According to a recent Swedish study, violence against caregivers is often underreported in nursing homes because the caregivers accept attacks as excusable and an unavoidable part of the job. At the same time, violent acts may sometimes be overreported. The problem is that “violence is in the eye of the beholder,” making it hard for caregivers to know what should and should not be reported.
“Violence in Nursing Homes: Perceptions of Female Caregivers” reports on the results of a study of 41 female members of the nursing staff at three Swedish nursing homes, including eight nursing assistants. The caregivers were asked to react to a vignette in which a male resident being helped by a female caregiver suddenly screams loudly, shakes his fist, calls her derogatory names and scratches and pinches her until a colleague comes to help her.
The caregivers generally considered acts to be violent only if they are intentional, so they generally excuse them in people with dementia. “As long as they are confused…and is in some kind of other world, then I cannot consider it as violence,” one said. And if a resident is not aware of who the caregiver is and does not direct the violence toward that individual, they are less likely to consider it violence.
The caregivers also tend to excuse violence for if the resident is old or has brain damage, if he becomes frightened because he doesn’t understand what is happening and responds with violence, and if he is suffering from pain and using violence to avoid being handled.
They see violence as part of the job, accepting things at work that they would consider violent in any other context, and they often blame themselves for being in the wrong place if they are attacked. And they don’t perceive being cursed at, even on a daily basis, as violence. “I cannot call it violence. I will call it …well, rudeness,” said one.
“It seemed that they did not want to describe the resident as a ‘perpetrator’ and themselves as ‘victims,’” the researchers note. “If the caregivers see themselves as ‘victims,’ they might question their skills. They ‘normalized’ the residents’ behavior by talking about it so it fell outside the boundaries of violence.”
The authors call for “a well-developed and operationalized definition of violence” as well as “individually structured and adjusted support for caregivers.”
The article ran in the Journal of Clinical Nursing, Volume 17 Issue 12. It’s free to subscribers only (others must pay $29.95.)
Elise Nakhnikian, Senior Online Editor
enakhnikian@phinational.org
At my work site, violence is taken very seriously. If the consumer does not have a TBI or some sort of diagnosis that would warn the staff that this sort of behavior may occur, the police may be called. There have been a couple incidents where this have happened in the past, but charges were dropped after the consumer apologized and had enrolled in an anger management program.
I understand that some consumers may not have control over their behavior - and the staff that work with them at my place of work are well trained and handle incidents in a highly professional and caring manner. Other consumers (Thankfully, a small minority!) that have attacked staff in the past have been warned that they can and will be arrested by the police if the victims wish to swear out a complaint.
Where I work, there are a few that get kind of Violent. Those are the ones that talk out of their head, and are in another world. Usually we can avoid their fist, every now and again, they will get ya. I’ve come home rather bruised up before.
Now, the ones that do know what they are doing, they get reported to the office. And after 3 strikes, they are outta there.