The elderly in nursing homes: psychological aspects of neglect

It has been argued that many elderly people are placed in nursing homes to isolate them from view, and little research has been done to investigate the effects of such isolation. Some research has focused on certain aspects of abuse and neglect of the elderly, particularly physical, material, and fiscal aspects of abuse. The purpose of this paper is to discuss psychological aspects of abuse and neglect of the elderly in the nursing home environment. Data are presented indicating that psychological aspects of neglect are subtle and not readily apparent to the observer; yet they may be very impactful in terms of their effects. Data also are presented indicating that they constitute the most common form of abuse. Psychological aspects of neglect are divided into categories including: the nature of the physical environment; nutrition and diet; physical appearance and grooming; infantilization; environmental deprivation; and benign neglect. Possible interventions are offered as alternatives to neglect, and research data are summarized as to how such interventions might benefit both the elderly and the clinical staff dealing with such a population.     

The Elderly in Nursing Homes

It has been argued that many elderly people are placed in nursing homes to isolate them from view, and little research has been done to investigate the effects of such isolation. Some research has focused on certain aspects of abuse and neglect of the elderly, particularly physical, material, and fiscal aspects of abuse. The purpose of this paper is to discuss psychological aspects of abuse and neglect of the elderly in the nursing home environment. Data are presented indicating that psychological aspects of neglect are subtle and not readily apparent to the observer; yet they may be very impactful in terms of their effects. Data also are presented indicating that they constitute the most common form of abuse. Psychological aspects of neglect are divided into categories including: the nature of the physical environment; nutrition and diet; physical appearance and grooming; infantilization; environmental deprivation; and benign neglect. Possible interventions are offered as alternatives to neglect, and research data are summarized as to how such interventions might benefit both the elderly and the clinical staff dealing with such a population.     

Früherkennung und Prävention von Misshandlung und Vernachlässigung in der familialen Pflege

The purpose of the PURFAM (“potentials and risk factors of family caregiving for older people”) project is to support staff members of home care services in preventing elder abuse by facilitating an assessment instrument for early recognition and a standard for action. During a pilot phase of the project nursing staff of home services were presented with training sessions in which the use of the PURFAM assessment was introduced using concrete examples from routine daily work. The article describes the development of the PURFAM assessment and its first evaluation by staff members of nursing home services. The preliminary results indicate a high practicability und acceptance of the instrument by staff members. The sustainability of PURFAM is yet to be tested using the data of the still ongoing main part of the evaluation.     

Resident behavior and staff distress in the nursing home

Newly enacted Federal regulations have focused increasing attention on the use of psychoactive drugs and on the treatment of disruptive behavior in the nursing home. To study the interaction between resident behavior and staff distress in nursing homes, we measured the frequency of seven types of behavior problems among 346 residents of intermediate care facilities who were receiving some form of psychoactive medication. Nurses were interviewed on two shifts to determine their perception of the frequency and severity of each behavior in each patient as well as the level of distress it caused among caregivers. The most common behavior problems noted were agitation (42%), withdrawal (33%), and noisiness (27%). Only half of the reported instances of behavior disorders were considered distressful by nursing home staff. While physical abuse caused distress 92% of the time and verbal abuse 90% of the time, wandering was seen as distressful to staff only 50% of the time. Nearly a third of "wandering" patients were restrained; they produced less distress than non-restrained wanderers. There was substantial disagreement, ranging from 6% to 22% for individual residents, over the presence of distress-causing behavior, although day and evening nursing shifts rated the frequencies of behavior and the degrees of distress equally on average. Residents with higher cognitive function were less likely to cause distress for all behaviors, except for verbal abuse where the reverse was true. Age and dependency in activities of daily living were not associated with problematic behavior or staff distress. These findings indicate that the existence of "problematic" behaviors in a given resident is often perceived differently by different staff, and its impact on staff also differs widely.     

The Abusive Resident

While much has rightly been written and discussed concerning the abuse of residents in institutional settings, very little has been done to address the problem of residents who disrupt the tranquility of the nursing home through verbal or physical abuse of the staff and other residents. This article presents a glimpse of whom these abusive residents are, and the scope of the current problem. It attempts to assess and understand the causes of the problem behavior and suggests possible action plans to provide activities that will prevent harm to the staff or residents and result in an enhanced quality of life for the abusive resident. In addition, the article discusses various methods for avoiding and/or minimizing the staff burnout that inevitably accompanies working in these high stress situations.     

Sexual abuse of older adults: APS cases and outcomes

PURPOSE: The purpose of this study was to develop a profile of sexual abuse cases among adults aged 60 and older receiving attention from Adult Protective Services units in Virginia over a 5-year period. DESIGN AND METHODS: We used bivariate analysis to characterize older adults (n = 82) experiencing sexual abuse and the circumstances of the abuse. We used multiple correspondence analysis, a multivariate method, to explore relationships between characteristics of the older adults and the type of sexual abuse experienced. RESULTS: Most victims of sexual abuse were women, between the ages of 70 and 89, residing in a nursing home. Typically, sexual abuse involved instances of sexualized kissing and fondling and unwelcome sexual interest in the person's body. The majority of perpetrators were nursing home residents who were 60 years of age and older. In most situations, witnesses to the sexual abuse were facility residents. IMPLICATIONS: Orientation affects the invasiveness of the sexual abuse experienced by older adults. Our data reveal a small but persistent number of cases identifying individuals who are especially vulnerable to this form of abuse. These findings establish a baseline for future research and set the stage for further examination in both domestic and institutional settings as well as possible interventions and staff training.     

Methadone maintenance and the problem with alcohol.

There is a growing concern with the rapid pace of physical and psychosocial deterioration of methadone patients who abuse alcohol. The need for a sample method for determining the extent of the problem, as well as the presence of an alcohol problem in individual patients, led the authors to test the validity of the Michigan Alcoholism Sreen Test (MAST) in a small urban methadone maintenance clinic (N = 125). The MAST was administered to every patient by their counselors, and the nursing staff was asked to independently rate each patient according to Keller's definition of alcoholism. The authors compared the patients' MAST scores with the global ratings of the nursing staff. Forty-six percent (n = 58) of the patients scored in the alcoholism range of the MAST questionnaire, while 34% (n = 43) of the patients were diagnosed as alcoholics by the nursing staff. There was 75% (n = 94) agreement between the MAST findings and the nurses' global ratings (p less than .001). The authors suggest that the MAST could be an effective screening tool in the area of alcohol abuse in methadone clinics. Going beyond the data, the authors recommend reexamination by psychiatrists of their peripheral role in the treatment of these difficult and multihandicapped patients.     

Effects of ambient baroque music on patients with dementia

Objective: To determine the effect of ambient baroque music on the behaviour of patients with dementia in a nursing home. Method: An observational study involving 14 dementia patients in a nursing home for six weeks. We measured adverse patient behaviours such as episodes of calling out, wandering, aggression, talking to self, verbal abuse and signs of agitation, as well as need for night sedation. Results: Adverse behaviours decreased by over 40% during the intervention period. Conclusions: A strong positive result was obtained in this pilot study. Potential benefits of the intervention are considerable as it is non‐invasive, cost‐effective and pleasant for patients and staff alike. Larger, randomised controlled studies are warranted.     

Childhood Sexual Abuse

Abstract

Little is known and less is written about post-traumatic stress disorder (PTSD) in institutionalized older adults, especially in the context of their past exposure to child sexual assault. The behavioral and psychological manifestations displayed by child sexual abuse survivors are considered especially in the context of possible symptom reactivation throughout the life course. Analysis is offered of the ways in which aging itself and the organizational practices of long-term care institutions may serve to reactivate and exacerbate long-dormant child sexual abuse thoughts, feelings, and symptoms in residents. Specific recommendations for needed research as well as nursing home staff training, programming, and policy are put forward.     

Enhancing mutual respect among nursing assistants, residents, and residents' families

Interviews with nursing assistants and residents revealed ways in which they experience respect, disrespect, attachment, and distancing in their relationships with each other. As a result of these findings, an inservice session on interpersonal respect was developed for nursing assistants. Manifestations of disrespect and strategies for promoting mutually respectful relationships among residents, their families, and staff in the facility are presented.     

Factors contributing to the hospitalization of nursing home residents

This anthropological study describes and analyzes the clinical and social-structural factors contributing to the hospitalization of nursing home residents. In 48.2% of the cases, hospitalization could have been avoided. Factors such as an insufficient number of adequately trained nursing staff, the inability of nursing staff to administer and monitor intravenous therapy, lack of diagnostic services, and pressure for transfer from the staff and family contributed to hospitalization. In the United States each year, an estimated 216,000 nursing home residents who are hospitalized might be treated in the nursing home, for a cost savings of $942,763,530.     

Elder abuse and its impact on quality of life in nursing homes in China

There are limited available data on elder abuse and its impact on quality of life (QOL) in China. This study investigated the prevalence of elder abuse in nursing homes and its associated demographic, clinical factors and QOL in Macau and Guangzhou, China. A total of 681 subjects (244 in Macau and 437 in Guangzhou) were consecutively recruited. The prevalence of elder abuse was 11.48% and 8.24% in Macau and Guangzhou, respectively. Multivariate analyses revealed that having a religion and depressive symptoms were independently and positively associated with elder abuse. No significant association between elder abuse and any QOL domain was found. Elder abuse is common in nursing homes in both Macau and Guangzhou. Appropriate strategies and educational programs should be developed for health professionals to reduce the risk of elder abuse.     

Qualifikationsentwicklung in der deutschen Pflege – Ergebnisse einer aktuellen Datenanalyse

Nursing provides a service catering to the needs of the individual and, as such, makes its own contribution towards community health care. Apart from organizational and instrumental determinants, manpower resources are of central significance in this context. The number of staff employed in nursing, their qualifications and competences are all factors which fundamentally influence the quality and efficiency of nursing care. Based on current data, the following article will first describe which manpower resources are available in the individual nursing sectors. It will then articulate as a central theme some of the main problems in professional training at the various levels (general, advanced and further education), including Germany's comparatively new university and college degrees in nursing. The results of our analysis indicate, on the one hand, that there is movement towards an improved professional profile in nursing, which could be classified as optimizing manpower resources. For example, far more than two thirds of all nursing staff and other care workers have completed three-year professional training courses. In addition, nursing trainees overproportionately graduate from junior levels of secondary schools. It may, furthermore, be noted that nursing continues to be in high demand as a vocational profession and that there has been a professional upgrade in particular at the teaching and leadership levels. On the other hand, however, we can make out anti-professional developments which contribute to an impairment of manpower resources in nursing. A comparison of 1996 and 1999 figures shows that the number of qualified staff in the care of the elderly has decreased whereas the number of untrained staff has increased by six times. In spite of heavier work loads there has been no increase in the number of staff and trainees in hospital nursing over the past few years. And, with the introduction of statutory insurance covering ongoing nursing care, various semi-professional trainee programs have emerged, leading to a partial displacement of qualified staff. In conclusion, the authors will reflect on how to overcome such developments and further optimize manpower resources in nursing.     

Urinary catheters: what type do men and their nurses prefer?

OBJECTIVES: Urinary catheters are used frequently, but the relative risks and benefits of different types of devices are not clear. We sought to determine the beliefs of both older male patients and nursing staff about the relative merits and problems of condom and indwelling catheters. DESIGN: Patient and nurse survey using convenience sampling. SETTING: A University-affiliated Veterans Affairs medical center. PARTICIPANTS: Men hospitalized on medical, rehabilitation and nursing home units using either an indwelling or a condom catheter were invited to participate as were all members of the nursing staff on these units. Of 116 eligible patients, 104 were interviewed (response rate = 90%). Of 107 eligible nursing staff members, 99 completed the questionnaires (response rate = 92%). INTERVENTION AND MEASUREMENTS: Consenting patients were interviewed personally about their urinary catheter. The nursing staff were asked to complete a self-administered questionnaire. RESULTS: Patients were mostly older and predominantly hospitalized on the medical service. Compared with those using an indwelling catheter, patients using a condom catheter were more likely to believe that their catheter was comfortable (86 vs 58%, P = .04) and less likely to believe it was painful (14 vs 48%, P = .008) or to restrict their activity (24 vs 61%, P = .002). The nursing staff had a mean of 13 years nursing experience, and the majority worked in the nursing home unit. Most of the nursing staff respondents believed that condom catheters were less painful and restrictive for patients and were easier to apply, but they also believed that they fell off and leaked more often and required more nursing time. CONCLUSIONS: Both patients and nursing staff prefer condom to indwelling catheters for patient comfort, but they recognize that dislodgment and leaking are major drawbacks of condom catheters. A more secure condom catheter would greatly improve the management of male incontinence.     

‘THERE MUST BE BETTER SONGS TO SING’ INSERVICE TRAINING FOR RESIDENTIAL AGED CARE

Adult learners are frequently anxious when faced with the learning process but are also committed to innovative learning methods. This paper relates to inservice training for nursing and personal care staff in a residential aged care nursing home. Negative attitudes towards the elderly and the ability of training programmes to overcome these are explored. The DO, LOOK, THINK, ACT and GROW model for inservice training is presented Four levels of mastery are described as they relate to various educational levels and abilities of participants. The overall programme of the Training and Resource Centre for Residential Aged Care (TARCRAC) is outlined.     

The Relationship Between Nursing Home Residents' Perceptions of Nursing Staff and Quality of Nursing Home Care

The purpose of the study was to determine if nursing home patients' perception of nursing staff members were associated with quality of nursing home care. Three hospital professional staff members who were familiar with the homes in the study rated the LO homes on a 1 = excellent to 4 = poor quality. Patients (N = 239) admitted to the 10 homes provided assessments after they had been in the nursing home for one month of the nursing staff activities. Homes were classified by the four levels of care and responses of the patients were compared by multivariate analysis of variance. Patient responses differed significantly among the four levels of quality, with significantly more favorable responses in the excellent homes and the least favorable in the poor homes. In poorer homes, patients perceived less respect, communication, res onse from calls, concern, and also belicved staff members L? td not like their work. In addition, when asked how the staff would respond to specific situations, patients in poorer quality homes less often selected the more favorable behaviors. The study demonstrates that patients are able to assess quality by their perceptions of nursing staff and suggests that patients' assessments should be included in evaluations of homes. Further, it points up the nced for in-service training in attempting to enhance the quality of care.     

养老机构养老护理员培训现状及需求调查分析

目的 了解养老机构养老护理员培训现状及其对培训方式和内容的需求情况,为提升养老护理员培训质量提供参考依据。方法 采用便利抽样法抽取养老机构中783名养老护理员,进行问卷调查。结果 持证和未持证的养老护理员在相关知识和技能得分的比较,除生活照料操作技能外,差异均有统计学意义(P<0.05);持证和未持证的养老护理员80%以上均有愿意参加培训,认同课堂讲授、以老带新和参观观摩的培训方式,希望由政府部门组织或在养老机构内,利用工作日的白天开展相关培训。在培训内容上,持证的养老护理员希望培训的内容是心理护理知识、人际关系与沟通知识、消防安全知识技能、生活照料操作技能;无证的养老护理员希望培训的内容是护理技术专业知识、老年人照护基础知识、心理护理知识、急救常识技能、服务礼仪个人防护知识。另外,持证和非持证的养老护理员支持按文化程度、职称、工作岗位进行分层次培训。结论 养老机构中,未持证的养老护理员相关知识和技能处于较低水平,应根据其需求增加培训机会,提高养老服务水平。     

Discrepancies between perceptions by physicians and nursing staff of intensive care unit end-of-life decisions

Several studies have pointed out ethical shortcomings in the decision-making process for withholding or withdrawing life-supporting treatments. We conducted a study to evaluate the perceptions of all caregivers involved in this process in the intensive care unit. A closed-ended questionnaire was completed by 3,156 nursing staff members and 521 physicians from 133 French intensive care units (participation rate, 42%). Decision-making processes were perceived as satisfactory by 73% of physicians and by only 33% of the nursing staff. More than 90% of caregivers believed that decision-making should be collaborative, but 50% of physicians and only 27% of nursing staff members believed that the nursing staff was actually involved (p < 0.001). Fear of litigation was a reason given by physicians for modifying information given to competent patients, families, and nursing staff. Perceptions by nursing staff may be a reliable indicator of the quality of medical decision-making processes and may serve as a simple and effective tool for evaluating everyday practice. Recommendations and legislation may help to build consensus and avoid conflicts among caregivers at each step of the decision-making process.     

S.H.A.R.E.

This paper presents a Canadian community hospital program for reducing health care costs and improving patient care associated with substance abuse. A case study is presented that illustrates the workings of the S.H.A.R.E. program, including medical staff education, patient identification and assessment, and referral to community treatment services.