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Natan, M.B., Lownstein, A., & Eisikovits, Z. (2010). Psycho-social

factors affecting elders
maltreatment inlong-term care facilities. International Nursing
Review, 57(1), 113-120.

Student: Charle Ryan Paguel

Student No: 822-851-358
Date Submitted: February 25, 2014
NURS 260: Practical Nursing Theory 2
Humber College North

Psycho-social factors affecting elders maltreatment in long-term

care facilities
Vulnerable adult is someone who reach the age of maturity that is in
need of special care related on their mental or physical disability, age, or
illness; who is in any given situation they are unable to take care of their
overall wellness, (Heath & Sturdy, 2007). Besides, vulnerable adults are
mostly elderly that lives in different setting, and most of them are staying in
long term facilities. Furthermore, with their depreciating health, they
experience different form of abuse from their caregivers or people that is
responsible of their health and wellness. In addition, Nurses are the main
caregivers in long term facilities, and they contribute to elderly abuse or
maltreatment. Abuse is a violation of a persons human and civil rights by
someone in any given time, (Heath & Sturdy, 2007). Moreover, a study was
conducted to determine the causes of elderly abuse and maltreatment in
long term facility. This research study was focus on three main areas; staff
traits, patient traits and facility features. Firstly, workers behaviour
associated with job pressures and burnouts can contribute to physical and
mental hostility, especially those nurses with inadequate knowledge and luck
of professional guidance. Secondly, patient character; focus on patient with
mental illness or primarily those with dementia. They suffer abuse and
maltreatment from their caregiver because they initiate aggressive
behaviour and unconscious rudeness. Similarly, patient character includes
patient gender and age; in the study, they found out that maltreatment
accelerates with age, especially to women compare to men because of

physical strength. Lastly, work place environment plays a very important

part in elderly abuse and maltreatment because the higher number of
patient within the facility, the higher the pressure on the staff providing care,
(Natan, Lowenstein & Eisikovits, 2010).
Furthermore, elderly abuse and maltreatment is primarily attributed to some
nursing implications including insufficient knowledge and skills, luck of
experience and excessive workloads.
Firstly, one nursing implication that contributes to elders abuse and
maltreatment is insufficient knowledge and skills. According to Statistic
Canada, elderly population has a rapid inclination through the past years and
progresses throughout the years, (Jarvis, 2014). Nursing profession cover a
wide scope of practice; including care of elderly in long term facilities. In fact,
sufficient knowledge and skills are needed to uphold the therapeutic
relationship between nurses and client, (College of Nurses of Ontario, 2006).
In addition, Nurses must be confident in applying their acquired knowledge
and skills in professional manner at all times. Similarly, in any aspect of life,
knowledge and skills are the foundation of a person to function in any given
task. Especially in the field of nursing that life and dignity of a patient is
crucial. Inadequate knowledge and skills of nurses will lead to some
problems; including elderly abuse like mental and physical neglect. Neglect
is a form of abuse that most of the times nurses overlooked, and does
contribute in poor health conditions of elderly. For example, when a nurse

neglect to position a patient every two hours or neglect to provide personal

hygiene on the patient. The outcome of this nursing action would be pressure
ulcer; a condition of a skin to breakdown because of luck in blood circulation,
(Jarvis, 2014). For these reason, a sufficient knowledge and skills of nurses
are needed to prevent a patient from harm.

Another nursing implication that contributes to elderly abuse and

maltreatment is luck of experience. According to the article Psycho-Social
Factors Affecting Elders Maltreatment in Long Term Facility, nurses with
more experience will less expect to act aggressively on elderly. Furthermore,
evidence have shown that new nurses are more likely to commit physical
abuse, (Natan, Lowenstein & Eisikovits, 2010), because they are not use to
their recent role and they dont stabilized their priorities when working, often
in long term facilities. In addition, nursing student after graduation probably
have the knowledge and skills needed to perform the job but they are not
properly expose to different kind of real situations that require critical
thinking.
For example, dealing with complicated situation like sudden change of
cognitive thinking of a person, more likely a normal condition for elderly
patient with dementia; because in later stage of life everything slows down,
the processing of information in their brain is much slower than in younger
adults, (Jarvis, 2014). In this aspect, this condition can contribute to a patient

aggressive behaviour. Furthermore, a good nursing practice to resolve this

situation is to know more about the patient, not only by name or date of birth
but also understanding a patients emotional and physical needs. This
practice is probably the effective way to establish trust and better
accommodate patient health situations. In some cases, elderly patient only
need a companion. A person that care and give them comfort, and this might
positively impact their behaviour. Moreover, In school student learn how to
assess a patient health issues and provide the care they need; in addition,
student are required to do a long hours of community service for them to
expose in different people, and also to provide them the experience they
need on their future nursing carrier.
Lastly nursing implication that contributes to elderly abuse and
maltreatment is excessive workloads. Nursing profession is not an easy
journey because someones life depends on their hand when their health and
wellness is at risk. A nurse must prioritize their patients health condition and
they must not take for granted because in a smallest mistake will take
someones life. Nurses are also human; they feel pain and stress, especially
when they had too much in their hand. Furthermore, fatigue can cause a
nurse mood and attitude to undesirable outcomes, especially when they are
dealing with elderly patient. Similarly, emotional distress of a nurse, cause
by imbalance workload (meaning too much work for one person to handle),
could lead a person to act violently. In long-term facilities one of the leading
cause of perpetrating maltreatment of elderly is emotional fatigue and

feeling of depersonalization of nurses, (Natan, Lowenstein & Eisikovits,

2010). Moreover, fatigue causes a person to feel stress and affects his/her
normal thinking, and can contribute to a persons negative behaviour.
In conclusion, there are nursing implication that can cause elderly
abuse and maltreatment; this includes insufficient knowledge and skills, luck
of experience and nurses excessive workload. The best way to prevent
abuse and maltreatment of elderly; nurses are require to have a standard
training on a regular basis, that focus on how to handle difficult situations,
especially when dealing with patient that needs special attention, like patient
with dementia (Natan, Lowenstein & Eisikovits, 2010) . Nurses also need to
overcome personal difficulties that can contribute to their stress when they
are working. Nurses must be provided with a balanced workload, periodic
training, adequate people and working equipment, for them to work
efficiently and can deliver a therapeutic care in every patient expectation.
References

Natan, M.B., Lownstein, A., & Eisikovits, Z. (2010). Psycho-social factors

affecting elders
maltreatment in long-term care facilities. International Nursing
Review, 57(1), 113-120.
Heath, H., & Sturdy, D. (2007). Vulnerable adults: The prevention, recognition
and management
of abuse. Nursing Older People, , 1-15. Retrieved from
http://search.proquest.com/docview/218608551?accountid=11530

College of Nurses of Ontario. (CNO). (2013). Practice Standard: Therapeutic

Nurse-Client
Relationship, Revised 2006. Retrieved from
http://www.cno.org/Global/docs/prac/41033_Therapeutic.pdf
Young, L. (2011). Elder abuse. Elder Abuse Article - RN Journal , Retrieved from
http://rnao.ca/sites/rnao-ca/files/Elder_Abuse_Article_-_RN_Journal_Sept-Oct_2011.pdf
Jrvis, C. (2014). Physical examination & health assessment. (pp. 99-100). Toronto, Canada:
Elsevier.