Relatives' experiences with abuse and neglect in Norwegian nursing homes. A qualitative study.

BACKGROUND: Elder abuse in nursing homes (NH) is a widespread and complex problem. Residents' ability to share their experiences are impeded, due to a high degree of cognitive problems and frailty, and previous studies are thus mainly based on reports from staff. Therefore, we aimed to give voice to the residents by investigating their relatives' experiences with elder abuse in NH. METHODS: Qualitative individual interviews were conducted with 16 relatives of residents with experience of abuse and/or neglect in NH. Content analysis was used to analyse the data. RESULTS: Relatives perceived neglect as most pervasive and staff-to-resident psychological abuse as a key problem. Physical abuse was mostly related to resident-to-resident aggression. Relatives perceived elder abuse in NH to be related to low competence among staff, low staffing, poor NH leadership, working cultures characterized by fear and loyalty to employer or co-workers, and a lack of individualized care for the residents. Furthermore, relatives themselves experienced maltreatment from NH, which caused them to suffer stress, anxiety and distrust. Relatives also expressed a need to compensate for lack of care. CONCLUSIONS: Relatives of NH residents who had experienced abuse reported that neglect of basic care and individual rights was predominant and viewed organizational explanations as most important. Relatives perceive themselves as collaborators in care and are emotionally attached to their family member. Therefore, if relatives experience resident abuse or neglect, it inflicts a feeling of being mistreated themselves, particularly if they are not listened to or their notice of abuse on the part of the resident is ignored or trivialized. Including relatives in a committed partnership with NH in care practices is not only a valuable path to reduce the risk of abuse, but it also leads to a more sustainable healthcare with high standards of quality and safety.

When the struggle against dejection becomes a part of everyday life: a qualitative study of coping strategies in older abused people.

BACKGROUND: Abuse of older people is a serious issue and is associated with an increased risk of morbidity and mortality, and professionals will encounter elderly victims of abuse in all areas of the health care system. An important health determinant is behavioral factors, including coping style, which will impact on how older people manage stress and maintain control in their lives, and thereby protect themselves from abuse. The aim of this study was to explore the coping strategies elderly people abused by their offspring used to manage everyday life. METHODS: A qualitative approach was used and 14 elderly victims of abuse were interviewed. The interviews were recorded, transcribed, and subjected to qualitative content analysis. RESULTS: Five main coping strategies were identified. The main strategy was linked to the role of parent. Another prominent strategy was attitude towards being victimized. Further strategies were associated with hope for a better relationship with offspring in the future, while others felt that they had done the best they could, or that their offspring were no longer their responsibility. The results are discussed in light of theoretical perspectives related to coping and resilience. CONCLUSION: Abuse of older people by their offspring imposes severe stress on victims and challenges the values and beliefs about the caring nature of families. The findings of this study indicate that victims of abuse use a wide range of coping techniques to manage everyday life, and that some strategies help them to maintain their self-respect in their role as parents and find some sort of resilience.

Identifying and handling abused older clients in community care: the perspectives of nurse managers.

BACKGROUND: Abuse of older people can lead to an increased need for health care services, and early identification of and intervention with abused, older clients should be a priority. OBJECTIVES: To gain knowledge about how nurse managers and their staff identify and handle abused older clients. DESIGN: Qualitative study. METHODS: Fifty-two participants were interviewed, the text transcribed and analysed using manifest qualitative content analysis. FINDINGS AND DISCUSSION: The identification and handling of older victims depended on individual nurses and the involvement of the participants and are based on clinical experience and less on knowledge through professional training and education. The participants emphasised the need for an individualised approach to older victims suspected of abuse. The important role of the nurse managers in the handling of abuse is discussed as well as the need for support of the nurse managers and the staff in community care by increased interdisciplinary collaboration to handle complex cases. CONCLUSION: The identification and handling of abused older clients are a challenging issue for community care, and more knowledge and support are needed. IMPLICATIONS FOR PRACTICE: The concept of elder abuse must be clarified, and strategies for its identification and intervention must be developed.

Challenges in handling elder abuse in community care. An exploratory study among nurses and care coordinators in Norway and Australia.

AIM AND OBJECTIVE: The aim of this study was to explore how nurses and care coordinators in community care in Norway and Australia experienced and handled cases of abused older clients, including the support they received in clinical interventions. BACKGROUND: Norway and Australia base their approaches to elder abuse problems on similar philosophies. The Australian Government, however, has taken a more active position on this issue by focusing on structures and policies that might influence professionals' handling of abuse cases. The organisation and funding of community care services in the two countries are different, although common concerns are client-centeredness, equal access to services and enabling the client to live at home as long as possible. DESIGN: Explorative design with a qualitative hermeneutic approach. METHOD: Twenty participants, nurses, auxiliary nurses and care workers in Norway and Australia, were recruited by purposeful sampling. They participated in in-depth interviews. RESULTS: The similarity of the information given in the two countries was striking. The interventions differed based on the type and seriousness of the abuse and the client's cognitive capacity. Financial abuse was a more prominent issue in Australia than in Norway. The handling of neglect cases in both countries followed much the same pathway and the intervention usually involved long-lasting processes. The managers' support and the elder protective services were of great importance to the nurses. CONCLUSIONS: Community care agencies in both countries struggle with similar problems in handling cases of abuse. The participants' concerns were securing and supporting the older victim by individualising the intervention. RELEVANCE TO CLINICAL PRACTICE: Community care agencies in both countries need to be aware of the huge impact of the managers' involvement and the services' responsibility and capacity to support professionals in the handling of elder abuse.

Nurses' clinical assessments of older clients who are suspected victims of abuse: an exploratory study in community care in Norway.

AIM AND OBJECTIVES: The aim of this study was to explore how nurses in community care experienced clinical assessment of suspected abuse cases and factors impacting on the assessment process. BACKGROUND: Elder abuse is a serious problem affecting an older person's health and well-being. A considerable number of older victims of abuse receive health care services. Health professionals, such as nurses in community care, will very likely meet clients suffering from abuse. In Scandinavia, research about older abuse is quite limited. This also applies to research into nurses' clinical assessments of older, abused clients under community care services. DESIGN: Qualitative, hermeneutic approach. METHOD: Ten nurses were recruited by purposeful sampling and interviewed in-depth. The analysis process was guided by Gadamer's recommendations on understanding and interpreting oral and written text. RESULTS: Three important phases in the clinical assessment were revealed, including the recognition of a possible abuse situation, an information gathering phase and, finally, judgement and conclusion. Two critical factors impacting on the process included the nurse's ability to get into position to perform the necessary observations in the home and the quality of the information gathered about the client's situation. In addition, factors related to the client and the community care organisation influenced the nurses' work and thereby promoted, delayed or interrupted the clinical assessment. CONCLUSIONS: Nurses' opportunities to identify older, abused clients might fail unless certain conditions are present that facilitate the clinical assessment. In particular, the involvement of the manager is important, in addition to the presence of alliances in the assessment process. RELEVANCE TO CLINICAL PRACTICE: The findings indicate the need for a framework that may facilitate the systematic clinical assessment of suspected older, abused clients in community care. Such a framework might ensure the quality of the service provided to victims of abuse.