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Mohd Mydin FH, Mikton C, Choo WY, Shunmugam RH, Murray A, Yon Y, Yunus RM, Hairi NN, Hairi FM, Beaulieu M, Phelan A. Psychometric properties of instruments for measuring abuse of older people in community and institutional settings: A systematic review. CAMPBELL SYSTEMATIC REVIEWS 2024; 20:e1419. [PMID: 39211334 PMCID: PMC11358705 DOI: 10.1002/cl2.1419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Revised: 05/23/2024] [Accepted: 05/27/2024] [Indexed: 09/04/2024]
Abstract
Background The examination of psychometric properties in instruments measuring abuse of older people (AOP) is a crucial area of study that has, unfortunately, received relatively little attention. Poor psychometric properties in AOP measurement instruments can significantly contribute to inconsistencies in prevalence estimates, casting a shadow of uncertainty over the magnitude of the problem at national, regional, and global levels. Objectives This review rigorously employed the Consensus-based Standards for the Selection of Health Measurement Instruments (COSMIN) guideline on the quality of outcome measures. It was designed to identify and review the instruments used to measure AOP, assess the instruments' measurement properties, and identify the definitions of AOP and abuse subtypes measured by these instruments, ensuring the reliability and validity of the findings. Search Methods A comprehensive search was conducted up to May 2023 across various online databases, including AgeLine via EBSCOhost, ASSIA via ProQuest, CINAHL via EBSCOhost, EMBASE, LILACS, ProQuest Dissertation & Theses Global, PsycINFO via EBSCOhost, PubMed, SciELO, Scopus, Sociological Abstract via ProQuest, Chinese National Knowledge Infrastructure (CNKI), Google Scholar and WHO Global Index Medicus. Additionally, relevant studies were identified by thoroughly searching the grey literature from resources such as Campbell Collaboration, OpenAIRE, and GRAFT. Selection Criteria All quantitative, qualitative (addressing face and content validity), and mixed-method empirical studies published in peer-reviewed journals or grey literature were included in this review. The included studies were primary studies that (1) evaluated one or more psychometric properties, (2) contained information on instrument development, or (3) examined the content validity of the instruments designed to measure AOP in community or institutional settings. The selected studies describe at least one psychometric property: reliability, validity, and responsiveness. Study participants represent the population of interest, including males and females aged 60 or older in community or institutional settings. Data Collection and Analysis Two reviewers evaluated the screening of the selected studies' titles, abstracts, and full texts based on the preset selection criteria. Two reviewers assessed the quality of each study using the COSMIN Risk of Bias checklist and the overall quality of evidence for each psychometric property of the instrument against the updated COSMIN criteria of good measurement properties. Disagreements were resolved through consensus discussion or with assistance from a third reviewer. The overall quality of the measurement instrument was graded using a modified GRADE approach. Data extraction was performed using data extraction forms adapted from the COSMIN Guideline for Systematic Reviews of Outcome Measurement Instruments. The extracted data included information on the characteristics of included instruments (name, adaptation, language used, translation and country of origin), characteristics of the tested population, instrument development, psychometric properties listed in the COSMIN criteria, including details on content validity, structural validity, internal consistency, cross-cultural validity/measurement invariance, reliability, measurement error, criterion validity, hypotheses testing for construct validity, responsiveness, and interoperability. All data were synthesised and summarised qualitatively, and no meta-analysis was performed. Main Results We found 15,200 potentially relevant records, of which 382 were screened in full text. A total of 114 studies that met the inclusion criteria were included. Four studies reported on more than one instrument. The primary reasons for excluding studies were their focus on instruments used solely for screening and diagnostic purposes, those conducted in hospital settings, or those without evaluating psychometric properties. Eighty-seven studies reported on 46 original instruments and 29 studies on 22 modified versions of an original instrument. The majority of the studies were conducted in community settings (97 studies) from the perspective of older adults (90 studies) and were conducted in high-income countries (69 studies). Ninety-five studies assessed multiple forms of abuse, ranging from 2 to 13 different subscales; four studies measured overall abuse and neglect among older adults, and 14 studies measured one specific type of abuse. Approximately one-quarter of the included studies reported on the psychometric properties of the most frequently used measurement instruments: HS-EAST (assessed in 11 studies), VASS-12 items (in 9 studies), and CASE (in 9 studies). The instruments with the most evidence available in studies reporting on instrument development and content validity in all domains (relevance, comprehensiveness and comprehensibility) were the DEAQ, OAPAM, *RAAL-31 items, *ICNH (Norwegian) and OAFEM. For other psychometric properties, instruments with the most evidence available in terms of the number of studies were the HS-EAST (11 studies across 5 of 9 psychometric properties), CASE (9 studies across 6 of 9 psychometric properties), VASS-12 items (9 studies across 5 of 9 psychometric properties) and GMS (5 studies across 4 of 9 psychometric properties). Based on the overall rating and quality of evidence, the psychometric properties of the AOP measurement instruments used for prevalence measurement in community and institutional settings were insufficient and of low quality. Authors' Conclusions This review aimed to assess the overall rating and quality of evidence for instruments measuring AOP in the community and institutional settings. Our findings revealed various measurement instruments, with ratings and evidence quality predominantly indicating insufficiency and low quality. In summary, the psychometric properties of AOP measurement instruments have not been comprehensively investigated, and existing instruments lack sufficient evidence to support their validity and reliability.
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Affiliation(s)
| | - Christopher Mikton
- Department of Social Determinants of Health, Division of Healthier PopulationsWorld Health OrganizationGenevaSwitzerland
| | - Wan Yuen Choo
- Department of Social & Preventive Medicine, Faculty of MedicineUniversiti MalayaKuala LumpurMalaysia
| | - Ranita Hisham Shunmugam
- Department of Library & Information Science, Faculty of Arts & Social SciencesUniversiti MalayaKuala LumpurMalaysia
| | - Aja Murray
- Department of PsychologyUniversity of EdinburghEdinburgUK
| | - Yongjie Yon
- World Health Organization Regional Office for EuropeCopenhagenDenmark
| | - Raudah M. Yunus
- Public Health MedicineUniversiti Teknologi MARASungai BulohMalaysia
| | - Noran N. Hairi
- Department of Social & Preventive Medicine, Faculty of MedicineUniversiti MalayaKuala LumpurMalaysia
| | - Farizah M. Hairi
- Department of Social & Preventive Medicine, Faculty of MedicineUniversiti MalayaKuala LumpurMalaysia
| | - Marie Beaulieu
- École de travail social, Faculté des lettres et sciences humainesUniversité de SherbrookeSherbrookeQuébecCanada
| | - Amanda Phelan
- School of Nursing, Midwifery & Health Systems, National Centre for the Protection of Older PeopleUniversity College Dublin, BelfieldDublinIreland
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Zhou L, Liu S, Li H. Home care practice behavior and its influencing factors of primary care providers: a multicenter cross-sectional study in Sichuan Province, China. BMC Nurs 2024; 23:303. [PMID: 38698388 PMCID: PMC11064234 DOI: 10.1186/s12912-024-01948-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Accepted: 04/18/2024] [Indexed: 05/05/2024] Open
Abstract
BACKGROUND Primary care providers play an important role in home health care, and their practice behavior is significant for care quality and patient outcomes. This study aimed to assess the home care practice behavior of Chinese primary care providers and to explore the factors associated with the practice behavior. METHODS A multicenter cross-sectional design with a convenience sample was used to survey 863 registered primary care providers from 62 primary health care settings in Sichuan Province, China. Descriptive statistics, t-test or ANOVA for one-way analysis, and Pearson's correlation analyses were used to compare the differences and examine the relationships between participants' demographics and experience of home care services and practice behavior. Multiple linear regression models were performed to identify salient variables associated with the practice behavior from among demographic and home care experience. RESULTS The score of home care practice behavior questionnaire was 97.25 ± 21.05. The average scores for the dimensions of home visit preparation, assessment, medical care behavior and safety practice were 3.70 ± 0.95, 3.76 ± 1.02, 3.66 ± 1.03, and 3.20 ± 0.46, respectively. Home care practice behavior was associated with working years, working experience in general hospitals, work area, home care experience such as client types of home care, service frequency and willingness, explaining 21.5% of the total variance. CONCLUSION Chinese primary care providers had a medium to high level of home care practice behavior but poor implementation of safety practice. The results may provide clues to increased focus and implementation of safety practice, as well as providing targeted measures based on influencing factors.
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Affiliation(s)
- Luling Zhou
- West China Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu, China
| | - Suzhen Liu
- West China Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu, China.
| | - Hang Li
- Department of Urology, West China Hospital, Sichuan University, Chengdu, China
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Lund SB, Malmedal WK, Mosqueda L, Skolbekken JA. "Just pee in the diaper" - a constructivist grounded theory study of moral distress enabling neglect in nursing homes. BMC Geriatr 2024; 24:366. [PMID: 38658812 PMCID: PMC11040955 DOI: 10.1186/s12877-024-04920-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Accepted: 03/25/2024] [Indexed: 04/26/2024] Open
Abstract
BACKGROUND A growing body of evidence shows that many nursing home residents' basic care needs are neglected, and residents do not receive qualitatively good care. This neglect challenges nursing staff´s professional and personal ideals and standards for care and may contribute to moral distress. The aim of this study was to investigate how nursing staff manage being a part of a neglectful work culture, based on the research question: "How do nursing home staff manage their moral distress related to neglectful care practices?" METHODS A qualitative design was chosen, guided by Charmaz´s constructivist grounded theory. The study was based on 10 individual interviews and five focus group discussions (30 participants in total) with nursing home staff working in 17 different nursing homes in Norway. RESULTS Nursing staff strive to manage their moral distress related to neglectful care practices in different ways: by favouring efficiency and tolerating neglect they adapt to and accept these care practices. By disengaging emotionally and retreating physically from care they avoid confronting morally distressing situations. These approaches may temporarily mitigate the moral distress of nursing staff, whilst also creating a staff-centred and self-protecting work culture enabling neglect in nursing homes. CONCLUSIONS Our findings represent a shift from a resident-centred to a staff-centred work culture, whereby the nursing staff use self-protecting strategies to make their workday manageable and liveable. This strongly indicates a compromise in the quality of care that enables the continuation of neglectful care practices in Norwegian nursing homes. Finding ways of breaking a downward spiralling quality of care are thus a major concern following our findings.
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Affiliation(s)
- Stine Borgen Lund
- Department of Public Health and Nursing, Norwegian University of Science and Technology (NTNU), 7491, Trondheim, PO Box 8905, Norway.
| | - Wenche K Malmedal
- Department of Public Health and Nursing, Norwegian University of Science and Technology (NTNU), 7491, Trondheim, PO Box 8905, Norway
| | - Laura Mosqueda
- Department of Family Medicine, Keck School of Medicine, University of Southern California, Los Angeles, USA
| | - John-Arne Skolbekken
- Department of Public Health and Nursing, Norwegian University of Science and Technology (NTNU), 7491, Trondheim, PO Box 8905, Norway
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Lund SB, Skolbekken JA, Mosqueda L, Malmedal W. Making Neglect Invisible: A Qualitative Study among Nursing Home Staff in Norway. Healthcare (Basel) 2023; 11:healthcare11101415. [PMID: 37239698 DOI: 10.3390/healthcare11101415] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Revised: 05/05/2023] [Accepted: 05/08/2023] [Indexed: 05/28/2023] Open
Abstract
BACKGROUND Research shows that nursing home residents' basic care needs are often neglected, potentially resulting in incidents that threaten patients' safety and quality of care. Nursing staff are at the frontline for identifying such care practices but may also be at the root of the problem. The aim of this study was to generate new knowledge on reporting instances of neglect in nursing homes based on the research question "How is neglect reported and communicated by nursing home staff?" METHODS A qualitative design guided by the principles of constructivist grounded theory was used. The study was based on five focus-group discussions (20 participants) and 10 individual interviews with nursing staff from 17 nursing homes in Norway. RESULTS Neglect in nursing homes is sometimes invisible due to a combination of personal and organizational factors. Staff may minimize "missed care" and not consider it neglect, so it is not reported. In addition, they may be reluctant to acknowledge or reveal their own or colleagues' neglectful practices. CONCLUSION Neglect of residents in nursing homes may continue to occur if nursing staff's reporting practices are making neglect invisible, thus proceeding to compromise a resident's safety and quality of care for the foreseeable future.
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Affiliation(s)
- Stine Borgen Lund
- Department of Public Health and Nursing, Norwegian University of Science and Technology (NTNU), 7491 Trondheim, Norway
| | - John-Arne Skolbekken
- Department of Public Health and Nursing, Norwegian University of Science and Technology (NTNU), 7491 Trondheim, Norway
| | - Laura Mosqueda
- Keck School of Medicine, University of Southern California, Los Angeles, CA 91803, USA
| | - Wenche Malmedal
- Department of Public Health and Nursing, Norwegian University of Science and Technology (NTNU), 7491 Trondheim, Norway
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Steinsheim G, Saga S, Olsen B, Broen HK, Malmedal W. Abusive episodes among home-dwelling persons with dementia and their informal caregivers: a cross-sectional Norwegian study. BMC Geriatr 2022; 22:852. [PMID: 36371161 PMCID: PMC9655791 DOI: 10.1186/s12877-022-03569-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Accepted: 10/27/2022] [Indexed: 11/15/2022] Open
Abstract
Background Elder abuse is a serious issue with a global prevalence of 15.7% in the community setting. Persons with dementia are at higher risk of elder abuse than the older population in general. With a high and increasing prevalence of dementia this issue cannot be neglected. Hence, the aims of this study were 1) to describe the proportion of abusive episodes among home-dwelling persons with dementia and their informal caregivers, and 2) to explore differences between informal caregivers who have reported committing and not committing abusive acts. Methods A cross-sectional survey was conducted among informal caregivers of home-dwelling persons with dementia in Norway from May to December 2021 with a total of 549 participants. Results Two-thirds of informal caregivers had committed at least one abusive episode toward the person with dementia in the past year (63.5% psychological abuse, 9.4% physical abuse, 3.9% financial abuse, 2.4% sexual abuse, 6.5% neglect). One-third of informal caregivers had experienced aggression from the person with dementia (33.9% psychological abuse, 7.8% physical abuse, 1.1% financial abuse, 1.4% sexual abuse). Tests for independence showed that the risk of abusive episodes from informal caregivers toward persons with dementia was higher when the informal caregiver was a spouse/partner of the person with dementia and if they experienced aggression from the person with dementia. Conclusions The results demonstrate that a majority of informal caregivers commit some form of abusive episodes, and episodes that fall within the scope of psychological abuse are most frequent. This study expands knowledge about elder abuse among home-dwelling persons with dementia. Increased understanding of the dynamics of abuse is essential to be able to reduce risk and prevent abuse.
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Husum TL, Pedersen R, Aasland O. Frequent Violations and Infringements against Users in Mental Health Care Confirmed by Both Users and Professionals - A Quantitative Study. Issues Ment Health Nurs 2022; 43:862-869. [PMID: 35452344 DOI: 10.1080/01612840.2022.2063461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
The main task of mental health care services is to provide good quality of care. Despite this, users are sometimes treated badly by staff. The purpose of this study was to investigate violations and infringements towards users in mental health care services, from the perspectives of both staff and users. Data were gathered through an anonymous online questionnaire sent to staff and users in Norway. Staff were recruited in collaboration with professional organisations and users in collaboration with user-organisations.
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Affiliation(s)
- Tonje Lossius Husum
- Centre for Medical Ethics, University of Oslo, Norway.,Oslo Metropolitan University, Oslo, Norway
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Hirt J, Adlbrecht L, Heinrich S, Zeller A. Staff-to-resident abuse in nursing homes: a scoping review. BMC Geriatr 2022; 22:563. [PMID: 35794542 PMCID: PMC9261065 DOI: 10.1186/s12877-022-03243-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2021] [Accepted: 06/20/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Elder abuse in long-term care is an important public health concern with social, health-related, and economic implications. Staff-to-resident abuse is of particular interest since institutions should protect residents' rights and prevent harm. To provide an up-to date comprehensive overview of staff-to-resident abuse in nursing homes, we performed a scoping review considering types of abuse, their prevalence and associated factors, descriptions, experiences, and preventive interventions. METHODS We performed a scoping review following the framework provided by Arksey and O'Malley. We searched MEDLINE (via PubMed), CINAHL, PsycINFO via Ovid, and Cochrane Library. Additionally, we performed free web searching using Google Scholar and checked relevant reviews. Two reviewers independently selected studies. We narratively synthesised the results. RESULTS Out of 3876 references retrieved by our search, we included 46 studies in 47 reports. The prevalence rates of abuse varied widely, ranging from 0 to 93% depending on the type of abuse. Associated factors of abuse at the staff, resident, and nursing home level were evaluated inconsistently. Abuse was perceived ambiguous: even though it was considered unacceptable, it was underreported. We found only four studies addressing preventive interventions. Of these, four made recommendations for intervention development. Only one study with an experimental design examined a multi-component intervention including education and mutual support. CONCLUSIONS The review yielded heterogenous evidence not allowing a concrete conclusion on prevalence and associated factors. However, the results show the significance of the problem and indicate that there are associate factors of abuse that can be influenced by appropriate interventions. These are amongst other staff education, organisational culture, and conditions. Further research should investigate the composition and content of preventive interventions and their potential to reduce abusive behaviours.
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Affiliation(s)
- Julian Hirt
- Center for Dementia Care, Institute of Applied Nursing Sciences, Department of Health, Eastern Switzerland University of Applied Sciences, Rosenbergstrasse 59, 9000 St.Gallen, Switzerland
- International Graduate Academy, Medical Faculty, Institute for Health and Nursing Science, Martin Luther University Halle-Wittenberg, Magdeburger Strasse 8, 06112 Halle (Saale), Germany
- Department of Clinical Research, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Laura Adlbrecht
- Center for Dementia Care, Institute of Applied Nursing Sciences, Department of Health, Eastern Switzerland University of Applied Sciences, Rosenbergstrasse 59, 9000 St.Gallen, Switzerland
| | - Steffen Heinrich
- Center for Dementia Care, Institute of Applied Nursing Sciences, Department of Health, Eastern Switzerland University of Applied Sciences, Rosenbergstrasse 59, 9000 St.Gallen, Switzerland
| | - Adelheid Zeller
- Center for Dementia Care, Institute of Applied Nursing Sciences, Department of Health, Eastern Switzerland University of Applied Sciences, Rosenbergstrasse 59, 9000 St.Gallen, Switzerland
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Sigurdardottir AS, Geirsdottir OG, Ramel A, Arnadottir IB. Cross-sectional study of oral health care service, oral health beliefs and oral health care education of caregivers in nursing homes. Geriatr Nurs 2021; 43:138-145. [PMID: 34890954 DOI: 10.1016/j.gerinurse.2021.11.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Revised: 11/15/2021] [Accepted: 11/17/2021] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To assess oral care beliefs and oral hygiene procedures among nursing home personnel to identify strengths and weaknesses in managing oral care. METHODS A cross-sectional study in two nursing homes using an oral health care questionnaire including the Nursing Dental Coping Belief Scale. RESULTS A total of 109 health personnel participated. Oral care was seldomly achieved twice a day and dental supplies were not guaranteed. Registered nurses found the oral health of residents more acceptable than did allied health personnel with less oral care education, who mostly delivered daily care. Conversely, nursing staff with oral care education had lower dental coping beliefs, suggesting a lack of self-reliance in controlling oral health outcomes. CONCLUSION Dental supplies should be part of nursing care equipment. Educational programs could increase positive oral health beliefs and enhance the quality of care in these settings, particularly among those who are accountable for oral care.
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Affiliation(s)
| | - Olof Gudny Geirsdottir
- Faculty of Food Science and Nutrition, School of Health Sciences, University of Iceland, Aragata 14, 101 Reykjavik, Iceland
| | - Alfons Ramel
- Faculty of Food Science and Nutrition, School of Health Sciences, University of Iceland, Aragata 14, 101 Reykjavik, Iceland
| | - Inga Bergmann Arnadottir
- Faculty of Odontology, School of Health Sciences, University of Iceland, Vatnsmyravegur 16, 101 Reykjavík, Iceland
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Saga S, Blekken LE, Nakrem S, Sandmoe A. Relatives' experiences with abuse and neglect in Norwegian nursing homes. A qualitative study. BMC Health Serv Res 2021; 21:684. [PMID: 34247595 PMCID: PMC8272837 DOI: 10.1186/s12913-021-06713-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Accepted: 06/29/2021] [Indexed: 12/22/2022] Open
Abstract
Background Elder abuse in nursing homes (NH) is a widespread and complex problem. Residents’ ability to share their experiences are impeded, due to a high degree of cognitive problems and frailty, and previous studies are thus mainly based on reports from staff. Therefore, we aimed to give voice to the residents by investigating their relatives’ experiences with elder abuse in NH. Methods Qualitative individual interviews were conducted with 16 relatives of residents with experience of abuse and/or neglect in NH. Content analysis was used to analyse the data. Results Relatives perceived neglect as most pervasive and staff-to-resident psychological abuse as a key problem. Physical abuse was mostly related to resident-to-resident aggression. Relatives perceived elder abuse in NH to be related to low competence among staff, low staffing, poor NH leadership, working cultures characterized by fear and loyalty to employer or co-workers, and a lack of individualized care for the residents. Furthermore, relatives themselves experienced maltreatment from NH, which caused them to suffer stress, anxiety and distrust. Relatives also expressed a need to compensate for lack of care. Conclusions Relatives of NH residents who had experienced abuse reported that neglect of basic care and individual rights was predominant and viewed organizational explanations as most important. Relatives perceive themselves as collaborators in care and are emotionally attached to their family member. Therefore, if relatives experience resident abuse or neglect, it inflicts a feeling of being mistreated themselves, particularly if they are not listened to or their notice of abuse on the part of the resident is ignored or trivialized. Including relatives in a committed partnership with NH in care practices is not only a valuable path to reduce the risk of abuse, but it also leads to a more sustainable healthcare with high standards of quality and safety.
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Affiliation(s)
- Susan Saga
- Department of Public Health and Nursing, Faculty of Medicine and Health Sciences NTNU, Norwegian University of Science and Technology, Trondheim, Norway.
| | - Lene Elisabeth Blekken
- Department of Public Health and Nursing, Faculty of Medicine and Health Sciences NTNU, Norwegian University of Science and Technology, Trondheim, Norway
| | - Sigrid Nakrem
- Department of Public Health and Nursing, Faculty of Medicine and Health Sciences NTNU, Norwegian University of Science and Technology, Trondheim, Norway
| | - Astrid Sandmoe
- Norwegian Centre for Violence and Traumatic Stress Studies, Oslo, Norway
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Botngård A, Eide AH, Mosqueda L, Blekken L, Malmedal W. Factors associated with staff-to-resident abuse in Norwegian nursing homes: a cross-sectional exploratory study. BMC Health Serv Res 2021; 21:244. [PMID: 33740965 PMCID: PMC7977325 DOI: 10.1186/s12913-021-06227-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Accepted: 03/01/2021] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Elder abuse is a public health problem that is gaining attention due to its serious impacts on people's health and well-being, and it is predicted to increase along with the world's rapidly ageing population. Staff-to-resident abuse in nursing homes is a complex and multifaceted phenomenon associated with multiple factors on different levels of the ecological model. This study aimed to explore individual, relational, and institutional characteristics associated with perpetrated staff-to-resident abuse in nursing homes, using a multilevel hierarchical approach. METHODS This was a cross-sectional exploratory study of 3693 nursing staff (response rate 60.1%) in 100 randomly selected nursing homes in Norway. We explored the characteristics of nursing staff, their relationship with residents, and institutional features associated with three types of abuse: psychological abuse, physical abuse, and neglect. These were modelled using multilevel mixed-effects logistic regression analyses. RESULTS Individual staff factors found to be associated with all three types of abuse were 1) being a registered nurse/social educator (OR 1.77-2.49) or licensed practical nurse (OR 1.64-1.92), 2) reporting symptoms of psychological distress (OR 1.44-1.46), 3) intention to leave the job (OR 1.35-1.40), and 4) reporting poor attitudes towards people with dementia (OR 1.02-1.15). Also, staff who reported poorer quality of childhood were more likely to perpetrate neglect (OR 1.14). Relational factors such as care-related conflicts (OR 1.97-2.33) and resident aggression (OR 1.36-2.09) were associated with all three types of abuse. Of institutional factors, lack of support from a manager was associated with perpetrating psychological abuse (OR 1.56). CONCLUSIONS We found several predictors of staff-to-resident abuse on different levels of the ecological model, which underlines the importance of using a multifaceted approach to identify risk factors of elder abuse in nursing homes. However, future studies should explore the underlying mechanism and causes with a prospective or qualitative design and target the multifaceted nature of risk factors when designing preventive interventions.
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Affiliation(s)
- Anja Botngård
- Department of Public Health and Nursing, Norwegian University of Science and Technology, Trondheim, Norway.
| | - Arne Henning Eide
- Department of Public Health and Nursing, Norwegian University of Science and Technology, Trondheim, Norway
- Department of Health Research, SINTEF Digital, Oslo, Norway
| | - Laura Mosqueda
- Department of Family Medicine, Keck School of Medicine of the University of Southern California, Los Angeles, USA
| | - Lene Blekken
- Department of Public Health and Nursing, Norwegian University of Science and Technology, Trondheim, Norway
| | - Wenche Malmedal
- Department of Public Health and Nursing, Norwegian University of Science and Technology, Trondheim, Norway
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Malmedal W, Kilvik A, Steinsheim G, Botngård A. A literature review of survey instruments used to measure staff-to-resident elder abuse in residential care settings. Nurs Open 2020; 7:1650-1660. [PMID: 33072348 PMCID: PMC7544835 DOI: 10.1002/nop2.573] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2020] [Revised: 06/15/2020] [Accepted: 07/01/2020] [Indexed: 12/02/2022] Open
Abstract
Aim To review the literature of existing survey instruments used to measure the occurrence of staff‐to‐resident elder abuse in residential care settings. Methods A comprehensive literature search during May 2017 produced 2,037 records. Two authors independently reviewed these records for inclusion, where a total of 17 studies met eligibility criteria. Descriptive information of all identified survey instruments is provided. Results This literature review reveals a diversity of survey instruments used to measure staff‐to‐resident abuse in residential care settings. The survey instruments varied greatly, where most instruments were self‐developed by the authors and provided none or limited information on psychometric properties. Most studies were conducted in high‐income countries and many of them in the United States.
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Affiliation(s)
- Wenche Malmedal
- Department of Public Health and Nursing Norwegian University of Science and Technology Trondheim Norway
| | - Astrid Kilvik
- The Medicine and Health Library Norwegian University of Science and Technology Trondheim Norway
| | - Gunn Steinsheim
- Department of Public Health and Nursing Norwegian University of Science and Technology Trondheim Norway
| | - Anja Botngård
- Department of Public Health and Nursing Norwegian University of Science and Technology Trondheim Norway
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Factors Affecting Mistreatment of the Elderly in Long-Term Care Facilities. Healthcare (Basel) 2020; 8:healthcare8030224. [PMID: 32717835 PMCID: PMC7551777 DOI: 10.3390/healthcare8030224] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 07/13/2020] [Accepted: 07/20/2020] [Indexed: 11/23/2022] Open
Abstract
In long-term care facilities, elderly mistreatment occurs routinely and frequently. However, few studies have empirically explored the multifaceted risk factor of mistreatment. The purpose of this paper was to explore the factors affecting elderly mistreatment by care workers in Japanese long-term care facilities and to examine the relationship between these factors and mistreatment. This analysis was based on a sample of 1473 care workers from long-term care facilities and used multiple regression analyses. The results revealed that the nursing care level, work period, resilience, and attitude towards mistreatment among residents and staff were factors significantly associated with the degree of mistreatment. Facility size, an institutional environment that does not limit the behavior of residents, and family and community support for the elderly were among the institutional environment factors that had significant relationships with mistreatment. Staff gender, care-related qualifications, and workload were not associated with mistreatment. These findings suggest that strengthening the staff’s attitude and coping skills to prevent mistreatment, as well as interventions for changes in the institutional environment, are needed to prevent and reduce the prevalence of mistreatment in Japan. In addition, raising staff resilience to stress situations and building a resident-centered facility care environment is an important measure to reduce mistreatment.
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Bravo-Segal S, Villar F. [Older people representation on the media during COVID-19 pandemic: A reinforcement of ageism?]. Rev Esp Geriatr Gerontol 2020; 55:266-271. [PMID: 32718581 PMCID: PMC7334901 DOI: 10.1016/j.regg.2020.06.002] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Revised: 05/30/2020] [Accepted: 06/02/2020] [Indexed: 11/04/2022]
Abstract
Antecedentes y objetivo La pandemia de la COVID-19 afecta de manera diferencial a distintos grupos etarios, concentrándose la mayor parte de fallecimiento entre las personas más mayores y con afecciones de salud previas. Esto ha implicado una mayor presencia de los mayores en la agenda informativa de todos los medios de comunicación. Este artículo pretende analizar esos discursos y representaciones relacionados con los mayores tal y como se presentan en los titulares de publicaciones difundidas en 2 diarios de alcance nacional (ABC y El País) durante la fase más crítica de la pandemia en España. Materiales y métodos Se analizaron 501 titulares relacionados con los mayores y la pandemia COVID-19 (380 del ABC y 121 de El País) desde la perspectiva de los Estudios Críticos del Discurso (van Dijk, 2003) y llevándose a cabo un análisis de contenido. Resultados El 71,4% de los titulares representaban de manera desfavorable a los mayores, presentándolos como un grupo homogéneo y asociándolos a fallecimientos, deficiencias en la atención residencial o vulnerabilidad extrema. La presencia de ciertos términos potencialmente peyorativos o impropios (ancianos, abuelos) estaba en coherencia con esa representación negativa. Conclusiones A la luz de esos resultados, se discute en qué medida la pandemia de la COVID-19 puede reforzar una narrativa edadista de los mayores, basada en la fragilidad, el declive y la dependencia, que pueda justificar prácticas discriminatorias dirigidas a este sector de la población.
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Affiliation(s)
- Stephany Bravo-Segal
- Departamento de Cognición, Desarrollo y Psicología de la Educación, Universitat de Barcelona, España.
| | - Feliciano Villar
- Departamento de Cognición, Desarrollo y Psicología de la Educación, Universitat de Barcelona, España
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Botngård A, Eide AH, Mosqueda L, Malmedal W. Resident-to-resident aggression in Norwegian nursing homes: a cross-sectional exploratory study. BMC Geriatr 2020; 20:222. [PMID: 32580701 PMCID: PMC7315524 DOI: 10.1186/s12877-020-01623-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Accepted: 06/18/2020] [Indexed: 12/23/2022] Open
Abstract
Background Resident-to-resident aggression in nursing homes is a public health problem of growing concern, impacting the safety, health and well-being of all residents involved. Despite this, little research has been conducted on its occurrence particularly in large-scale national studies. The aim of this study was to explore the extent and nature of resident-to-resident aggression in Norwegian nursing homes, as reported by nursing staff. Methods We conducted a cross-sectional exploratory study, where nursing staff in 100 randomly selected Norwegian nursing homes completed a pen and paper survey measuring how often they had observed incidents of resident-to-resident aggression during the past year. These rates were separated according to nursing home size, location and units of workplace. Results Of the 3693 nursing staff who participated (response rate 60.1%), 88.8% had observed one or more incidents of resident-to-resident aggression during the past year, with acts of verbal and physical aggression being the most commonly reported. Nursing staff working in dementia special care units, larger nursing homes and nursing homes located in suburban/urban municipalities, reported more incidents of resident-to-resident aggression than staff in short-term and long-term units, small institutions, and nursing homes located in rural municipalities. Conclusions This is the first national study of resident-to-resident aggression in Norwegian nursing homes and is one of the largest surveys worldwide exploring the extent and nature of resident-to-resident aggression in long-term care settings. Overall, we found a high occurrence of all types of aggression, suggesting a need for strategies to improve residents’ safety and quality of life in nursing homes.
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Affiliation(s)
- Anja Botngård
- Department of Public Health and Nursing, Norwegian University of Science and Technology, Trondheim, Norway.
| | - Arne Henning Eide
- Department of Public Health and Nursing, Norwegian University of Science and Technology, Trondheim, Norway.,Department of Health Research, SINTEF Digital, Oslo, Norway
| | - Laura Mosqueda
- Department of Family Medicine, Keck School of Medicine of the University of Southern California, Los Angeles, USA
| | - Wenche Malmedal
- Department of Public Health and Nursing, Norwegian University of Science and Technology, Trondheim, Norway
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15
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Nightingale's Legacy: Old Holistic Insight Supported by New Science. Holist Nurs Pract 2020; 34:234-243. [PMID: 32404726 DOI: 10.1097/hnp.0000000000000393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Nursing today could benefit from building on Florence Nightingale's legacy. The aim of this article is to describe and discuss how her holistic approach to nursing is supported by scientific discoveries within human ecology, psychoneuroimmunology, and communicology. This combination may bridge the gap between current nursing practices and Nightingale's ethos.
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16
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Haugan G, Eide WM, André B, Wu VX, Rinnan E, Taasen SE, Kuven BM, Drageset J. Joy-of-life in cognitively intact nursing home residents: the impact of the nurse-patient interaction. Scand J Caring Sci 2020; 35:208-219. [PMID: 32200564 DOI: 10.1111/scs.12836] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2019] [Revised: 01/12/2020] [Accepted: 02/11/2020] [Indexed: 12/17/2022]
Abstract
BACKGROUND The nursing-home population is at a high risk of declined well-being and quality of life. Finding approaches to increase well-being among older adults in nursing-homes is highly warranted. Responding to this need, the approach framed 'Joy-of-Life-Nursing-Homes' (JoLNH) was developed in Norway. AIM To investigate the association between nurse-patient interaction and joy-of-life in the nursing-home population. METHODS Cross-sectional data were collected in 2017 and 2018 using the Nurse-Patient Interaction Scale and the Joy-of-Life Scale. A total of 204 cognitively intact nursing-home residents met the inclusion criteria and 188 (92%) participated. A structural equation model (SEM) of the relationship between nurse-patient interaction and joy-of-life was tested by means of STATA/MP 15.1. Ethical approval was given and each participant provided voluntarily written informed consent. RESULTS The SEM-model yielded a good fit with the data (χ2 = 162.418, p = 0.004, df = 118, χ2 /df = 1.38, RMSEA = 0.046, p-close 0.652, CFI = 0.97, TLI = 0.96, and SRMR = 0.054). As hypothesised, nurse-patient interaction related significantly with joy-of-life (γ1,1 = 0.61, t = 7.07**). LIMITATIONS The cross-sectional design does not allow for conclusions on causality. The fact that the researchers visited the participants to help fill in the questionnaire might have introduced some bias into the respondents' reporting. CONCLUSION Relational qualities of the nurse-patient interaction should be essential integral aspects of nursing-home care. Consequently, such qualities should be emphasised in clinical practice, and research and education should pay more attention to nurse-patient interaction as an important, integral part of the caring process promoting joy-of-life and thereby well-being.
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Affiliation(s)
- Gørill Haugan
- NTNU Center for Health Promotion Research, NTNU Norwegian University of Science and Technology, Trondheim, Norway.,Faculty of Nursing and Health Sciences, Nord University, Bodø, Norway
| | - Wenche Mjanger Eide
- Faculty of Health and Social Sciences, Western University of Applied Sciences, Bergen, Norway
| | - Beate André
- NTNU Center for Health Promotion Research, NTNU Norwegian University of Science and Technology, Trondheim, Norway
| | - Vivien Xi Wu
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Eva Rinnan
- Department of Public Health and Nursing, NTNU Norwegian University of Science and Technology, Trondheim, Norway
| | - Siv Eriksen Taasen
- Faculty of Health and Social Sciences, Western University of Applied Sciences, Bergen, Norway
| | - Britt Moene Kuven
- Faculty of Health and Social Sciences, Western University of Applied Sciences, Bergen, Norway
| | - Jorunn Drageset
- Faculty of Health and Social Sciences, Western University of Applied Sciences, Bergen, Norway.,University of Bergen, Department of Global Public Health and Primary Care, Bergen, Norway
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17
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Myhre J, Saga S, Malmedal W, Ostaszkiewicz J, Nakrem S. Elder abuse and neglect: an overlooked patient safety issue. A focus group study of nursing home leaders' perceptions of elder abuse and neglect. BMC Health Serv Res 2020; 20:199. [PMID: 32164695 PMCID: PMC7069163 DOI: 10.1186/s12913-020-5047-4] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Accepted: 02/26/2020] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND The definition and understanding of elder abuse and neglect in nursing homes can vary in different jurisdictions as well as among health care staff, researchers, family members and residents themselves. Different understandings of what constitutes abuse and its severity make it difficult to compare findings in the literature on elder abuse in nursing homes and complicate identification, reporting, and managing the problem. Knowledge about nursing home leaders' perceptions of elder abuse and neglect is of particular interest since their understanding of the phenomenon will affect what they signal to staff as important to report and how they investigate adverse events to ensure residents' safety. The aim of the study was to explore nursing home leaders' perceptions of elder abuse and neglect. METHODS A qualitative exploratory study with six focus group interviews with 28 nursing home leaders in the role of care managers was conducted. Nursing home leaders' perceptions of different types of abuse within different situations were explored. The constant comparative method was used to analyse the data. RESULTS The results of this study indicate that elder abuse and neglect are an overlooked patient safety issue. Three analytical categories emerged from the analyses: 1) Abuse from co-residents: 'A normal part of nursing home life'; resident-to-resident aggression appeared to be so commonplace that care leaders perceived it as normal and had no strategy for handling it; 2) Abuse from relatives: 'A private affair'; relatives with abusive behaviour visiting nursing homes residents was described as difficult and something that should be kept between the resident and the relatives; 3) Abuse from direct-care staff: 'An unthinkable event'; staff-to-resident abuse was considered to be difficult to talk about and viewed as not being in accordance with the leaders' trust in their employees. CONCLUSIONS Findings in the present study show that care managers lack awareness of elder abuse and neglect, and that elder abuse is an overlooked patient safety issue. The consequence is that nursing home residents are at risk of being harmed and distressed. Care managers lack knowledge and strategies to identify and adequately manage abuse and neglect in nursing homes.
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Affiliation(s)
- Janne Myhre
- Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology NTNU, Trondheim, Norway
| | - Susan Saga
- Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology NTNU, Trondheim, Norway
| | - Wenche Malmedal
- Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology NTNU, Trondheim, Norway
| | - Joan Ostaszkiewicz
- Centre for Quality and Patient Safety Research- Barwon Health Partnership, Institute for Healthcare Transformation, Deakin University, Geelong, Australia
| | - Sigrid Nakrem
- Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology NTNU, Trondheim, Norway
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18
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Botngård A, Eide AH, Mosqueda L, Malmedal W. Elder abuse in Norwegian nursing homes: a cross-sectional exploratory study. BMC Health Serv Res 2020; 20:9. [PMID: 31900138 PMCID: PMC6942332 DOI: 10.1186/s12913-019-4861-z] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Accepted: 12/22/2019] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Elder abuse is a global public health and human rights problem that is predicted to increase as many countries experience a rapid growth in their population of older adults. Elder abuse undermines an older person's well-being and is associated with a range of serious health consequences. In institutional care settings, older residents are particularly vulnerable and hence at higher risk of being abused, but few countries have explored the extent and nature of this phenomenon in national studies. The aim of this study is to estimate the prevalence of observed and perpetrated staff-to-resident abuse in Norwegian nursing homes. METHODS We conducted a cross-sectional exploratory study of nursing staff in 100 randomly drawn Norwegian nursing homes. Nursing staff completed a pen and paper survey measuring how often during the past year they had observed staff commit acts of neglect and psychological, physical, financial/material, and sexual abuse towards residents. They also reported how often they had perpetrated acts of abuse themselves, and these rates were disaggregated by nursing staff's gender, age and education. RESULTS Of 3693 nursing staff (response rate 60.1%), 76% had observed one or more incidents of elder abuse during the past year, and 60.3% reported they had perpetrated one or more incidents of abuse in the same period. Psychological abuse and neglect were most commonly reported. Male staff reported more acts of physical abuse, while female staff reported more acts of neglect. Higher education of staff was associated with higher rates of self-reported psychological abuse, physical abuse and neglect. CONCLUSIONS This first national survey of staff in Norwegian nursing homes is one of the largest studies globally estimating the prevalence of elder abuse in institutional settings. Overall, we found staff-to-resident abuse to be relatively common, and our findings propose a need for preventive strategies to improve the quality of life and safety of residents in Norwegian nursing homes.
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Affiliation(s)
- Anja Botngård
- Department of Public Health and Nursing, Norwegian University of Science and Technology, Trondheim, Norway.
| | - Arne Henning Eide
- Department of Public Health and Nursing, Norwegian University of Science and Technology, Trondheim, Norway
- Department of Health Research, SINTEF Digital, Oslo, Norway
| | - Laura Mosqueda
- Keck School of Medicine of University of Southern California, Los Angeles, USA
| | - Wenche Malmedal
- Department of Public Health and Nursing, Norwegian University of Science and Technology, Trondheim, Norway
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19
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Ion R, Olivier S, Darbyshire P. Failure to report poor care as a breach of moral and professional expectation. Nurs Inq 2019; 26:e12299. [PMID: 31162786 DOI: 10.1111/nin.12299] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Revised: 05/10/2019] [Accepted: 05/12/2019] [Indexed: 12/01/2022]
Abstract
Cases of poor care have been documented across the world. Contrary to professional requirements, evidence indicates that these sometimes go unaddressed. For patients, the outcomes of this inaction are invariably negative. Previous work has either focused on why poor care occurs and what might be done to prevent it, or on the reasons why those who are witness to it find it difficult to raise their concerns. Here, we build on this work but specifically foreground the responsibilities of registrants and students who witness poor care. Acknowledging the challenges associated with raising concerns, we make the case that failure to address poor care is a breach of moral expectation, professional requirement and, sometimes, legal frameworks. We argue that reporting will be more likely to take place if those who wish to enter the profession have a realistic view of the challenges they may encounter. When nurses are provided with robust and applied education on ethics, when "real-world" cases and exemplars are used in practice and when steps are taken to develop and encourage individual moral courage, we may begin to see positive change. Ultimately however, significant change is only likely to take place where practice cultures invite and welcome feedback, promote critical reflection, and where strong, clear leadership support is shown by those in positions of influence across organisations.
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Affiliation(s)
- Robin Ion
- Division of Mental Health Nursing and Counselling, Abertay University, Dundee, UK
| | | | - Philip Darbyshire
- Philip Darbyshire Consulting Ltd., Adelaide, South Australia, Australia
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20
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Stodolska A, Parnicka A, Tobiasz-Adamczyk B, Grodzicki T. Exploring Elder Neglect: New Theoretical Perspectives and Diagnostic Challenges. THE GERONTOLOGIST 2019; 60:e438-e448. [DOI: 10.1093/geront/gnz059] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background and Objectives
Neglect of older adults is a complex and important social problem which is difficult to detect. The aim of this review is to explore and categorize different characteristics of elder neglect, to facilitate a uniform conceptualization and provide recommendations for identification of the phenomenon.
Research Design and Methods
Articles published between January 1990 and February 2019, both from developed and developing countries, were taken into consideration. The literature search was performed in PubMed, Web of Science, and CINAHL using keywords related to elder abuse and neglect. Articles regarding the concept of elder neglect, identifying or measuring this phenomenon were reviewed. The identified indicators were presented according to the Maslow’s hierarchy of needs.
Results
From 7,207 articles found in the initial search, 63 relevant studies were selected for the final analysis. Indicators most frequently used by researchers (functionality, physical appearance and health, social and psychological background, mental health, and environment) correspond to different aspects of needs. Caregiver’s responsibility, satisfaction of needs, and risk of harm are the core elements to consider in identification of neglect.
Discussion and Implications
The identified elements and categories of indicators provide the framework for developing standard definitions and measures of elder neglect. The proposed diagram demonstrates gaps in identification and can be useful in detecting potential neglect in various categories of needs. Further research on perceptions and prevalence of elder neglect in different countries would be helpful for cross-country analysis as well as for adaptation of the instruments to cultural specifics.
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Affiliation(s)
- Agata Stodolska
- Department of Medical Sociology, Chair of Epidemiology and Preventive Medicine & Chair of Internal Medicine and Gerontology, Jagiellonian University Medical College, Kraków, Poland
| | - Agnieszka Parnicka
- Chair of Internal Medicine and Gerontology, Jagiellonian University Medical College, Kraków, Poland
| | - Beata Tobiasz-Adamczyk
- Department of Medical Sociology, Chair of Epidemiology and Preventive Medicine, Jagiellonian University Medical College, Kraków, Poland
| | - Tomasz Grodzicki
- Chair of Internal Medicine and Gerontology, Jagiellonian University Medical College, Kraków, Poland
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21
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Søvde BE, Hovland G, Ullebust B, Råholm M. Struggling for a dignifying care: experiences of being next of kin to patients in home health care. Scand J Caring Sci 2019; 33:409-416. [DOI: 10.1111/scs.12638] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Accepted: 11/13/2018] [Indexed: 01/01/2023]
Affiliation(s)
- Bente Egge Søvde
- Faculty of Health and Social Sciences Western Norway University of Applied Sciences Bergen Norway
| | - Gro Hovland
- Faculty of Health and Social Sciences Western Norway University of Applied Sciences Bergen Norway
| | - Berit Ullebust
- Centre for Development of Institutional and Home Care Services (USHT) Førde Norway
| | - Maj‐Britt Råholm
- Faculty of Health and Social Sciences Western Norway University of Applied Sciences Bergen Norway
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22
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Malmedal W. Omsorg på vranga. TIDSSKRIFT FOR OMSORGSFORSKNING 2018. [DOI: 10.18261/issn.2387-5984-2018-03-13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Affiliation(s)
- Wenche Malmedal
- Institutt for samfunnsmedisin og sykepleie
- Fakultet for medisin og helsevitenskap, NTNU
- Senter for omsorgsforskning, midt
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23
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Radermacher H, Toh YL, Western D, Coles J, Goeman D, Lowthian J. Staff conceptualisations of elder abuse in residential aged care: A rapid review. Australas J Ageing 2018; 37:254-267. [PMID: 30062840 DOI: 10.1111/ajag.12565] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
OBJECTIVE The purpose of this rapid review was to explore how residential aged care staff conceptualise and identify elder abuse. METHODS English-language publications, between 2000 and 2017, about elder abuse in residential aged care in developed countries were sought from three academic databases. Only perspectives on staff-to-resident and resident-to-resident abuse were included. RESULTS Over 2000 articles were screened, and 19 journal articles were included in the review. A wide range of abusive behaviours was identified, but there was little common understanding of what constituted elder abuse. Furthermore, disparities in conceptualisations were greater for certain types of abuse (e.g. verbal, psychological and caregiving). CONCLUSION Elder abuse in residential aged care was conceptualised and identified by staff in diverse and different ways. This lack of common understanding hinders the development of effective interventions and prevention strategies, which include staff education and training as well as significant structural and institutional changes.
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Affiliation(s)
- Harriet Radermacher
- Department of General Practice, Monash University, Melbourne, Victoria, Australia
| | - Ying Li Toh
- Department of General Practice, Monash University, Melbourne, Victoria, Australia
| | - Deborah Western
- Department of Social Work, Monash University, Melbourne, Victoria, Australia
| | - Jan Coles
- Department of General Practice, Monash University, Melbourne, Victoria, Australia
| | - Dianne Goeman
- School of Medicine and Public Health, University of Newcastle, Newcastle, New South Wales, Australia
- Central Clinical School, Monash University, Prahran, Victoria, Australia
- NHMRC Cognitive Decline Partnership Centre, Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
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Braaten KL, Malmedal W. Preventing physical abuse of nursing home residents- as seen from the nursing staff's perspective. Nurs Open 2017; 4:274-281. [PMID: 29085653 PMCID: PMC5653394 DOI: 10.1002/nop2.98] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2017] [Accepted: 08/17/2017] [Indexed: 12/02/2022] Open
Abstract
Aim This study aims to capture first‐hand information from nursing home staff's own understanding regarding what they think and have experienced about prevention of physical abuse of nursing home residents and what measures they consider useful to implement in their daily work. Design The design is qualitative. Methods A convenient sample of staff in three nursing homes was used and data were collected during three focus group interviews. The total number of informants was 14. Thematic content analysis was used. The data collection period was from December 2015–February 2016. Results According to the staff, several factors contribute to the prevention of physical abuse of residents in nursing homes. There is a requirement for increased competence among staff about the concept of abuse and known risk factors. Good communication skills and trusting relationships are important factors, as well as a culture that fosters openness where ethical dilemmas can be discussed.
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Affiliation(s)
| | - Wenche Malmedal
- Department of Public Health and Nursing Norwegian University of Technology and Science Trondheim Norway
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25
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Aas G. The Norwegian police and victims of elder abuse in close and familial relationships. J Elder Abuse Negl 2017; 30:20-41. [PMID: 28816617 DOI: 10.1080/08946566.2017.1364683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Over recent decades, domestic violence or family violence, violence against women and child abuse has received much attention in the media, in political discourse and in social research. However, abuse of older adults arouses limited interest. In government action against domestic violence and in police guidance manuals, the elderly receive little attention. The aim of this article is primarily to demonstrate how the police attempt to prevent elder abuse in close relationships, especially in parent-child relationships. This article highlights some contradictions between the need of the police to produce criminal cases (often contrary to the interests of the victims) on the one hand, and the police's duty to prevent further abuse on the other. Research has documented that help and prevention measures in question make the situation even worse for the victims they are meant to help.
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Affiliation(s)
- Geir Aas
- a The Norwegian University Police College , Oslo , Norway
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26
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Slettebø Å, Saeteren B, Caspari S, Lohne V, Rehnsfeldt AW, Heggestad AKT, Lillestø B, Høy B, Råholm MB, Lindwall L, Aasgaard T, Nåden D. The significance of meaningful and enjoyable activities for nursing home resident's experiences of dignity. Scand J Caring Sci 2016; 31:718-726. [PMID: 27910119 DOI: 10.1111/scs.12386] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2016] [Accepted: 08/31/2016] [Indexed: 11/26/2022]
Abstract
BACKGROUND Living in a nursing home may be challenging to the residents' experience of dignity. Residents' perception of how their dignity is respected in everyday care is important. AIM To examine how nursing home residents experience dignity through the provision of activities that foster meaning and joy in their daily life. METHOD A qualitative design was used and 28 individual semistructured interviews conducted with nursing home residents from six nursing homes in Denmark, Norway and Sweden. The data were analysed with qualitative content analysis. Independent ethical committees in all participating countries granted their approval for the study. FINDINGS The participants highlight two dimensions of the activities that foster experiences of dignity in nursing homes in Scandinavia. These two categories were (i) fostering dignity through meaningful participation and (ii) fostering dignity through experiencing enjoyable individualised activities. CONCLUSION Activities are important for residents to experience dignity in their daily life in nursing homes. However, it is important to tailor the activities to the individual and to enable the residents to take part actively. Nurses should collect information about the resident's preferences for participation in activities at the nursing home.
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Affiliation(s)
| | - Berit Saeteren
- Oslo and Akershus University College of Applied Sciences, Oslo, Norway
| | - Synnøve Caspari
- Oslo and Akershus University College of Applied Sciences, Oslo, Norway
| | - Vibeke Lohne
- Oslo and Akershus University College of Applied Sciences, Oslo, Norway
| | | | | | | | - Bente Høy
- VIA University College, Århus, Denmark
| | | | | | - Trygve Aasgaard
- Oslo and Akershus University College of Applied Sciences, Oslo, Norway
| | - Dagfinn Nåden
- Oslo and Akershus University College of Applied Sciences, Oslo, Norway
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Maurits EEM, de Veer AJE, Groenewegen PP, Francke AL. Dealing with professional misconduct by colleagues in home care: a nationwide survey among nursing staff. BMC Nurs 2016; 15:59. [PMID: 27777510 PMCID: PMC5062941 DOI: 10.1186/s12912-016-0182-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2016] [Accepted: 10/04/2016] [Indexed: 11/23/2022] Open
Abstract
Background Professional misconduct in healthcare, a (generally) lasting situation in which patients are at risk or actually harmed, can jeopardise the health and well-being of patients and the quality of teamwork. Two types of professional misconduct can be distinguished: misconduct associated with incompetence and that associated with impairment. This study aimed to (1) quantify home-care nursing staff’s experiences with actual or possible professional misconduct; (2) provide insight into the difficulty home-care nursing staff experience in reporting suspicions of professional misconduct within the organisation and whether this is related to the individual characteristics of nursing staff; and (3) show which aspects of professional practice home-care nursing staff consider important in preventing professional misconduct. Methods A questionnaire survey was held among registered nurses and certified nursing assistants employed in Dutch home-care organisations in 2014. The 259 respondents (60 % response rate; mean age of 51; 95 % female) were members of the Dutch Nursing Staff Panel, a nationwide group of nursing staff members in various healthcare settings. Results Forty-two percent of the nursing staff in home care noticed or suspected professional misconduct by another healthcare worker during the previous year, predominantly a nursing colleague. Twenty to 52 % of the nursing staff experience difficulty in reporting suspicions of different forms of incompetence or impairment. This is related to educational level (in the case of incompetence), and managerial tasks (both in the case of incompetence and of impairment). Nursing staff consider a positive team climate (75 %), discussing incidents (67 %) and good communication between healthcare workers (57 %) most important in preventing professional misconduct among nursing staff. Conclusions Suspicions of professional misconduct by colleagues occur quite frequently among nursing staff. However, many nursing staff members experience difficulty in reporting suspicions of professional misconduct, especially in the case of suspected impairment. Home-care employers and professional associations should eliminate the barriers that nursing staff may encounter when they attempt to raise an issue. Furthermore, advocating a positive team climate within nursing teams, encouraging nursing staff to discuss incidents and facilitating this, and promoting good communication between healthcare workers may be appropriate strategies that help reduce professional misconduct by nursing staff.
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Affiliation(s)
- Erica E M Maurits
- Netherlands Institute for Health Services Research (NIVEL), P.O. Box 1568, 3500 BN Utrecht, The Netherlands
| | - Anke J E de Veer
- Netherlands Institute for Health Services Research (NIVEL), P.O. Box 1568, 3500 BN Utrecht, The Netherlands
| | - Peter P Groenewegen
- Netherlands Institute for Health Services Research (NIVEL), P.O. Box 1568, 3500 BN Utrecht, The Netherlands ; Department of Sociology and Department of Human Geography, Utrecht University, Utrecht, The Netherlands
| | - Anneke L Francke
- Netherlands Institute for Health Services Research (NIVEL), P.O. Box 1568, 3500 BN Utrecht, The Netherlands ; Department of Public and Occupational Health, EMGO Institute for Health and Care Research (EMGO+), VU University Medical Center, Amsterdam, The Netherlands
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Phelan A. Protecting care home residents from mistreatment and abuse: on the need for policy. Risk Manag Healthc Policy 2015; 8:215-23. [PMID: 26640391 PMCID: PMC4657805 DOI: 10.2147/rmhp.s70191] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
With a rising older person population with increasing life expectancies, the demand for care homes will increase in the future. Older people in care homes are particularly vulnerable due to their dependencies related to cognitive and/or functional self-care challenges. Although many care homes provide good care, maltreatment and abuse of older people can and does occur. One major step in preventing and addressing maltreatment in care homes is having comprehensive and responsive policy, which delineates national expectations that are locally implemented. This paper examines the literature related to maltreatment in care homes and argues for policy based on a multisystems approach. Policy needs to firstly acknowledge and address general societal issues which tacitly impact on older person care delivery, underpin how care homes and related systems should be operationalized, and finally delineate expected standards and outcomes for individual experience of care. Such a policy demands attention at every level of the health care and societal system. Furthermore, contemporary issues central to policy evolution in care homes are discussed, such as safeguarding education and training and fostering organization whistle-blowing protection.
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Affiliation(s)
- Amanda Phelan
- School of Nursing, Midwifery and Health Systems, University College Dublin, Ireland
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Harrington C, Armstrong H, Halladay M, Havig AK, Jacobsen FF, MacDonald M, Panos J, Pearsall K, Pollock A, Ross L. Comparison of Nursing Home Financial Transparency and Accountability in Four Locations. AGEING INTERNATIONAL 2015. [DOI: 10.1007/s12126-015-9233-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Sexual abuse of older nursing home residents: a literature review. Nurs Res Pract 2015; 2015:902515. [PMID: 25642347 PMCID: PMC4302365 DOI: 10.1155/2015/902515] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2014] [Accepted: 12/23/2014] [Indexed: 11/17/2022] Open
Abstract
Despite an increasing literature related to elder abuse, sexual abuse of older persons in general and of vulnerable adults living in nursing homes in particular is still sparsely described. The purpose of this study was to assess the state of knowledge on the subject of sexual abuse against older nursing home residents through a literature review. Systematic searches in reference databases including Cinahl, Medline, OVID Nursing Database, ISI Web of Science, PsycINFO, Cochrane Library, and SveMed + were conducted. Through several phases of selection of the articles, using strict inclusion and exclusion criteria, six articles were chosen for a deeper examination. Findings from the review show that sexual abuse occurs in nursing homes and that both older women and men are victims of sexual abuse. Perpetrators appear mainly to be staff and other residents and mainly to be men, but also women abuse both older men and older women. Findings from the literature review show that there is a need for knowledge and further research on the topic of sexual abuse against older residents in nursing homes. Furthermore, there is a need for good policies and reporting systems, as an important step in seriously addressing sexual abuse against older persons.
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Winsvold Prang I, Jelsness-Jørgensen LP. Should I report? A qualitative study of barriers to incident reporting among nurses working in nursing homes. Geriatr Nurs 2014; 35:441-7. [PMID: 25305674 DOI: 10.1016/j.gerinurse.2014.07.003] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2014] [Revised: 07/16/2014] [Accepted: 07/19/2014] [Indexed: 10/24/2022]
Abstract
Adverse events, errors and acts of inadequate care have been shown to occur quite frequently in hospitals, and there is growing evidence that this poor care may also occur in nursing homes. Based on hospital studies, we know that incidents are only reported to a limited extent and that there may be a high number of unrecorded cases. Moreover, little is known about the barriers to incident reporting in nursing homes compared to hospitals. Consequently, the aim of this study was to explore the barriers to incident reporting in nursing homes. Thematic analysis of 13 semi-structured interviews with nurses revealed that unclear outcomes, lack of support and culture, fear of vilification and conflicts, unclear routines, technological knowledge and confidence, time and degree of severity were the main drivers of not reporting incidents. These findings may be important in planning quality and safety improvement interventions in nursing homes.
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Svanström R, Johansson Sundler A, Berglund M, Westin L. Suffering caused by care-elderly patients' experiences in community care. Int J Qual Stud Health Well-being 2013; 8:20603. [PMID: 24262375 PMCID: PMC3837301 DOI: 10.3402/qhw.v8i0.20603] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/18/2013] [Indexed: 12/02/2022] Open
Abstract
Background Growing old involves many changes in life and implies an increased risks of illness and different forms of disabilities. Life may change in a radical way when a person gets a disease like dementia or moves to a nursing home due to disabilities or needs. In both cases, it often leads to an increased dependency on care where the patient becomes exposed and vulnerable and thereby at a higher risk for experiencing different forms of suffering. Aim The aim of this study was to elucidate and gain a deeper understanding of elderly patients’ experiences of suffering in relation to community care in nursing homes and home care services. Materials and methods A lifeworld hermeneutical approach was used. Phenomenological interviews and conversations with an open approach were conducted and analysed with a focus on meanings. Findings The findings were presented in four main themes; an absence of the other in care, an absence of dialogues, a sense of alienation and a sense of insecurity. The findings in this study revealed that persons who were cared for in nursing homes and home care services sometimes were exposed to an unnecessary suffering. The suffering sometimes was caused by various caring actions, that is, unnecessary suffering. The suffering caused by care that aroused was due to caregiver’s inability to be present, to show their face, and truly meet the patient. Conclusion Suffering from care increased the elderly patients’ feelings of insecurity, loneliness, and alienation; this seemed to be the foundation for patients’ experiences of being outside a human community. There was a lack of knowledge and understanding about the patient’s lifeworld.
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Affiliation(s)
- Rune Svanström
- School of Life Sciences, University of Skövde, Skövde, Sweden;
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Effects of a computerized decision support system on care planning for pressure ulcers and malnutrition in nursing homes: An intervention study. Int J Med Inform 2013; 82:911-21. [DOI: 10.1016/j.ijmedinf.2013.05.009] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2013] [Revised: 05/28/2013] [Accepted: 05/30/2013] [Indexed: 01/19/2023]
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Reader TW, Gillespie A, Mannell J. Patient neglect in 21st century health-care institutions: a community health psychology perspective. J Health Psychol 2013; 19:137-48. [PMID: 24058107 DOI: 10.1177/1359105313500256] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Despite the technological and organisational advances of 21st century health-care systems, care scandals and burgeoning complaints from patients have raised concerns about patient neglect in hospitals. This article reviews the concept of patient neglect and the role of community health psychology in understanding its occurrence. Patient neglect has previously been conceptualised as a problem associated with hospital staff attitudes and behaviours, with regulation and training cited as solutions. Yet, a community health psychology perspective shows that the wider symbolic, material and relational aspects of care are crucial for understanding why patient neglect occurs and for outlining new solutions to augment existing interventions.
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Schwendimann R, Zúñiga F, Ausserhofer D, Schubert M, Engberg S, de Geest S. Swiss Nursing Homes Human Resources Project (SHURP): protocol of an observational study. J Adv Nurs 2013; 70:915-26. [PMID: 24102650 DOI: 10.1111/jan.12253] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/17/2013] [Indexed: 11/26/2022]
Abstract
AIM To explore the relationships among various nursing homes characteristics including work environment, careworker outcomes and resident outcomes in Swiss nursing homes. BACKGROUND In Switzerland, a growing number of older people live in nursing homes. Although research has addressed the issue of quality of nursing care in such facilities, few have integrated a range of interrelated factors that may influence the quality and safety of residential care. The Swiss Nursing Homes Human Resources Project will comprehensively assess key organizational factors, their interrelationships and the associations between these factors and careworker and resident outcomes. DESIGN Cross-sectional design. METHODS Three-year multi-centre study (2011-2013) including a representative sample of approximately 160 nursing homes across the three language regions in Switzerland. Survey data will come from approximately 6000 careworkers and 160 administrators. Survey questionnaires will include variables on organizational facility characteristics and resident outcomes, careworker socio-demographic and professional characteristics, the quality of their work environments, resident safety climates and careworker outcomes. Appropriate descriptive and comparative analysis will be used and multivariate and multilevel analyses will be applied to examine the relationships among the various factors including quality of the work environment, safety climate, work stressors, rationing of care, workload, careworker and resident characteristics, as well as resident and careworker outcomes. DISCUSSION The study results will contribute to a comprehensive understanding of the interrelationships between key organizational factors and resident/careworker outcomes and will also support planning and conducting interventions to improve quality of care concerning organizational factors affecting careworkers in daily practice.
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Phillips LR, Guo G, Kim H. Elder mistreatment in U.S. residential care facilities: the scope of the problem. J Elder Abuse Negl 2013; 25:19-39. [PMID: 23289415 DOI: 10.1080/08946566.2012.712851] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Many in the United States believe elder mistreatment in long-term care is serious and widespread, but until recently few studies focused on the problem. This study was designed to describe the scope of mistreatment in assisted living facilities (ALFs) in Arizona during a 3-year period. Findings showed that receiving citations for elder mistreatment was relatively rare. However, analysis of narrative reports from only 7% of facilities showed 598 allegations of mistreatment in complaint investigations, of which 372 (62.2%) were substantiated and given citations for something other than mistreatment. Results show that elder mistreatment in ALFs is seriously underidentified, even by state inspectors.
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Affiliation(s)
- Linda R Phillips
- School of Nursing, University of California-Los Angeles, Los Angeles, California 90095-1702, USA.
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37
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Reader TW, Gillespie A. Patient neglect in healthcare institutions: a systematic review and conceptual model. BMC Health Serv Res 2013; 13:156. [PMID: 23631468 PMCID: PMC3660245 DOI: 10.1186/1472-6963-13-156] [Citation(s) in RCA: 91] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2012] [Accepted: 04/24/2013] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Patient neglect is an issue of increasing public concern in Europe and North America, yet remains poorly understood. This is the first systematic review on the nature, frequency and causes of patient neglect as distinct from patient safety topics such as medical error. METHOD The Pubmed, Science Direct, and Medline databases were searched in order to identify research studies investigating patient neglect. Ten articles and four government reports met the inclusion criteria of reporting primary data on the occurrence or causes of patient neglect. Qualitative and quantitative data extraction investigated (1) the definition of patient neglect, (2) the forms of behaviour associated with neglect, (3) the reported frequency of neglect, and (4) the causes of neglect. RESULTS Patient neglect is found to have two aspects. First, procedure neglect, which refers to failures of healthcare staff to achieve objective standards of care. Second, caring neglect, which refers to behaviours that lead patients and observers to believe that staff have uncaring attitudes. The perceived frequency of neglectful behaviour varies by observer. Patients and their family members are more likely to report neglect than healthcare staff, and nurses are more likely to report on the neglectful behaviours of other nurses than on their own behaviour. The causes of patient neglect frequently relate to organisational factors (e.g. high workloads that constrain the behaviours of healthcare staff, burnout), and the relationship between carers and patients. CONCLUSION A social psychology-based conceptual model is developed to explain the occurrence and nature of patient neglect. This model will facilitate investigations of i) differences between patients and healthcare staff in how they perceive neglect, ii) the association with patient neglect and health outcomes, iii) the relative importance of system and organisational factors in causing neglect, and iv) the design of interventions and health policy to reduce patient neglect.
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Affiliation(s)
- Tom W Reader
- Institute of Social Psychology, London School of Economics, Houghton Street, London WC2A 2AE, UK
| | - Alex Gillespie
- Institute of Social Psychology, London School of Economics, Houghton Street, London WC2A 2AE, UK
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Habjanič A, Saarnio R, Elo S, Turk DM, Isola A. Challenges for institutional elder care in Slovenian nursing homes. J Clin Nurs 2012; 21:2579-89. [PMID: 22889448 DOI: 10.1111/j.1365-2702.2011.04044.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
AIMS AND OBJECTIVES To investigate deficiencies in the institutional elder care that is being offered to residents of nursing homes in Slovenia. BACKGROUND Public criticism of the provision of elder care in nursing homes is growing all over the world, including in Slovenia. Many studies on this issue have been conducted, but seldom have assessed different viewpoints simultaneously. DESIGN A qualitative research design that involved individual unstructured interviews was used in 2007. The participants (n=48) comprised 16 residents, 16 relatives and 16 members of the nursing staff from four nursing homes in Slovenia. METHODS The data generated were subjected to qualitative content analysis. RESULTS The major themes that emerged from this analysis were neglect, unprofessional communication, uncomfortable physical environment and inadequate administration. CONCLUSIONS The participants of the study identified issues in institutional elder care in Slovenia that have also been highlighted by international research. Due to staff shortages, low motivation, insufficient communication skills and inexperience, members of the nursing staff reported that they were not in a position to offer the best possible quality of care. RELEVANCE TO CLINICAL PRACTICE To improve the living environment in nursing homes, it is important to consider the opinions of all those who are involved closely in institutional elder care. Correction of deficiencies should be a priority and should result in more engagement with residents.
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Affiliation(s)
- Ana Habjanič
- Faculty of Health Sciences, University of Maribor, Maribor, Slovenia.
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Abstract
Age is the only social category identifying subgroups that everyone may eventually join. Despite this and despite the well-known growth of the older population, age-based prejudice remains an understudied topic in social psychology. This article systematically reviews the literature on ageism, highlighting extant research on its consequences and theoretical perspectives on its causes. We then identify a crucial gap in the literature, potential intergenerational tensions, speculating how a growing-older population-and society's efforts to accommodate it-might stoke intergenerational fires, particularly among the younger generation. Presenting both sides of this incipient issue, we review relevant empirical work that introduces reasons for both optimism and pessimism concerning intergenerational relations within an aging society. We conclude by suggesting future avenues for ageism research, emphasizing the importance of understanding forthcoming intergenerational dynamics for the benefit of the field and broader society.
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Affiliation(s)
- Michael S North
- Department of Psychology, Princeton University, Princeton, NJ 08540, USA.
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Abstract
RÉSUMÉCet article examine les développements dans le domaine de la maltraitance et de la négligence des aînés depuis la publication de Elder Abuse and Neglect in Canada (Butterworths, 1991). Les arguments présentés ici sont de deux ordres : d’abord, nous n’avons aucune idée de la taille ou de la nature du problèmes de la violence et de la négligence dans la communauté ou dans les institutions et, d’autre part, nous ne savons pas comment résoudre ces problèmes ou leurs questions connexes qui ont été masqués par la rhétorique et le recyclage de l’information pendant les 20 dernières années. C’est le temps d’avancer au-delà de la « phase de sensibilisation ». Ce à quoi nous devons nous attaquer à l’avenir est aussi évident aujourd’hui qu’il ne l’était il y a 20 ans. Notre connaissance est incomplète parce qu’il nous manque le type d’enquêtes dont le besoin se fait le plus urgent: les études de prévalence dans la communauté et les institutions, un développement théoriquement solide, et des essais cliniques randomisé pour tester à la fois nos interventions socialement et juridiquement.
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Habjanič A, Lahe D. Are frail older people less exposed to abuse in nursing homes as compared to community-based settings? Statistical analysis of Slovenian data. Arch Gerontol Geriatr 2011; 54:e261-70. [PMID: 21872349 DOI: 10.1016/j.archger.2011.07.006] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2011] [Revised: 07/15/2011] [Accepted: 07/19/2011] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Although international research in recent years has often focused on elder abuse, its extent is not clear in community-based settings and even bigger mystery in nursing homes. BACKGROUND Until now in the literature it has in most cases only been assumed that nursing homes offer better protection from abuse for frail older people. METHODS A cross-sectional research design was applied by use of structured interviews. Those involved were frail older people (n=300) who were in need of some sort of professional nursing assistance. RESULTS Nursing home accommodation was extracted as the strongest predictor, significantly reducing the risk of physical abuse (odds ratio, OR 0.1, 95% confidence interval, 95% CI 0.0-0.3) and financial abuse (OR 0.2, 95% CI 0.1-0.4). Spouses and sons were revealed as the most regular perpetrators of physical and financial abuse. The results showed no statistical significance between settings as predictors of the occurrence of mental abuse (OR 0.9, 95% CI 0.5-1.6). DISCUSSION Results of the statistical analysis add to the general assumption that nursing home accommodation offers protection for frail older people in escaping physical and financial abuse. CONCLUSION In their clinical practice, community nurses should give special attention to frail older people who, besides their healthcare needs, are also heavily dependent in the activities of daily living (ADLs). In order to combat elder abuse, conditions in the family should be regularly verified.
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Affiliation(s)
- Ana Habjanič
- University of Maribor, Faculty of Health Sciences, Žitna ulica 15, SI-2000 Maribor, Slovenia.
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Fossum M, Alexander GL, Ehnfors M, Ehrenberg A. Effects of a computerized decision support system on pressure ulcers and malnutrition in nursing homes for the elderly. Int J Med Inform 2011; 80:607-17. [PMID: 21783409 DOI: 10.1016/j.ijmedinf.2011.06.009] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2010] [Revised: 06/16/2011] [Accepted: 06/24/2011] [Indexed: 10/18/2022]
Abstract
BACKGROUND Computerized decision support systems (CDSSs) have been shown to help health care professionals to avoid errors and improve clinical practice and efficiency in health care. Little is known about its influence on nursing practice and outcomes for residents in nursing homes. AIM The aim of this study was to evaluate the effects on the risk for and prevalence of pressure ulcers (PUs) and malnutrition of implementing a CDSS to improve prevention and care of PUs and also to improve nutrition in the elderly in nursing homes. DESIGN SETTING AND PARTICIPANTS The study used a quasi-experimental design with two intervention groups and one control group. A convenience sample of residents from 46 units in 15 nursing homes in rural areas in Norway was included. A total of 491 residents participated at baseline in 2007 and 480 residents at follow-up in 2009. METHODS The intervention included educational sessions in prevention of PUs and malnutrition for registered nurses (RNs) and nursing aides (NAs) in the two intervention groups. In addition, one intervention group (intervention group 1) had a CDSS integrated into the electronic healthcare record (EHR) based on two research-based risk assessment instruments: the Risk Assessment Pressure Scale (RAPS) for PU risk screening and the Mini Nutritional Assessment (MNA(®)) scale for screening nutritional status. In each participating nursing home trained RNs and NAs examined all residents who consented to participate on the RAPS and the MNA(®) scale. This examination included a skin assessment and details about PUs were collected. RESULTS The proportion of malnourished residents decreased significantly in intervention group 1 between the two data collection periods (2007 and 2009). No other significant effects of the CDSS on resident outcomes based on the RAPS and MNA(®) scores were found. CONCLUSION CDSSs used by RNs and NAs in nursing homes are still largely unexplored. A CDSS can be incorporated into the EHR to increase the meaningful use of these computerized systems in nursing home care. The effects of CDSS on healthcare provider workflow, clinical decision making and communication about preventive measures in nursing home practice still need further exploration. Based on results from our study, recommendations would be to increase both sample size and the number of RNs and NAs who participate in CDSS education programs.
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Affiliation(s)
- Mariann Fossum
- School of Health and Medical Sciences, Örebro University, Örebro, Sweden.
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Fossum M, Alexander GL, Göransson KE, Ehnfors M, Ehrenberg A. Registered nurses’ thinking strategies on malnutrition and pressure ulcers in nursing homes: a scenario-based think-aloud study. J Clin Nurs 2011; 20:2425-35. [DOI: 10.1111/j.1365-2702.2010.03578.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Kjølseth I, Ekeberg Ø, Steihaug S. Elderly people who committed suicide--their contact with the health service. What did they expect, and what did they get? Aging Ment Health 2010; 14:938-46. [PMID: 21069599 DOI: 10.1080/13607863.2010.501056] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVE Contact between elderly patients and healthcare professionals may be crucial for suicide prevention if suicidal tendencies are revealed and help is to be provided. The objective of the study was to investigate how elderly suicide cases had perceived the health service and what characterised their contact with it. METHOD This is a psychological autopsy study based on qualitative interviews with people who had known 1 of the total of 23 suicide cases aged over 65. The 63 informants were relatives, general practitioners (GPs) and home-based care workers. The systematic text condensation method was applied to analyse interviews. RESULTS Many of the elderly expressed distrust of health service once their functional decline began. They feared losing their autonomy if they became dependent on help, and many therefore refused health service provisions. Communication between them and helpers failed. As they gradually became more dependent on medical care, many experienced that they were not given the desired help, which confirmed their distrust. CONCLUSION Contact between these people and the health service must inspire confidence for it to prevent suicide. Elderly people at risk of suicide are vulnerable: they feel degraded if their autonomy is threatened by health personnel. The structure and organisation of the health service, and each worker's contact with the elderly, must preserve their dignity. Dignity must be evinced through the healthcare professionals' treatment of elderly people and a system that meets their needs.
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Affiliation(s)
- Ildri Kjølseth
- RVTS, Oslo University Hospital, Aker, 0514 Oslo, Norway.
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Abstract
ABSTRACTThe aim of the study was to assess the prevalence of abuse among the residents of long-term care facilities in Israel, and its associations with risk indicators. Seventy-one such residents aged 70 or more years were assessed in the internal and orthopaedic departments of two university medical centres for possible abuse by carers at the long-term facilities from which they were admitted. The study collected socio-demographic and health profiles and a list of maltreatment or abusive acts, and administered the Signs of Abuse Inventory and the Expanded Indicators of Abuse Questionnaire. Among the 71 residents, 31 per cent reported some form of maltreatment, most being instances of disrespectful behaviour. Signs of abuse, mostly of neglect, were detected in 22.5 per cent of the sample. Hierarchical regression analysis revealed that higher scores on risk indicators and higher dependence on others for the activities of daily living significantly associated with reported abuse, while age, gender, risk indicators and lower blood albumin level (being an indicator of worse nutritional and health status) significantly associated with identified signs of abuse. It is concluded that direct questioning mainly discloses instances of disrespectful behaviours and humiliation, while the assessment of signs of abuse is more sensitive to cases of neglect. Risk indicators were found to be reliable indicators of abuse. Routine screening for these indicators is recommended to improve detection and thereby to prevent abuse in long-term care facilities.
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Lekan D, Hendrix CC, McConnell ES, White H. The Connected Learning Model for disseminating evidence-based care practices in clinical settings. Nurse Educ Pract 2010; 10:243-8. [PMID: 20100666 DOI: 10.1016/j.nepr.2009.11.013] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2008] [Revised: 09/23/2009] [Accepted: 11/15/2009] [Indexed: 10/19/2022]
Abstract
Clinical practice guidelines have been developed to improve patient care and outcomes. Guideline implementation is often stymied by the complexity of patients' conditions, complex care environments, and limited advanced clinical training of nursing staff. To translate key elements of heart failure guidelines into practice in a nursing home, the Connected Learning Model was developed based on the diffusion of innovations framework. An advanced practice nurse in geriatrics fostered greater interaction and collaboration among key administrative, medical, and nursing staff to promote awareness of heart failure guidelines and to translate key practices from those guidelines into the nursing home setting. Direct care staff skills for early recognition and reporting of signs and symptoms of acute heart failure were enhanced through a learner-centered educational program which included classroom and unit-based instruction and bedside clinical teaching. The Connected Learning Model is a promising method to mobilize advanced nursing expertise to bridge research/practice gaps through implementation of clinical practice guidelines that are systematically adapted to accommodate diverse health care contexts.
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Affiliation(s)
- Deborah Lekan
- Duke University School of Nursing, 311 Trent Drive, Box 3322 DUMC, Durham, NC 27710, USA.
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Malmedal W, Hammervold R, Saveman BI. To report or not report? Attitudes held by Norwegian nursing home staff on reporting inadequate care carried out by colleagues. Scand J Public Health 2009; 37:744-50. [DOI: 10.1177/1403494809340485] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Aims: The aims of this study are, first, to describe attitudes held by nursing home staff on reporting acts of inadequate care committed by their colleagues, and second, to investigate whether nursing staff have different attitudes depending on age, education, and length of experience of working in the healthcare services. Methods: A questionnaire survey was conducted among nursing staff in 16 nursing homes in the central part of Norway. The response rate was 79% (n=616). Results: A positive attitude towards reporting acts of inadequate care committed by their colleagues was held by the participants in this study. Compared with younger staff, the older staff seemed to be more reluctant to report colleagues, to feel less brave, to be more afraid of what would happen to them if they reported, and to agree that it is best to deal with such matters internally. Regarding education, it seemed that a higher educational level was related with a more positive attitude towards a willingness to report and less fear of negative sanctions. Conclusions: Staff who observe acts of inadequate care committed by colleagues agree that it is their intention to report such incidents. Institutions need to develop and implement mechanisms for understanding and evaluating acts of inadequate care, and staff must be encouraged to speak out on behalf of residents rather than be punished for doing so.
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Affiliation(s)
- Wenche Malmedal
- Faculty of Health Education and Social Work, Sør-Trøndelag University College, Trondheim, Norway,
| | - Randi Hammervold
- Sør-Trøndelag University College, Trondheim Business School, Trondheim, Norway
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