By Victoria White
GAINESVILLE, Fla.---Verbal and physical attacks are common in the nation's nursing homes, but who many of the victims are might come as a surprise: nursing assistants, who endure aggressive behavior from residents on a daily basis, a University of Florida researcher has found.
Such aggression not only makes caregivers' jobs more difficult: It sometimes triggers retaliatory abuse against residents by staff who buckle under the pressure.
"Nursing assistants are yelled, kicked and sworn at," said Mary Conlin Shaw, who researched the topic for her doctoral dissertation at UF's College of Nursing. "Racially derogatory remarks are very common. Staff have urinals thrown at them and fingers bent back. I talked to one staff member who said a resident tried to kick her when she was eight months pregnant."
The majority of residents do not exhibit such behavior, Shaw noted. "But there are usually a few who cause great stress for many staff members."
There are more than 19,000 nursing homes in the United States, providing homes for 2.3 million people each year. As the graying of America continues, approximately one in four people can expect to spend some time living in one.
"We think of the typical nursing home resident as a frail and debilitated elderly person, so if you suggest there is abuse by a resident, people will say, 'That doesn't happen.' But it does and it happens frequently," said Shaw, a former nursing assistant who completed her dissertation last year under the supervision of Sally Hutchinson, a professor in the College of Nursing's department of health-care environments and systems.
Reliable estimates of abuse of residents and nursing assistants are not available, because residents often lack the physical or mental capacity to report ill treatment and nursing assistants generally are required to accept aggression as part of the job.
"Aggressive behavior by residents directed toward nurse aides and other staff is something for which every nursing home must be prepared," said Robert Greenwood, public affairs manager for the American Association of Homes and Services for the Aging. "Because many of the residents have cognitive impairments, it is one of the situations nurse aides must be trained to handle."
Nursing assistants provide 80 to 90 percent of the direct care in long-term care facilities. In the six homes Shaw visited throughout Florida, nursing assistants typically cared for six to 15 residents each day and earned an average of $8.45 an hour.
"Nursing assistants are faced with call lights being on constantly, patients wanting them all the time, and families visiting who insist, 'Mom needs this now,'" said Shaw, who is associate director of education and evaluation for the Geriatric Research, Education and Clinical Center at the Veterans Affairs Medical Center in Gainesville.
The limited numbers of staff, heavy workload and the need to provide care quickly lay the foundation for staff abuse. A resident is more likely to act aggressively when he is overwhelmed by care, his personal space is invaded, and he is made fearful by a sudden flurry of activity around him.
Many nursing assistants, however, proclaim to love their jobs and the residents. They learn ways to prevent residents aggression, such as getting to know their idiosyncrasies, staying clear of their personal space and choosing carefully when to assist with private tasks.
Shaw, who interviewed nursing home staff in 1996-97, said many nursing assistants develop an "immunity" to the abuse. They excuse residents' behavior, reasoning that many are sick, demented or frustrated with nursing home life.
But some nursing assistants never learn to cope or lose the ability when too much stress builds at home or at work. The result? Some quit, contributing to the high turnover of nursing assistants. Others can end up retaliating against a resident who has done something to them, Shaw said.
Shaw suggests that training programs for nursing assistants include role-playing activities to show students the types of verbal and physical aggression they can expect to encounter from residPents. Such realism might help weed out people who would react abusively to verbal and physical attacks or who just don't seem to belong in a nursing home job, Shaw said.
Nursing homes should give nursing assistants a measure of freedom in their schedules so they can get to know residents better by taking them for a walk, sitting and talking, or just watching television together for a few minutes, Shaw said.
"Those activities would give nursing homes a more homelike feeling, and would make residents less likely to become agitated and strike out at staff," Shaw said.
Shaw suggested that nursing homes provide on-the-job support for nursing assistants to help them cope with personal problems and decrease their stress levels.
"In the long run, valuing and caring for nursing assistants will result in better care for nursing home residents and less abuse and injury of staff and residents," Shaw said.
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