Department of Public Health and Nursing, Faculty of Medicine and Health Sciences NTNU, Norwegian University of Science and Technology, Trondheim, Norway.
Centre for Quality and Patient Safety Research - Barwon Health Partnership, Institute for Healthcare Transformation, Deakin University, Geelong, VIC, Australia.
BMC Health Serv Res. 2020 Dec 1;20(1):1111. doi: 10.1186/s12913-020-05969-x.
Elder abuse in nursing homes is a complex multifactorial problem and entails various associations across personal, social, and organisational factors. One way leaders can prevent abuse and promote quality and safety for residents is to follow up on any problems that may arise in clinical practice in a way that facilitates learning. How nursing home leaders follow up and what they follow up on might reflect their perceptions of abuse, its causal factors, and the prevention strategies used in the nursing home. The aim of this study was to explore how nursing home leaders follow up on reports and information regarding staff-to-resident abuse.
A qualitative explorative design was used. The sample comprised 43 participants from two levels of nursing home leadership representing six municipalities and 21 nursing homes in Norway. Focus group interviews were conducted with 28 care managers, and individual interviews took place with 15 nursing home directors. The constant comparative method was used for the analyses.
Nursing home leaders followed up incidents of staff-to-resident abuse on three different levels as follows: 1) on an individual level, leaders performed investigations and meetings, guidance, supervision, and occasionally relocated staff members; 2) on a group level, feedback, openness, and reflection for shared understanding were strategies leaders used; and 3) on an organisational level, the main solutions were to adjust to available resources, training, and education. We found that leaders had difficulties defining harm and a perceived lack of power to follow up on all levels. In addition, they did not have adequate tools for evaluating the effect of the measures that were taken.
Nursing home leaders need to be clear about how they should follow up incidents of elder abuse on different levels in the organisation and about their role in preventing elder abuse. Evaluation tools that facilitate systematic organisational learning are needed. Nursing homes must operate as open, blame-free cultures that acknowledge that incidents of elder abuse in patient care arise not only from the actions of individuals but also from the complex everyday life of which they are a part and in which they operate.
养老院中的虐待老人行为是一个复杂的多因素问题，涉及个人、社会和组织因素等各个方面。领导者可以通过以下方式防止虐待老人行为，为居民提供更高质量和更安全的服务：对临床实践中可能出现的任何问题进行跟进，以便促进学习。养老院领导者的跟进方式以及他们关注的内容可能反映了他们对虐待老人行为、其因果因素以及养老院中使用的预防策略的看法。本研究旨在探讨养老院领导者如何跟进有关员工虐待老人的报告和信息。
本研究采用定性探索性设计。研究对象为来自挪威两个层面的养老院领导者，共 43 人，代表了六个市和 21 家养老院。28 名护理经理参加了焦点小组访谈，15 名养老院院长接受了单独访谈。分析采用了恒定比较法。
养老院领导者在三个不同层面上对员工虐待老人事件进行了跟进：1）在个人层面，领导者进行调查和会议、指导、监督，并偶尔调动员工；2）在团体层面，领导者采用反馈、开放和反思来促进共同理解；3）在组织层面，主要的解决方案是调整现有资源、培训和教育。研究发现，领导者在定义伤害和感知到缺乏权力来全面跟进所有层面方面存在困难。此外，他们没有足够的工具来评估所采取措施的效果。
养老院领导者需要明确在组织的不同层面上应如何跟进虐待老人事件，以及他们在预防虐待老人行为方面的角色。需要使用便于系统组织学习的评估工具。养老院必须营造开放、无责的文化氛围，承认患者护理中的虐待老人事件不仅源于个人行为，还源于他们所处的复杂日常生活以及他们在其中的运作方式。
Zotero 插件