Psychosocial factors affecting elders maltreatment 1

Journal review of
Title: Psychosocial factors affecting elders maltreatment in long
term-care facilities.
International Nursing Review,
Author names: Merav Ben Natan, Ariela Lownstein, and Zvi
Eisikovits
Year of publication: 2010
Student name: Bello Sadiq Adisa
Student number: 824-067-144
Submitted to: Mary McGrory

Date of submission: March 4th 2015

Psychosocial factors affecting elders maltreatment 2

The cases of elder abuse in nursing home has been prevalent over the years,
abusive behavior denounces our level of humanity, respect and honor
towards geriatric residents in nursing homes. Elder abuse can be neglect,
sexual abuse, physical abuse, sexual abuse and emotional abuse all of which
can undermine the therapeutic relationship towards a client. The journal
article Psycho-social factors affecting elders maltreatment in long-term care
facilities focuses on addressing the cause and effect of elder abuse in
nursing homes using sets of theoretical approach. This approach address
causes of maltreatment in long term care facilities as a result of patient
traits, staff trait and features of facilities available at the institution. The
journal article elder abuse in nursing homes: an ecological perspective
gives a conceptual approach to the environmental settings, conditions of the
both the abuser and victim and justification for eliciting abusive behavior
looking at various ecological system. All of which I find convincing and a
good source for expanding knowledge on elders maltreatment, especially
how to effectively address issues relating to elder abuse.
Patients trait or condition of the resident can be a cause for abuse in nursing
home. Patient with dementia tend to be aggressive which gives room for care
givers to retaliate with the similar behavior.

Studies examining the

behaviour of nursing staff towards elderly patients with dementia found that
aggressive patient behaviour is related to physical and verbal abuse by the

Psychosocial factors affecting elders maltreatment 3

caregiving staff (Natan et al., 2010 P.114).As care givers, we have to be

aware of risk associated with dealing with residents with dementia or other
forms of psychological disorder so as to prevent abuse. Care givers are to
offer the best therapeutic care to their patient irrespective of their condition.
Cases of abuse have been reported for residents who have no family
members visiting the institution. The college of nurse Ontario has a tool for
dealing with client abuse such as the one is one too many tool which
focuses on dealing with challenging situation and alternatives line of action
in such scenarios. Reducing cases of abuse from dementia resident include
familiarization and regular paring of same care giver with residents with this
condition in order to reduce the level of anxiety of the resident. Also, the
pattern of behavior of residents could also contribute to abuse. For example
residents who are provocative or execute random aggressive behavior such
as pinching and pulling pose problem for care givers. Nurses are to exemplify
a great deal of patience when dealing with such residents. Some of the
nursing intervention is to first determine the cause of aggressive behavior
and taking note of clients preference and environmental conditions in time
of care nurses are obliged to refrain from abandoning, abusing or neglecting
clients and to provide empathetic and knowledgeable care (C.N.O. Practice
standard Ethics, 2009 P.9).
Also, staff trait could contribute to elder abuse in nursing home. The major
factor contributing to staff trait is the behavior of care giver, orientation of
care giver towards residents and staff burnout. Care givers have to care for

Psychosocial factors affecting elders maltreatment 4

residents with regards to completing activities of daily living within a certain

period of time. This time bound activity put pressure on care givers to bypass
or not follow standard precaution which limits the quality of care being
offered to residents and enhances the chance for abuse by care givers
worker burnout was found to be associated with physical and mental
violence. Burnout leads to negative attitudes towards work and lack of
empathy towards the elderly (Natan et al., 2010 P.114). Care giver stressor
level can contribute to elder abuse due to emotional and psychological
burden from homes. Care givers who have been abused or are facing abuse
in their homes could exert this behavior to elders being catered for in nursing
homes. The implication of staff burn out is that it deteriorates the quality of
care being offered; it is now dependent on the institution to employ more
staff to accommodate for the workload in catering for geriatric residents
Institutional caregivers frequently balance a heavy and potentially stressful
workload with their own personal stressors such as family problems, physical
and emotional exhaustion, substance abuse, or in some cases, a history of
domestic violence (Schiamberg et al., 2011 P. 199). Staff burnout could be
addressed by holding staff support group aimed at sharing emotional burden
and work stress related to dealing with dementia or aggressive residents.
This avenue gives care givers a sense of belonging and ways for which abuse
can be mediated.
Thirdly, feature of facilities available at the institution could contribute to
abuse. Inadequate equipment affords care giver to develop rough or cutting

Psychosocial factors affecting elders maltreatment 5

edge ways in caring for geriatric residents which can be abusive at times.
The lack of facility equipment contributes to staff burnout and work related
stress which leads to abuse. Standard practices include fostering an
environment in which nurse and client are safe from abuse (C.N.O.
Professional Standards, 2009 P.11). Care giver administrative role is to
constantly advocate for clients needs and knowing how to tackle job related
stress.

Looking at the ecological perspective of abuse relating to the

available facilities in the institution and the environment; staff burnout, staff
attitude towards work could contribute to abuse. Care givers who are
unhappy with their job are very likely to elicit abusive behavior because of
poor financial wage and this brings into discussion whether care givers in
their profession for the money or for their satisfactory youthful ambition.
The challenges about this are related to economic issue regarding job
opportunities and job satisfaction.
Cultural difference contributes to the probability of abuse. The issue of
stereotyping in delivering competent care to residents are contributory
factors to abuse; this brings into limelight standards of care givers in
delivering cultural sensitive and competent care to patients by not imposing
their beliefs on client choice through practicing self-reflection nurses can
enhance their knowledge of various cultures by asking culturally relevant
questions. Reflecting on their cultural beliefs and interacting with client and
colleagues from different culture can broaden the understanding of various
cultures (C.N.O. Practice Guideline Culturally competent care, 2009 P.4)

Psychosocial factors affecting elders maltreatment 6

In conclusion, I have addressed the journal article based on three focal point
staff trait, patient trait and features of facilities available at the institution.
Staff traits relating to abuse is caused by staff burnout and behavior of care
givers if they themselves are facing abuse in their respective homes, all of
which can be addressed by holding support groups, trainings and developing
ways for dealing with combative residents. A great deal of patience has to be
maintained when dealing with patients who are combative for example
dementia and Alzheimers looking at patients trait.

Common ways for

reduction of aggressive behavior is by taking note of clients preference in

time of care, and familiarization of caregivers with client. Also, Staff burnout
can be associated with factors relating to lack of availability of equipment in
catering for residents activity of daily living which contributes to by passing
standard procedures by caregivers resulting into abuse. Standard guideline is
to ensure that residents and caregivers are safe from abuse at all times.

REFERENCE
Natan, M.B., Lownstein, A., & Eisikovits, Z. (2010). Psycho-social factors
affecting elders
maltreatment in long-term care facilities. International Nursing Review,
57(1), 113-120.
College of Nurses Ontario, (C.N.O.). Practice Standard and Guidelines:
www.cno.org

Psychosocial factors affecting elders maltreatment 7

Lawrence B. Schiamberg PhD , Gia G. Barboza PhD , James Oehmke PhD ,

Zhenmei Zhang PhD , Robert J. Griffore PhD , Robin P. Weatherill PhD ,
Levente von Heydrich PhD, MSW & Lori A. Post PhD (2011). Elder Abuse in
Nursing Homes: An Ecological Perspective, Journal of
Elder Abuse & Neglect, 23:2, 190-211, DOI: 10.1080/08946566.2011.558798