Reduction of Resident to Staff Violence in Nursing Homes

Reduction of Resident to Staff Violence in Nursing Homes
Violence is any act, physical or verbal aimed at a second party, and which causes massive bodily or mental damage and/or harm. In a society aiming at upholding peace and harmony, such acts are unacceptable if not deplorable. Despite this, the violence experienced in nursing homes is beyond any wild imagination. The staff members in nursing homes and the Certified Nursing Assistants have frequently yet silently been the subjects of violence for a long time. To say that it is understandable given the nature of their work is simply being ignorant. The time to implement the recommendations made by the multitude of researchers over time has surely come. The administrators, policy makers and all other stakeholders, therefore, have to grab this opportunity and minimize, if not eradicate altogether all the atrocities borne by staff members in nursing homes. Since the experiences and the information obtained from the Daughter of Miriams Nursing Home is reflective of the events occurring in other nursing homes nationwide, it would not be wrong to assume that the suggestions put forward would be revelatory. They (the suggestions) would not only be a turning point to the Daughter of Miriams Nursing Home, but also to all other nursing homes aiming to improve the staff satisfaction, and with it, enhance staff productivity

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The woes bedeviling nursing homes so far point at one crucial fall-out; the working conditions of nursing homes staff members and certified nursing assistants. Certified nursing assistants are the largest group of employees working in nursing homes. For that reason, research has demonstrated that they are a group of workers most prone to abuse, both physical and verbal. Indeed, research has also demonstrated that they bear the lion’s share of violence aimed at nursing home staff. Nevertheless, violence in nursing homes is all-inclusive and staff members together with residents are likely victims. A number of suggestions aimed at bringing this vice under control have been made. The most outstanding and viable suggestion has to do with the working environment in the nursing homes. This is a broad area and encompasses staff training, remuneration, quality and quantity of staff availed, motivation among other factors.

Before getting approval to work in a nursing home, individuals are required to undergo training to meet the job demands at their work stations. These training demands set the basis for selection or dropping of applicants. In most instances, the training level required for one to land a job in a nursing home remains vague. If not vague, where specified, the training more often than not focuses on basic skills such as feeding, bathing and clothing the residents. Training of staff should be a top priority affair and needs to be comprehensively done. It is a task that should be handled with the sensitivity and the seriousness it deserves. Apart from basic bathing, feeding and clothing knowledge, nursing homes staff members need to undergo extensive training that is specific on interpersonal and quality care giving skills. The staff members need to be trained on what is otherwise known as gentle persuasion. This involves imparting exquisite skills that go a long way in equipping them with the right words and attitude when dealing with the residents. Improved interpersonal relations inculcate a respect-dominated and harmonious coexistence, not just between the staff members and the residents, but also among the residents themselves. A resident who feels accepted and appreciated is less likely to wreak havoc compared to one who is ignored and abused. Improving the technical know-how of the staff in care giving improves their productivity and that of the nursing home as an institution. A more productive workforce translates to satisfied and happy clientele. The clients of nursing homes are not just the residents themselves, but also the friends and families of the residents who see the need of according their loved ones specialized and quality attention.

The certified nursing assistants and the whole nursing home staff fraternity needs to be trained on managing and coping with difficult residents. At times, staff residents can prove to be quite a handful. In their own way, they deal with a lot of internal dilemma, challenges and moments of uncertainty. Most of them feel sorry, or even angry at themselves for not being able to perform the simple tasks they earlier performed with a lot of ease. Loss of memory and inability to recall simple information does not make the situation any better for them. In a twist of events, they express this feeling of unworthiness from within through fits of rage and acts and words of violence. With the knowledge of what is going on through the residents’ minds, the staff members can regulate their reaction, taking precaution not to send a resident into further fits of anger and episodes of violence. With the increasing base of knowledge on what transpires in the minds of people with dementia, formidable training can be accorded to nursing home staff to keep them averse with the goings-on. Further, extensive research should be conducted, especially on topics such as the relation of dementia and acts of violence among patients. The research conducted can aid in shedding more light on the topics and making worthwhile discoveries, significant in improving the lives of people with psychiatric shortcomings. With an improved knowledge base, the adequately trained staff will know what to do or not to do in case they are faced with a situation of a violent resident. This goes a long way in preventing an altercation which would subsequently degenerate to an out and out violent episode.

Training nursing homes staff members in conflict resolution is necessary. Even though most violent acts and words are commonly directed at nursing homes staff members by residents, it also remains true that some of the combative acts and acid words are aimed at fellow residents by some residents, or even aimed at residents by staff members! Violence in nursing homes is never always aimed at staff members, neither is it always aimed by residents. This brings to light the need to equip the staff members with the relevant skills on handling, managing and quelling a potentially violent scenario before it unfolds. The staff members, more than any other party possess the ability to unlock an impasse, bearing in mind that a resident’s mental condition may not always allow him or her to see the situation as logically, clearly and concisely as the staff members can. Enlightening the staff members on when to stand their ground regarding an instruction given or when to lie low and avoid an argument with a resident is necessary. The staff members also need to be trained to anticipate violence and violent reactions and the best ways to extinguish them before they come to term. They need to be trained on controlling their own emotions and reactions by avoiding impulsive reaction and embracing wise, calculated moves aimed at making a deteriorating situation better.

Problem solving skills are a key attribute, particularly in a setting in which disagreements and altercations are likely to spring up. This provides sufficient reason why, other than conflict resolution, nursing home staff members need to be given comprehensive training in problem solving skills. In a way, the two factors go hand in hand. However, conflict resolution usually comes way after the problem has degenerated and culminated into something worse. Nevertheless, enlightening the staff members on ways of nipping a problem in the bud before it explodes into a full blown tragedy makes a significant difference in its own way. Research has demonstrated that most cases of assault and violence occur during incidents of approximate staff-resident contact. This interaction is inevitable and, therefore, only ways and means of limiting foreseeable problems can be devised. This can be seen through by imparting skills on problem solving on the staff members.

Research has shown that the most dominant cause of violence towards staff or by staff members in nursing homes is a lack of mutual understanding between a resident and a staff member. Lack of adequate information, especially by a staff member on a resident most likely causes friction, in the process evoking the resident’s irritable traits. An interpersonal association breeds a different level of understanding between the resident and the staff member. It would, therefore, be tremendously beneficial for the resident, the staff member and the nursing home as a whole if the staff members are provided with in-depth and reliable information on a resident’s mental condition and health status and his or her likes and dislikes. For instance, it has been shown that people with dementia and Alzheimer’s disease are more predisposed to engaging in physical or verbal violence compared to other people. They are usually frustrated by their inability to perform simple tasks, and to remember information they previously had on their fingertips. With this knowledge, staff members would be more careful when around people with such mental problems. They can as well keep such individuals in seclusion, especially after exhibiting tendencies of violence, not just to the staff members, but also to fellow residents.

Whenever an individual joins a nursing school, they never expect, let alone sign up the kind of treatment that is sometimes accorded to them at the nursing homes. Their objectives, goals and expectations are usually a stark difference from the reality on the ground. The demands of the job, coupled with being in a long term care facility for a good part of their day comes with a lot of mental burden for some of the staff members. As a result, they are highly prone to suffering from bouts of depression and even stress. This stressful situation may boil over and may be exhibited in the way the staff members treat the residents. Unintentionally, they may see out frequent outbursts and acts of violence towards the residents. In return, the residents may retaliate. This effectively sets up a vicious cycle. To bring this scenario under control, it is prudent to train the staff members of nursing homes on stress reduction techniques. Their ability to efficiently and effectively manage stressful situations goes a long way, not only in preventing triggering violence by the residents, but also in enabling them appreciate their job more. This essentially builds on job satisfaction which is largely important for the productivity of the staff members.

Screening of staff members is a crucial stage in hiring nursing homes staff members, and should neither be underestimated nor overlooked. For the simple reason that nursing homes staff members experience higher workplace violence than any worker in the nation, the sensitivity of the profession lies bare for all to see. Screening staff members before hiring assures an able, willing and competent work force. Individuals’ history on work ethics needs to be looked into extensively to ascertain that at no time in their careers did they engage in unethical or unacceptable behavior in the work place. They also need to be screened on their anger management skills and any records of violence towards residents or any other person analyzed. People with previous anger management difficulties, especially in the outside world are quite unlikely to be any different in a nursing home. If anything, they could only get worse. The interviewing panel also needs to find out an individual’s drive for choosing the career. Only upon issuance of a convincing response should the person be shortlisted. From the ongoing, it has become apparent that people join the nursing profession for various reasons. Those who give out questionable reasons such as monetary returns or family backing should be filtered out. Such characters are more likely to yield to stressful situations and even act unprofessionally in that event. Lastly, during the screening process, each person should be asked to give his or her taking on elderly people and how they should be treated. An answer to this question may give the panel a clue to the kind of person it is dealing with. People who have a negative attitude towards the elderly are unlikely to thrive in a nursing home, bearing in mind that the elderly form a great percentage of the population, if not the whole population. Screening gives the panelists a rough idea on the kind of person a candidate is. Even though it might not be thoroughly objective and comprehensive, it may go a long way in identifying possibly recommendable candidates. Employing a staff with the right attitude and feeling goes a long way in avoiding common causes of fall-outs between administrators and staff members.

In a bid to improve the working conditions of the staff members, adequate, qualified and competent staff members should be hired. An inadequate workforce exerts a lot of pressure on the few available members of staff. This likely takes a toll on them, in the process hindering their morale and efficiency. Hiring unqualified staff could also very well lead to further problems. Dissatisfied customers would be a frequent scene. For the residents, there are a limited number of ways of expressing their dissatisfaction. One of these is through violence. Cases of violence are, therefore, likely to rise dramatically. Aging and the accompanying changes that come with it more often than not lead to deterioration in the mental capacity of the subjects. There actions, on a number of occasions are out of control. Again, with an incompetent workforce, the staff will be more result-oriented than quality oriented. The quantitative and qualitative performance indicators include improvement in the health and well-being of the residents. However, with an incompetent staff, meeting of daily obligations is made a priority at the expense of the residents’ well being.

One of the most crucial factors for the progress of any institution or organization is communication. Likewise, the influence of communication is humongous in cutting down on violent acts aimed at staff members in nursing homes. Fruitful communication between the staff members and the administrators and between the staff members and the residents is necessary. Staff members and administrators need to be constantly in touch to stay up to date with any developments on the residents. Valuable information that can go a long way in improving service delivery to the residents can be exchanged through this way. If served well and according to their expectations, it is highly unlikely that residents would act or react violently. In the same way, communication between the staff members and the residents is even more important. Research has shown that in their struggle to find their bearing, most residents need more than anything, someone who shows a level of understanding towards them. Someone who shows even a slight tendency of understanding their predicament and goes the extra mile to win their hearts over becomes an instant favorite. It is noteworthy that some of the violent residents do not just react to being placed in seclusion. It has been shown that they (residents) would react in the same way they do in the nursing homes as they would in the comfort of their homes. Therefore, it has little to do with the vicinity and more to do with the treatment. The staff members in nursing homes therefore need to show a great level of commitment and try and find out what makes each resident tick and what does not. This way, the staff members shall have solved a significant part of the puzzle.

Improvement of the working environment should not only be done materially. Financially, staff members in nursing homes need to have their salaries raised to go hand in hand with the work demand. Staff members working their socks off yet earning peanuts at the end of the month are less likely to develop job satisfaction and loyalty, according to research. This is an area that requires immediate address. Staff members who feel overworked yet underpaid in most cases end up engaging in their own personal activity when they should be attending to residents. The frustration and lack of recognition by the various authorities pushes them into oblivion. The repercussions are untended residents who have few avenues of venting out their anger or letting their frustration be known. Hitting, grabbing, pinching, pulling, shoving , scratching, biting and spitting just to name a few; these are their ways of making sure their message gets home. With an improved remuneration package, in order to uphold wage parity the staff members in nursing homes would feel appreciated. As a result, they would embrace their jobs with a lot of zeal and zest. A fully functional team that is efficient in its undertakings much more likely yields a satisfied customer, in essence reducing the tantrums that would otherwise be thrown by displeased clients.
Other than giving the staff member’s monetary incentives, they can also be offered mobility in terms of position. It is the expectation of every professional to get promoted after performing exemplary work. The case is by no means different in the case of certified nursing assistants and other staff members in nursing homes. Promoting an employee shows him or her that his or her hard work has neither gone unnoticed nor unrewarded. It boosts the morale of the staff and motivates them in a pleasant way. This motivation and boost of morale is paid back in improved performance which in turn results to fewer or no violent cases at all in the nursing home.

Recognition, understanding and appreciation of the difficulties certified nursing assistants and other staff members in nursing homes undergo goes a long way in improving their productivity. Recognition and appreciation can be done every so often and may involve simple gestures such as throwing a party. Simple gestures they are, but the impression they leave on the staff is magnificent. This way, the nursing home ends up with a happier, more satisfied workforce ready to go out of its way to ensure residents are well served. As it goes, an efficiently served resident usually has few reasons to be violent.