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"Hurt People Hurt People"

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June 01, 2017

On a recent radio broadcast about the rehabilitation of incarcerated men and women, the prison expert offered her observation that the majority of the prison inmates had been victims of domestic abuse or parental neglect. This lead her to the insight that “hurt people hurt people.”

As a health care professional in the geriatric and long-term care (LTC) field, my thoughts are often filtered through the lens of my daily work in nursing facilities. As I applied this idea to my work, I thought: given that the nursing home industry is heavily dominated by female employees who provide the majority of care to our residents, it is likely that some proportion of our staff may be more susceptible to abuse, which should prompt some consideration.

I am not suggesting that we screen new hires for domestic violence or avoid hiring employees with histories of being abused or neglected, however, our educational programs on abuse should acknowledge that work in a nursing facility can be highly stressful and may provoke responses that run counter to what is acceptable in this setting. For example, post-traumatic stress disorder may be exacerbated by physical or psychological aggression by residents.

The acknowledgment of these ideas should lead to a greater awareness of potential problems or interactions, so that providers can have an open discussion about such stressors—whether recent or remote and triggered by resident, family, or staff behaviors. Mandatory discussions about abuse and neglect often fail to acknowledge how the environment may negatively impact the employee and sometimes completely fail to address what an employees’ supervisor should do when it appears an individual has reached a breaking point.

We tend to give our best nursing assistants the most difficult assignments because we know that less efficient staff would not be able to meet the challenge. But, repeatedly giving the heaviest assignment to the same employee may result in burn-out of that staff member, often evidenced by the loss of self control.

A focused effort should be made to find appropriate ways of supporting staff by establishing procedures that enable the certified nursing assistants (CNAs) to verbalize their frustrations to the supervisor, to obtain assistance or change assessments, or to get coverage for the residents when needed, allowing the aide to leave the floor and regain their focus or composure.

I recently asked a group of my masters in aging and LTC students who they believed were more stressed—CNAs or the administrator. Many believe that the administrator had significantly more stress due to the nature of the position, but they did acknowledge a certain amount of freedom that allows the nursing home administrator to go outside, take a walk, or leave the  premises, whereas the CNA is usually compelled to continue working on their assignment and afforded no opportunity to decompress.

We ought to be mindful of the kinds of stress CNAs encounter, their past and current social situations, and the support they may need moving forward. If we expect our staff to treat residents as individuals as a means of preserving dignity, it is necessary to afford our staff with the same individualized respect.

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Ilene Warner-Maron, PhD, RN-BC, CWCN, CALA, NHA, FCPP, has been practicing nursing for 33 years, specializing in the care of geriatric patients. She is an Assistant Professor at Philadelphia College of Osteopathic Medicine in the department of Interdisciplinary Health Services. Dr. Warner-Maron is the president of the Institute for Continuing Education and Research, providing educational programs for individuals seeking licensure in nursing home administration.

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