safety Action Plan (2021) states that no one should ever be subjected to repeated threats of physical violence or verbal abuse.

The consequences for the client’s well-being caused by verbal abuse were often left undescribed. However, the information would be needed for the services’ quality evaluation from the client’s perspective. Thus, professionals need prompting to report also the consequences. Verbal abuse mainly compromises clients’ emotional well-being. This is supported by Gankanda et al.’s (2021) finding that verbal abuse by staff during labour was significantly associated with postpartum depression. Furthermore, the results of the current study indicated that verbal abuse by service providers may eventually lead to physical violence towards clients by staff or towards staff by clients. This stresses the importance of verbal abuse prevention. Some of the reports in the current study describe the recurrence of verbal abuse, including sometimes physical aggression by staff. This highlights the necessity of timely analyses of verbal abuse reports and immediate responses with follow-up measures by managers and leaders.

The actions implemented for verbal abuse in the statutory reports were overall active and varied, reflecting the intervention recommendations suggested in the literature. However, rather than a traditional reactive approach, further attention could be paid to proactive staff education and reducing the psychological distress of repeated exposure to straining situations. Similarly, Shen et al. (2021) systematic review and meta-analysis of six quantitative studies investigating interventions to reduce the overall incidence of elder abuse suggests a preference for proactive training.

The results show evidence that in social care services, there is still a need for further development of the services to protect clients from verbal abuse committed by social care professionals. Social care clients are in a vulnerable position when no other person might be present during social services visits. Proactive training and encouragement of professional behaviour and active reporting observations of verbal abuse will support service providers in meeting legal requirements to protect clients’ rights, health, and well-being. This would advance the implementation of the National Client and Patient Safety Action Plan (Ministry of Social Affairs and Health, 2022a). Further research is needed on the effectiveness of diverse interventions to protect clients from the risk of verbal abuse in social care, committed by social care staff, workers of collaborating service providers or by family members in clients’ everyday life environments.

Strengths and limitations

The results are limited to the analysis of client safety reports, which are required by law in social services and reported in one large organisation in Finland between 2016 and 2020. Not all instances of verbal abuse may be reported to the SPro system (Härkänen et al., 2023), which may lead to sample bias. However, the SPro reporting system is crucial for supporting the safety and ethics of clients and the quality of social services by making threats and risks visible. The data were not originally collected for research purposes; thus, the information is incomplete, which may lead to inaccuracy bias.

The analysis was conducted by a single author, which may have led to interpretation bias. In order to increase credibility, all authors critically commented on the analysis results and discussed them until a consensus was reached throughout the study process. Original text extracts were provided to ensure transparency of the analysis process, authenticity of the results and verifiability. The context and the analysis process are described as detailed as possible (regarding anonymity) to strengthen the reliability, transferability of the results and replicability of the study (Vaismoradi et al., 2013).

Verbal abuse is under-researched in social services, and the relevant available literature is limited. Therefore, some supporting literature from health care services was used for arguments. Standards for reporting qualitative research (SRQR; O’Brien et al., 2014) were used in the reporting (Supplemental material 2).

Conclusions

Paradoxically in caring relationships of social services, verbal abuse is committed by professionals towards clients. It is conducted through inappropriate speaking styles, oppression, and dominance, and sometimes combined with the threat of or actual physical violence. Verbal abuse can affect clients’ well-being and the delivery of social care services. Regardless of the rare cases of verbal abuse, continuous staff training is needed to ensure all clients’ legal rights to dignity and to protect vulnerable groups from abuse. Professional and ethical encounter and whistleblowing against verbal abuse needs enhancement. Managers’ possibilities could be strengthened for securing timely analysis of safety reports and proactive defusing interventions to reduce the risk of verbal abuse. Effectiveness studies are needed on interventions to find optimal solutions to protect clients from verbal abuse.

Acknowledgments

We thank the Awanic Ltd. company for assistance with data transfer.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Data availability statement

Due to the nature of the research, due to ethical data protection reasons, supporting data is not available.

Supplementary material

Supplemental data for this article can be accessed online at https://doi.org/10.1080/02650533.2024.2376066.

Additional information

Funding

This work was supported by the Finnish Nursing Education Foundation for the PI.

Notes on contributors

Tiina Syyrilä

Tiina Syyrilä is a Postdoctoral researcher at the University of Eastern Finland, Department of Nursing Science, and a registered nurse. Her main research interests are in medication and client and patient safety in social and health care.

Mari Vänttinen

Mari Vänttinen is a Master’s degree candidate at the University of Eastern Finland, Department of Nursing Science, and a registered nurse and public health nurse.

Saija Koskiniemi

Saija Koskiniemi is a Doctoral researcher at the University of Eastern Finland, Department of Nursing Science, and a registered nurse. Her research focuses on client and patient safety in social care and health care.

Mia Mäntymaa

Mia Mäntymaa is a Master of Social Sciences in Social Policy, a Registered Social Worker, and a Development Consultant at the City of Helsinki Social Services, Health Care and Rescue Services Division, Helsinki, Finland.

Jouko Ranta

Jouko Ranta is a registered nurse, Master of Nursing Science and Quality Manager (retired) at the City of Helsinki Social Services and Health Care Division, Helsinki, Finland.

Minna Säilä

Minna Säilä is a Registered Nurse, a Master of Nursing Science and a senior planning officer at the City of Helsinki Social Services and Health Care Division, Helsinki, Finland.

Aini Pehkonen

Aini Pehkonen is D.Soc.Sc., professor of social work at the University of Eastern Finland/Wellbeing Services County of North Savo. Her research interests focus on client safety in social work, social well-being and social services/care.

Marja Härkänen

Marja Härkänen is a Registered Nurse, PhD, Associate Professor (tenure track) and Academic Research Fellow at the University of Eastern Finland: Department of Nursing Science. Research Centre for Nursing Science and Social and Health Management, Kuopio University Hospital, Wellbeing Services County of North Savo. Her research expertise is in medication, patient and client safety.