Residents of LTC who abuse the staff

[BVUstudent]

I am currently doing research on this very subject. My wife is a CNA,CMA and the main shower aide in her LTC facility. This is how I have my knowledge. I am conducting a huge research project: "Certified Nursing Aides within the healthcare profession have a greater risk of physical abuse by residents in the workplace."

I have looked everywhere I can think of ( so have my instructors) to find Accredited Journals in the United States to support my research. Well I have found none and there is no word from my instructors. So if any of you CNA's, LPN's, or RN's have seen such a journal I would be ever so grateful. I will be completing my Masters in Social work/Human resources in the next 3 years. This is a primary focus.

My main goal is to bring awareness to owners and administrators that this behavior from the residents IS NOT "part of the job description".

My question: What can be done to remedy this problem within the LTC facilities? Why is this subject so "hush hush"?

[gentlegiver, ASN, LPN, RN]

I've worked in LTC since I graduated. I too have been abused in just about all manners abuse can come in. Was it my fault? Did I move too fast for the patient? I'm sure it was a few times. However, the patients with dementia I have no problem with, I document what happened and move on. It's the patients who come in, A&O x3, that attack you because:

1) meds were not delivered on time (we do have a 2 hour window, but they want it exactly when due)

2) "I've been ringing for an hour!!!" bell just went off

3) my dinner is cold, not what I want, given too early, given too late

4) my roommate snores

5) I want to go outside to smoke, or smoke in my room (non-smoking facility)

6) I'm bored

7) all nurses are here to serve my every desire... (as stated by the patient)

and last but not least, the one that gave me whiplash:

8) I want to go to the ER because the CNA's threw the rotted food I had in my room out! ( Belted me when I said it was not a valid reason to go to the ER)

In all cases, management turned away, refused to do anything. The only time anything was done was when the patients turned on other patients. Mostly we just learn to duck & dodge.

[JacknSweetpea]

The facility I work work for is a LTC with a lot of middle-aged psych patients, and abuse often occurs. A lot of the residents have diagnoses of bipolar disorder, schizophrenia, as well as other medical needs. Don't forget the unfortunate personality disorders either. Years ago, the patients used to receive a "Patient's Responsibilities" handout with their admission packet, however, that doesn't occur anymore because it doesn't go along with management's idea of customer service.

[pollydog318]

I work as a LPN in LTC. I have been hit, punched, spit on, had objects thrown at me, cursed at , threatned, and all the above. Was it written in my job description or anyone elses NO. With that said any health care professional with a little bit of common sense will know that we are at risk for being physically harmed by residents/patients. Good luck with trying to convince administrators but I don't see it happening. Instead of convincing them that it is not in the job description you should convince them to have quarterly inservices on how to deal with combative patients/residents.

Most of what I see is not residents harming staff out of spite but it is because they have some form of dementia or pyschological issue that they can't control at times.

My advice to any health care worker... if you don't want to risk being physically harmed than get out of the profession. Unfortanetly, this comes with the territory.

Once again good luck with your research.

I have 14 years as an RN in LTC. Could not agree with you more! But no matter what I never went home at thew end of my shift not wanting to come back. Training, approach and understanding the Dementia/Alheizmer's process goes a long way in the reduction of aggressive residents.

[Moogie]

A few articles for you:

Pulsford, D., & Duxbury, J. (2006). Aggressive behaviour by people with dementia in residential care settings: a review. Journal of Psychiatric and Mental Health Nursing 13, 611-618

Foley, K. L., Sudha, S., Sloan, P. D., & Gold, D. T. (2003). Staff perceptions of successful management of severe behavioral problems in dementia special care units. Dementia, 2(1), 105-124 DOI: 10.1177/1471301203002001998

Nakahira, M., Moyle, W., Creedy, D., & Hitomi, H. (2008). Attitudes toward dementia-related aggression among staff in Japanese aged care settings. Journal of Clinical Nursing, 18, 807-816 DOI: 10.1111/j.1365-2702.2008.02479.x

I also strongly suggest that you check out the University of Iowa's Geriatric Education Center, where you will find MANY resources: http://www.healthcare.uiowa.edu/igec/

Some of the journals that you might find helpful are: Journal of Gerontological Nursing, Advances in Gerontological Nursing, Research in Gerontological Nursing, American Journal of Alzheimer's Disease and Other Dementias, International Journal of Alzheimer's Disease, and Dementia.

From what I have read in the literature, bathing is the care activity most commonly associated with aggressive behavior in persons with cognitive impairment. Here's an article that might provide some practical advice for your wife:

Cooke, H., & Gutman, G., (2005). Improving the bathing experience for residents with dementia. Canadian Nursing Home, 16(2), 13-15

Hope this gives you a start! Please feel free to PM me and we can discuss this further!

[Moogie]

Patients often feel out of control with their situation and 'act out' in frustration. The staff most at danger of suffering abuse (physical or verbal) is the staff with the most daily contact. The LPN or RN directly overseeing the staff taking care of ADLs, as well as other portions of patient care, needs to investigate what happened and to intervene when necessary. He/she also needs to instruct the staff in ways to handle the patient to prevent future occurances. Sometimes giving mini-classes in patient/staff interactions is possible.

I agree with this. However, it is not sufficient to teach those who give direct care to persons with dementia. It is imperative that management---yes, even non-nurse administrators---understand dementia care so they can break the cycle of blaming the victim when a cognitively impaired individual does act out physically against staff. When I was hit by a cognitively impaired individual, the first thing my manager wanted to know was what I did wrong. It didn't matter that the previous nurse had forgotten to administer a scheduled antipsychotic medication...

In all cases, management turned away, refused to do anything. The only time anything was done was when the patients turned on other patients. Mostly we just learn to duck & dodge.

The facility I work work for is a LTC with a lot of middle-aged psych patients, and abuse often occurs. A lot of the residents have diagnoses of bipolar disorder, schizophrenia, as well as other medical needs. Don't forget the unfortunate personality disorders either. Years ago, the patients used to receive a "Patient's Responsibilities" handout with their admission packet, however, that doesn't occur anymore because it doesn't go along with management's idea of customer service.

Amen!

[regularRN]

If you don't have access to a university's library, you could try searching online with "Google Scholar"

[neutrophil]

It. Is a difficult part of nursing. However if one thinks of the condition of the patient and their limited abilities comparing to who they were in their productive life it is relatively easy to understand that a nurse is one that is an extension of their wants and needs. Not just any one can be a nurse.

[Patrick Cote, RN, BS]

Issues re:assaulltive behavior in LTC facilities is a high priority for many of us. There are federal and state guidelines for creating a safer work place. Please feel free to contact me for a follow-up conversation if you hav an interest.

[N1colina]

I work as a LPN in LTC. I have been hit, punched, spit on, had objects thrown at me, cursed at , threatned, and all the above. Was it written in my job description or anyone elses NO. With that said any health care professional with a little bit of common sense will know that we are at risk for being physically harmed by residents/patients. Good luck with trying to convince administrators but I don't see it happening. Instead of convincing them that it is not in the job description you should convince them to have quarterly inservices on how to deal with combative patients/residents.

Most of what I see is not residents harming staff out of spite but it is because they have some form of dementia or pyschological issue that they can't control at times.

My advice to any health care worker... if you don't want to risk being physically harmed than get out of the profession. Unfortanetly, this comes with the territory.

Once again good luck with your research.

You could not have worded this ANY BETTER! (I worked in LTC for 3 years)

[N1colina]

I have worked LTC and actually had no problem with demented patients who thought I was trying to hurt them or women who thought they were about to be raped at shower time(how could I?) It was the awake, alert, and oriented patients who told you outright that "I can do what I want and if you do/say anything to me you'll be in big trouble".

Yes, but remember it is those patients that either have some sort of mental disorder, or they are just plain miserable and believe me, I understand. I worked in LTC as well. I know how some of them can be, and it can get extremely frustrating but that's why I got out of that environment! NurseLovejoy88 has a great point!

[achot chavi]

Hi, I know this is an older link, was a study ever done? What were the results? Was it published anywhere?

Inquiring minds want to know...

[Anne36, LPN]

Staff gets verbally and physically abused everyday where I work. Not everyone can be redirected. and we have a lot of psych residents along with our combative dementia residents. Recently another Nurse related to me that a corporate suit was in recently and commented to her that they do not care if staff is hit , etc. Welcome to long term care. This is one of the reasons why I want to find another profession eventually.