Evelyn Fitzwater

Violence against caregivers in nursing homes. Expected, tolerated, and accepted

Violence against caregivers is not a new phenomenon. Caregivers have experienced verbal and physical assaults from nursing home residents for many years. However, because much of the violence has been associated with demented or mentally ill residents, the word aggression was used in lieu of violence. This study found that the caregivers and nursing directors considered the assaults to be violence. The study suggests that such violence occurs frequently and is of concern to caregivers and nursing directors. The study also suggests that nursing homes may not have policies or procedures in place for preventing, monitoring, and controlling violence in their workplaces. In 1996, OSHA published violence prevention guidelines for health are facilities. These guidelines support OSHAs mandate that employees are entitled to a safe and healthy workplace (OSHA, 1996b). Although it is not possible to prevent all violence against caregivers in this unique setting, nursing home directors and administrators have a legal and moral responsibility to develop an action plan to minimize the violence and plan interventions for its effects. Violence against caregivers in nursing homes no longer can be thought of as expected, tolerated, and accepted. Quality of care and employee well-being depend on it.

Relationships of Stressors, Strain, and Anger to Caregiver Assaults

Nursing assistants (NAs) working in nursing homes are at risk for nonfatal workplace violence. The aims of this study were to describe the context in which assaults occur and to identify characteristics of the NAs related to the incidence of assaults. One hundred and thirty eight subjects participated. NAs completed a demographic and employment survey, the Occupational Stress Inventory and the State Trait Anger Expression Inventory-2, and recorded information on an Assault Log for 80 hours of work. The mean number of assaults per NA was 4.69 (range 0-67). Significant relationships were found among incidence of assaults and staffing ratios, age, occupational strain, occupational role stressors, and anger. Results provide new and useful information when planning violence prevention programs for caregivers in nursing homes.

Reducing assaults against nursing home caregivers

BackgroundNursing assistants (NAs) working in long-term care have the highest incidence of workplace assault among all workers in the United States. ObjectivesThe objective of this study was to test the effectiveness of a violence-prevention intervention, on the basis of Social Cognitive Theory to increase knowledge, self-efficacy, and skills, and to decrease assaults. MethodsInvestigators conducted a quasi-experimental study with 138 NAs in 3 intervention and 3 comparison homes. A baseline questionnaire was used to obtain information on demographics, employment, and violence experience. At pre-, post- and 6 months after the intervention, all participants completed the State Trait Anger Inventory and the Knowledge and Self-Efficacy Survey, carried an Assault log for 80 hr of work, and participated in a simulation exercise to assess violence-prevention skills. Tabulations, analysis of variance, and Poisson regression were used to analyze the data. ResultsThe intervention participants showed significant increases in knowledge, self-efficacy, and violence-prevention skills. Although the intervention had no significant main effect on the incidence of assaults, there was an interaction effect between the intervention and the number of preintervention assaults. The intervention had a significant effect on those NAs who had fewer than 6 assaults preintervention (p < .001) and no significant effect on those who had more than 7 assaults on preintervention. There were significant relationships between assaults and the following covariates: age, state anger, and the number of residents assigned. DiscussionAlthough the incidence of violence cannot be eliminated, it can be decreased and it should never be tolerated or accepted as “part of the job” because to do so devalues the NA.

COMPARISON OF NURSING STUDENTS’ ATTITUDES TOWARD THE ELDERLY IN NORWAY AND THE UNITED STATES

Two‐hundred and seven nursing students in Norway and the United States were surveyed using Kogans (1961) Attitude Toward Old People Scale, visual analogue scales, a request for descriptive paragraphs, and demographic data questions. Although the two groups’ mean Kogan scores were very similar—181 for the United States and 182 for Norway—correlations between the other variables and Kogan scores were quite different between the two groups. Level in the educational program, past family experience with the elderly, number of past experiences with the elderly, amount of lecture time spent learning about the elderly, amount of clinical time spent with the elderly, and the choice to work with the elderly were all correlated with Kogan scores in the American subjects. For Norwegian and U.S. subjects, as the number of past experiences increased, the description of past experiences with the elderly was more positive. This correlation was statistically significant. The majority of both Norwegian and American subjec...

Violence and home care. A focus group study.

This study describes home caregivers’ and managers’ beliefs and experiences related to violence in their workplace. Suggested strategies are recommended that can help home care organizations recognize, prevent, and manage violence in their workplace.

Internet Training to Respond to Aggressive Resident Behaviors

PURPOSE This research evaluated an individualized Internet training designed to teach nurse aides (NAs) strategies to prevent or, if necessary, react to resident aggression in ways that are safe for the resident as well as the caregiver. DESIGN AND METHODS A randomized treatment and control design was implemented, with baseline, 1-, and 2-month assessments for 158 NAs. The training involved 2 weekly visits. The Internet intervention was a behaviorally focused and video-based training that included content on skills for safely dealing with physical aggression. Measures included video situation testing and assessment of psychosocial constructs associated with behavior change. RESULTS Analysis of covariance showed positive results for knowledge, attitudes, self-efficacy, and empathy, with medium-large effect sizes maintained after 2 months. The training was well received by participants. IMPLICATIONS Internet training is a viable approach to shape appropriate NA reactions to aggressive resident behaviors. This format has future potential because it offers fidelity of presentation and automated documentation, with minimal supervision.

Development of Instruments to Assess: Assaultive Behavior in Nursing Homes

The use of psychometric techniques is not usually considered in the development of non-scale tools. In the development of these tools, both content validation and inter-rater reliability were assessed in an effort to produce better quality tools than would have occurred otherwise. The procedure employing content experts for content validation followed the usual protocol for both of the tools. In each case, valuable information about the tools was obtained, in addition to data supporting the content validity of the tools. The development of vignettes for the inter-rater assessment would probably not have occurred if the authors were not familiar with the different techniques for assessing inter-rater reliability. The only way data concerning inter-rater reliability could be obtained was by having each respondent view the same stimuli. Creating vignettes was the best way to accomplish this goal in a cost-effective manner. The additional data obtained from the respondents also provided invaluable information for the development of the tools. This pilot study was conducted to assess all aspects of the tools in the nursing home setting. Clarity of items and usability of the tools were major considerations. Because NAs were involved in the pilot study, both readability by most NAs and clarity of the items in the revised tool were assured. Considerable time was spent assessing these tools, but the completed tools are evidence that the time was well spent. The use of psychometric techniques resulted in objective evidence that led to quality improvement decisions. The revised tools have the potential for use in obtaining quality data for research projects, in policy development by an agency, and for training agency personnel.

An Internet Training to Reduce Assaults in Long-Term Care

Physical and verbal assaults by residents on care staff are not uncommon in long-term residential care facilities (LTCs). This research evaluated an Internet training designed to teach nurse aides (NAs) strategies to work with aggressive resident behaviors. Six LTCs were randomized in an immediate treatment (IT) and delayed treatment (DT) design, and NAs were recruited in each (IT: n = 58; DT; n = 45). The treatment involved 2 weekly visits to the online training. Hard copy assessments collected participant responses at baseline (T1), 8 weeks (T2), and at 16 weeks (T3). The DT group viewed the program after T2. Hierarchical linear models showed significant group differences at T2 in knowledge, and these levels were maintained at T3. The number of aggressive incidents reported per day by the IT group were nonsignificant at T2 but decreased significantly from T1 to T3 with a large effect size. The program was well received by users. These results suggest that the Internet training was an effective tool to reduce assaults in LTCs, and training effects may improve over time as NAs gain experience using the techniques.

The Development and Use of Gaming in Multidisciplinary Geriatric Education.

Many health care professionals have developed specialty training in geriatrics. Educational programs, however, are typically isolated from those of other professionals and many students in health care professions do not receive instruction in problem‐solving beyond a narrow clinical discipline. Problems that arise in the care of the elderly in long‐term institutions are complex and require problem‐solving strategies utilizing the expertise of professionals from many fields. The Game of Institutional Long‐Term Care was developed to help students from different disciplines learn how to solve patient‐management problems in nursing homes. The educational objectives of the game are (1) to teach students about the different goals and motivations of the key players in decision making, (2) to teach students how to identify and analyze problems, (3) to help students learn about the process of negotiation, compromise, and cooperation in problem‐solving, and (4) to expose students to the feelings and frustrations th...

Assessment to guide placement, plan care, and track change in individuals with Alzheimer's disease

Appropriate placement of residents is of critical concern. Multi-dimensional assessment is a complexprocess that could more precisely guide the placement and care of elderly persons withAlzheimers disease. The use of the HaycoxDementia Rating Scale with 11 individuals withAlzheimers disease in a closed unit, has assisted staf in the placement of residents in a protective unit at a tine when such a unit could increase or deter functional loss in selected areas of functioning. Moreover, the assessment tool has helped to identify the impact of dementia in the functional capabilities of individuals. Dressing and grooming was most impaired on admission to the unit, but changed very little during the ensuing 12 months. Functions dealing with social skills and awareness tended to increase. Increase of motor coordination impairment heralded a decrease in function for three residents.