Nurses knowledge on elderly abuse

Running Head: NURSES’ KNOWLEDGE ON ELDERLY ABUSE

Nurses’ knowledge on elderly abuse

Name

Date

Introduction

The purpose of this study is to assess the knowledge of nurses working in a long term care facility for the elderly about the abuse of older people. This study aims to examine nurses’ recognition skills about identifying markers of elderly abuse and to explore their knowledge concerning the causes and consequences of elderly abuse.

`The intent is to carry out a quantitative cross-sectional research study in a local long term care facility. The subjects will be recruited by a convenience sampling and will be selected from any ward. The tool is aimed to be completed in about 20 – 30 minutes.

The salient characteristics will be those nurses (including enrolled nurses and nursing officers and specialty nurses) who work on full-time or part-time basis only at the facility where the study will be carried out. The sample size includes forty nurses. Approval from the Manager Nursing Services from the cooperating institution where the study will be carried out has been obtained.

Literature review

Overview of the topic

One of the tragedies in society today concerns the issue of elderly abuse and the neglect of the abused who are ironically under the care of the nursing staff based in nursing homes. The expectation is that within the nursing homes the elderly receive excellent care however this is far from reality. According to Quinn and Tomita (1997) every year thousands of elderly citizens in America are abused not only in their homes but also within facilities that have been given the responsibility of caring for them. CBS (2000) report that government statistics indicate that annually, at least one out of every four nursing homes are cited for causing serious injury or death of a resident. They add that thirty percent of the elderly state that they would rather die than stay in nursing homes though eighty percent of them already stated that they could choose to stay in the homes until their deaths if there was no imminent danger of abuse.

Nursing inspection documents additionally show that abuse in elderly homes has grown since the year 1998 where less than two percent of the reported violations constituted elderly abuse (CBS, 2000). Summers, Hoffman and APHA (2006) agree stating elderly abuse in nursing homes has in fact become a big law enforcement challenge. Federal regulators have been quoted affirming that the statistics available do reveal how bad things in elderly care homes in America are. They further unveil that the situation is bound to worsen as most homes have been found to have hired nurses who have previously had a history of abuse as more people age and check into such facilities.

The residents in these homes are usually vulnerable with the majority facing dehydration, malnutrition, frequent falls, fractured bones, as well as pressure sores (Reichel, 2006). Quinn and Tomita (1997) explain that the elderly within the homes are usually physically frail and may consequently not be able to stand up to or withstand bullying or any attacks. They sometimes do not hear, see and think clearly as they previously used to, thus creating room for unscrupulous nurses and relatives to take advantage of their situation and them.

Nurses’ knowledge of elderly abuse

Quinn and Tomita (1997) note that it is not surprising to walk into a care home and find the elderly lying in their personal urine or even excrement. Many abuses that can not be described go on in elderly care homes showcasing lack of respect and protection of the human rights of older people.

EAP (2001) claim that several surveys have been conducted to try and discern the level of nurses awareness’s and knowledge regarding abuse against the elderly. They continue to state that most reports indicate that a considerable number of nurses are actually aware that the elderly within their homes do get abused. Binstock, Robert & Shanas (1985) similarly acknowledges that most nurses are at least certain that the elderly within their institutions have faced poor treatment, abuse, neglect as well as discharge that is ill-considered

According to Summers, Hoffman and APHA (2006) the abuse of the elderly is grievous and should be undoubtedly termed as a societal injustice. Research further shows that nurses perceive the opportunity of abuse is created by the fact that the elderly mostly rely on their abusers for the purpose of the provision of care and assistance in terms monetary or emotional support. Harris (2005) clearly illustrates that those people who are older together with the disabled have higher chance of being abused by the caretakers.

Soldo (1980) suggests that nurses have knowledge of elderly abuse because they too take part or carry out the abusive actions. He states for instance the society of the Alzheimer shows up to 40% of all the elderly patients ail from dementia that has resulted from irrelevant prescription, overmedication or under medication.

Birren & Cunningham (1985) additionally state that within the homes the elderly have been exposed to unhygienic conditions a fact that has made them even more vulnerable to deadly infections. EAP (2001) assert that mixed-sex wards have been encouraged thus exposing particular genders to sexual abuse. In addition there has been absence of confidentiality in case of the discussion involving elderly medical problems. It has been largely assumed that confidentiality becomes inapplicable when dealing with elderly patients.

In research nurses clarify their knowledge of abuse. They agree that elderly abuse goes beyond physical abuse to encompass psychological as well as financial maltreatment.

Types and indicators of abuse

Harris (2005) explains that according to nurses the abuse of elders in nursing homes usually takes different forms. It may for instance involve threats or intimidation against the elderly, neglect or even financial chicanery.

Summers, Hoffman and APHA (2006) and Allan (2002) offer the same description of physical abuse. They assert that physical abuse in the homes is usually described as the non accidental employment of force on the elderly person resulting to his injury, impairment or physical pain. Such abuse apart from physical assaults in form of shoving or hitting additionally entails inappropriate administration of drugs, confinement or unnecessary restraints. Harris (2005) describes physical abuse as one of the most common type of the elderly abuse. He similarly indicates that it also covers the range of slapping, shaking, kicking, pushing, bruising, beating, pinching as well as burning. It may furthermore involve intimidating the elderly person together with threatening him with the intention of inflicting pain or injury on the elderly person. Study indicates that bruises that are unexplained as well as fractures, eyeglasses that are broken together with abrupt changes and modification in behavior should be potential indicators of such abuse (Allan, 2002).

Emotional abuse is also a type of seniors’ abuse that has been found to exist. Margolis (1995) writes that psychological and emotional senior abuse occurs when the nurses treat or speak to the elderly in a manner that causes emotional distress or pain. Verbal forms include humiliation and ridicule, intimidation through threats and yelling and habitual scapegoating and blaming. Non verbal abuse on the other hand occurs through the isolation of the senior from activities that he loves or his friends, menacing or terrorizing the elderly person and simply ignoring him.

Emotional abuse may also result from neglect of the elderly person. Neglect may involve the failure of the caregiver to give the elderly person basic necessities like food, medication, comfort as well as personal hygiene. Another extreme type of neglect is associated with abandonment. This refers to desertion of the elderly persons by the people charged with the responsibility of provision of care to the elderly people. This also includes leaving the patient alone in a temporarily particularly at the times that he is incapable of taking care of himself (Areen, 1987).

Kelly (2004) perceives the most prominent markers of neglect as including loss of weight, unkempt appearance, dehydration, malnutrition, health problems that are untreated as well as poor conditions of living. However other signs associated with psychological abuse include agitation, withdrawal, as well as the absence responsiveness. Behaviors that are unusual in nature such as aggressive rocking as well as strong biting should moreover indicate the presence abuse. Furthermore the elderly people who have been abused tend to become fearful as well as reluctant to speak out about themselves (Campion, Bang & May, 1983).

Kelly (2004) points out that unfortunately the detection of psychological abuse is usually associated with a certain degree of difficulty as the mentioned signs are also not easily obvious or a definite indicator of abuse. This confirms and proves that in fact if such signs are depicted they may as well be an indication of another disorder and not necessarily abuse. The data that has been presented by most literature particularly regarding the indicators of physical and emotional abused do not provide a standard method of diagnosing elderly abuse without carrying out other tests.

Sexual abuse is also part of elderly abuse. This is generally defined as sexual contact made with the elderly person without his consent. Quinn and Tomita (1997) reveal the such contact not only involve physical sex acts but also forcing the senior to watch pornographic material or sex acts or even forcing him to undress.

Financial exploitation as an abuse involves the unauthorized utilization of the elderly person’s property or funds. This involves the preying upon together with the taking of the advantage of the vulnerability of the physical as well as his mental state so as to gain financially. The signature of the elderly person may be forged or their checks may be cashed against their consent. The elderly person may also be deceived to sign a certain document for example the will.

Margolis (1995) also quickly adds that financial abuse occurs when the nurses charge for healthcare services that they are not providing, undermedicate or overmedicate, double bill medical services, recommend fraudulent remedies for medical conditions or illness, encourage Medicaid fraud and get kickbacks for prescribing certain drugs or referrals to certain providers.

Causes and elderly abuse risk factors

Schaie & Willis (2003) claims that nurses admit the vulnerability of an old person to abuse is increased by his age. Additionally the responsibility and the great demanding tasks that come along with taking care of this people also make abuse more likely. Schneider (2005) also believes the same and agrees that nurses or family feel pressured by the responsibilities accruing especially as they increase as the elderly persons condition degenerates. Birren & Cunningham (1985) further explain that the nurses find themselves burned out, stressed and consequently become impatient and unable to restrain themselves from issuing threats and humiliating words as they care for the elderly.

In his work Margolis (1995) notes that abuse is inevitable where the nurse lacks resilience to cope with the accruing stress, is depressed and fails to get support from other staff members. Schaie & Willis (2003) seem not to give much consideration and excuses given by the other authors to validate elderly pointing out that it is most of the time merely perpetrated by some nurses’ perception that caring for the elderly is burdensome and has no potential psychological rewards. From these perspectives it can be concluded that elderly abuse is encouraged by both a mix of strain accruing from pressures of dealing with the elderly and the personal attitudes of some nurses.

Alarmingly Quinn and Tomita (1997) purport that substance abuse by the nurses can also put the senior at risk of abuse. They assert that the members of the family together with the nurses who are confronted by personal problems like alcohol dependence and the addiction to drugs have a higher chance of becoming abusers.

Study also shows that several other conditions and factors related to the elderly history can also been blamed for increasing chances of elderly abuse. Harris (2005) for instance unveils that the intensity of the elderly person dementia or illness and social isolation whereby the nurse is left with the patient alone most of the time increase risk. Additionally the elders’ role which refers to their anger spurts and aggressiveness resulting from earlier relations with an abusive spouses or parents may also elicit violent response from nurses.

Schneider (2005) in fact argues that the most the elderly abuse does not stem from the nurses but rather relatives and friends of the elderly. Nurses’ contribution to the abuse arises from the financial and emotional requirements of the nurses on the victims. He explains that older patients are actually mostly abused by the family that visit and people that they trust. He continues to clarify that most of the physical and psychological abuse from nurses is never intentional. Most of the time it results from the nurses stretched capabilities and patience and therefore as much as they may not intend or mean to strike, yell or ignore the elderly care needs they find themselves doing so (Shugarman, Fries, Wolf, & Morris, 2003). The question then arises what do the nurses do when they are aware that their colleagues are abusing patients? The question is also that because relatives and friends constitute the majority of the elderly abusers what do the nurses do to protect the patients? Do they report or keep the knowledge of such activities to themselves?

Reporting elderly abuse

As much the majority of nurses are aware of the abuse within nursing homes they mostly do nothing about it. According to Henig (2002) this is because most of those nurses are in the dark regarding mandatory requirements of reporting such cases or the stipulations of the protective laws in such instances. Margolis (1995) agrees that the nurses acknowledge the presence of elderly abuse in society nevertheless they lack the understanding of the basic prequisites of law when these cases occur including the procedures of such reporting.

The argument is also that despite the fact that most states in America have mandatory reporting laws for elderly abuse the fear of reporting by nurses is because reporting may end up infringing on autonomy and freedom of competent elderly people. Nurses fear reporting or infrequently report such abuse because they also do not want to offend the patient or do not just have the proper case evaluation and recognition skills to determine which ones are actually tantamount to abuse. They express the fact that victims of abuse usually blame themselves for the acts, have poor esteem, fail to accept their vulnerabilities and perceive reporting of such cases as betrayal of their families.

Schneider (2005) confirms that most of the nurses do not report such cases because they are scared of misinterpreting the cases. In a poll conducted on 800 nurses sixty percent admitted that fear stops them from raising the alarm while twenty six percent stated that likelihood of revenge from abusers also impeded efforts to report cases.

On the contrary Summers, Hoffman and APHA (2006) indicate that in another survey that there was no indication that abuse in care homes was going unreported. They argue that nurses actually did report and when they did not it was not as a result of fear of retribution of misinterpretation. It has everything to do with the response from authorities after reporting such cases. Reichel (2006) illustrates that while both licensed practical nurses and registered nurses in nursing homes have witnessed elderly abuse in the time of their careers they expressed differences in satisfaction of how such cases are handled when reported to state authorities. Licensed practical nurses particularly reported greater satisfaction and appreciation of the response received and action initiated after reporting. However their general satisfaction was not good enough to motivate their frequent reporting of the cases. The perception that nothing much will be done is essentially responsible for the instances of some cases remaining unreported. Others also are not willing to report the cases because they do not want to involve themselves in lengthy legal procedures.

Additionally in another study the nurses also showcased little belief in the existence of good care services and procedures to diagnose elders abuse (Harris, 2005). They think that with proper knowledge on abuse detection then it would be easier to report this cases as it will be based on verifiable evidence.

Quinn and Tomita (1997) however affirm that all nurses do accept that they have the responsibility of reporting cases of elderly abuse and demonstrate the need of capacity building to enable them to effectively deal with this situations.

It is imperative to note that elderly abuse can have severe consequences on the older people. This people are generally physically weaker and their recovery tends to take longer therefore any minor injury whether physically or emotionally has serious implications on them. Consequently premature death is not an unrealistic consequence of elderly abuse.

Gaps in literature

It is unarguable that there exist a lot of data regarding elderly abuse. However most of the data concentrates on the elderly abuse that result from family members and home based care givers. The assumption is that within the nursing elderly homes the nurses themselves can not perpetrate elderly abuse. It has been assumed that nurses totally adhere to the nursing code of ethics and thus can not possibly commit acts that lead to elderly abuse. It is forgotten that nurses play the same roles as the elderly care givers that are home based and are also confronted by the same challenges that face the home based care givers. Consequently they are likely to behave in the same manner as the care givers when responding to the elderly. It appears therefore that research has not been conducted or documented regarding the role of nurses in elderly abuse.

There is also scarce data regarding the nurses’ knowledge and recognition skills of elderly abuse. Many studies touch on the subject in passing thus do little to provide tangible evidence that pinpoints the levels of awareness that the nurses have regarding elderly abuse, their causes and even consequences. This study therefore hopes to provide a valid document that proves and showcases the awareness that nurses have on the issue and how it increases the vulnerability of the elderly to even more abuse.

Additionally future studies that will be conducted on the subject of elderly abuse may find it necessary to explore the ethical principles in nursing violated by acts of elderly abuse. Such a document may go ahead to showcase whose responsibility it is to ensure that morality and nursing ethics are upheld when it comes to elderly care. Such research would furthermore point out any other subjects in the health care industry that have the autonomous duty to ensure that the welfare and rights of the elderly are properly addressed.

Furthermore it may be important to conduct research on the prevalence of elderly abuse in the other countries abroad. Most data that is available on the subject concentrates on abuse that the American adults are exposed to neglecting presentation of facts regarding prevalence of the same in other countries around the globe.

Conclusion

Studies indicate that many elderly people are at risk of being of being abused in nursing homes and thus it is up to everyone to take the necessary precautions to reduce risks. Nursing homes residents are supposed to unconditional receive the best possible care that is also free of any form of abuse.

For proper reduction and management of abuse cases there is need to be supportive and understand the dilemmas of nurses without assigning blame. Any suspected abuse of the elderly needs to without fail be reported to relevant state agencies.

Nurses should also be encouraged to respond swiftly to such cases even if they are not comfortable with reporting them at that time. They may for instance choose to place the elderly patients in danger in special care shelters until further notice. Most importantly nurses must recognize that when they report a case the result will be the protection of those individuals from further abuse. Additionally nurses must not be scared of upsetting the patient or embarrassing him because it is their duty to protect them.

The nurses should be reminded of their roles and responsibilities that are related to maltreatment, neglect and abuse prevention in health care settings. This would really assist in assessing elderly abuse because of the fact that the elderly themselves find it difficult to report such cases and other care providers have poor attitudes towards the elderly.

Additionally with nurses enhanced recognition skills of such cases it would also be easier to design standard intervention measures and revised reporting procedures for elderly abuse that will be applicable in the modern health care system.

Better training is necessary to help nurses have better recognition and prevention skills of abuse and thus assist in rooting it out from the care systems. Training as well as counseling of the nurses and family can be helpful and influential towards assisting providers in addressing stress related factors arising from elderly care. Training and periodic counseling will be expected to lead to a reduction of strain and stress which are major contributors of elderly abuse.

Community and other support groups need to assist families and nurses to offer care to the elderly and thus aiding in reducing rates of elderly abuse. Adoption of respite care can also be useful to help decrease rates of this abuse. This substitute care provides breaks for nurses and families responsible for the care of the elderly. It may also be healthy for families to investigate the history’s of nursing homes before leaving their members under the care of the staff.

Basically more professional training for nurses on elder abuse issues, coordination among care providers, offering technical assistance to nurses, development of protocols and manuals outlining preferred and proper procedure of handling the elderly and public education regarding elderly care should moreover work to ensure that abuse is reduced.

Methodology

There will be a need to expose the subjects a 20 – 30 minute questionnaire which they are expected to respond to in order to assess the inherent knowledge as pertains elderly abuse. The tool of application in this study is an adaptation of some previously conducted studies. The permission to put this tool into application was obtained as per the procedure. The process of data collection is expected to be at one point in time only so it shall be conducted only once. The information will be presented in a table format as the following table.

SECTION A

Demographic Data

Please fill the following blanks while checking your reactions with regard to the questions that appear below.

State your gender?Male ¨Female ¨

State your nursing status at present?

Enrolled Nurse¨

Registered Nurse¨

Deputy Nursing Officer¨

Nursing Officer¨

Other – Please indicate:

State preparation for academic nursing?

EN Course¨Post Graduate Diploma¨

SRN Course¨Masters Degree¨

Certificate¨PhD¨

Bachelor Degree¨

For what period of time have you worked as a nurse?

0 – 5 years¨

6 – 10 years¨

11 – 15 years¨

16 – 20 years¨

More then 20 years¨

For what period of time have you worked in the position of geriatric locale as a nurse?

0 – 5 years¨

6 – 10 years¨

11 – 15 years¨

16 – 20 years¨

More then 20 years¨

How many hours do you work in a geriatric setting per month? Hours

What is your employment status within the geriatric setting?

Full-time¨

Part-time¨

Have you ever received any formal training about any of the following?

Gerontology¨

Elderly abuse¨

Policy making in health care¨

None of the above¨

Have you ever received continuing education/in-service training on elderly abuse?

Yes¨No¨

If you ticked “yes” please go to question 10.

If you ticked “no” please go to question 11.

Where did you receive your education on elderly abuse? (Check all that apply)

At the University of Malta¨

On-line Resource Modules¨

Conference, Workshop, Etc¨

Course about elderly abuse¨

Other: Please indicate______

SECTION B

What do you understand by the term elderly abuse?

__________________________________________________________________

To what degree do you feel prepared to assess for elderly abuse?

Well prepared¨

Prepared¨

Somewhat prepared¨

Not prepared¨

Do you know of any different types of elderly abuse?

Yes¨No¨

If yes please list the different types:

__________________________________________________________________

Do you know of any signs that would help you recognize abuse when assessing an elderly patient?

Yes¨No¨

If yes please list these signs:

__________________________________________________________________

Which abuse screen or risk factor instrument can be used for assessment of an alleged elderly abuse report?

Caregiver Abuse Screen for the Elderly (Reis & Nahmiash, 1995).

Elder Abuse Detection: Indicators (Bloom, Ansell, & Bloom, 1989).

Indicators of Abuse (IOA) Screen (Reis, & Nahmiash, 1998).

Sengstock-Hwalek Screen (Sengstock-Hwalek, 1987).

All of the above

Don’t Know

Do you know of any particular characteristics that pre-dispose the elderly to become abused?

Yes¨No¨

If yes please list these characteristics:

__________________________________________________________________

When you suspect the presence of elderly abuse, what action(s) would you take?

________________________________________________________________________

SECTION C

Most elderly abuse is caused by care giver stress.