Staff-to-resident abuse in nursing homes: a scoping review

Abstract

Background Elder abuse in long-term care is an important public health concern with social, health-related, and economic implications. Staff-to-resident abuse is of particular interest since institutions should protect residents’ rights and prevent harm. To provide an up-to date comprehensive overview of staff-to-resident abuse in nursing homes, we performed a scoping review considering types of abuse, their prevalence and associated factors, descriptions, experiences, and preventive interventions. Methods We performed a scoping review following the framework provided by Arksey and O’Malley. We searched MEDLINE (via PubMed), CINAHL, PsycINFO via Ovid, and Cochrane Library. Additionally, we performed free web searching using Google Scholar and checked relevant reviews. Two reviewers independently selected studies. We narratively synthesised the results. Results Out of 3876 references retrieved by our search, we included 46 studies in 47 reports. The prevalence rates of abuse varied widely, ranging from 0 to 93% depending on the type of abuse. Associated factors of abuse at the staff, resident, and nursing home level were evaluated inconsistently. Abuse was perceived ambiguous: even though it was considered unacceptable, it was underreported. We found only four studies addressing preventive interventions. Of these, four made recommendations for intervention development. Only one study with an experimental design examined a multi-component intervention including education and mutual support. Conclusions The review yielded heterogenous evidence not allowing a concrete conclusion on prevalence and associated factors. However, the results show the significance of the problem and indicate that there are associate factors of abuse that can be influenced by appropriate interventions. These are amongst other staff education, organisational culture, and conditions. Further research should investigate the composition and content of preventive interventions and their potential to reduce abusive behaviours.

The work status of nurses in long‐term care institutions in elderly care: A qualitative descriptive study

“…Studies (Feng et al, 2019; van der Cingel & Brouwer, 2021) have shown that there were still stereotypes about the nursing profession in society, that nursing work was simple and not professional, so that nurses were not respected and recognized as they should be. In addition, this study also found that due to the large workload and difficulty of long‐term care, coupled with their lack of ability, individual nurses were prone to vent their stress in an inappropriate form (Chen et al, 2020), which also exists in other countries (USA, Norway, UK, etc) (Hirt et al, 2022), seriously affects the quality of care and health of seniors. In this regard, nurses in long‐term care facilities should continuously strengthen their professional ethics, increase their humanistic care capabilities, and establish a respectable industry image.…”

Residents' Fear of Retaliation in America’s Nursing Homes: An Exploratory Study

“…One critical but largely overlooked factor limiting the effectiveness of this safeguard is residents' fear of staff retaliation when voicing concerns about rights violations, poor care, and mistreatment. Specifically, in the context of the power imbalance between residents and staff (Hirt et al, 2022), the National Long-Term Care Ombudsman Resource Center (2018) asserted, "Fear of retaliation is one of the most common reasons residents do not want to pursue a complaint and disclose their identity. Since residents live in a facility and rely on staff for their basic needs, their fear of retaliation cannot be overemphasized.…”

“…One critical but largely overlooked factor limiting the effectiveness of this safeguard is residents’ fear of staff retaliation when voicing concerns about rights violations, poor care, and mistreatment. Specifically, in the context of the power imbalance between residents and staff (Hirt et al, 2022), the National Long-Term Care Ombudsman Resource Center (2018) asserted, “Fear of retaliation is one of the most common reasons residents do not want to pursue a complaint and disclose their identity. Since residents live in a facility and rely on staff for their basic needs, their fear of retaliation cannot be overemphasized.”Fear of retaliation is defined as, “a concern or feeling of vulnerability that one’s actions may cause retaliation by another” (Connecticut Fear of Retaliation Workgroup) while retaliation is defined as, “acts of retaliation / revenge by facility staff in response to complaint to the facility, Ombudsman program, or state survey agency” (The National Ombudsman Reporting System).…”

“…The lack of or delayed resident reporting due to fear of retaliation is of concern also because staff mistreatment of residents is underreported by nursing homes (Hirt et al, 2022; U.S. Office of Inspector General, 2017a, 2017b, 2019b) while mistreatment complaint investigations tend to result in more serious deficiency citations compared with those issued during annual surveys (Liu et al, 2022).…”

“…Office of Inspector General, 2017a, 2017b, 2019b) while mistreatment complaint investigations tend to result in more serious deficiency citations compared with those issued during annual surveys (Liu et al, 2022). Furthermore, in nursing homes, the majority (57.6%) of long-stay residents have dementia (Centers for Disease Control and Prevention, 2022), a condition placing these individuals at risk of mistreatment (Fang & Yan, 2018; Hirt et al, 2022) with limited ability to recall and/or report it in the advanced stages of the brain disease (CMS, 2023a).…”