By Emilee Evans, Legal Intern

This blog will look at how bullying can be assessed by the nurses and staff who oversee residents. Studies that examine trigger factors in resident aggression allow nurses to identify areas of tension and ways to avoid bullying and violence among residents. This post will include some perspectives of nurses on issues of bullying within the nursing home, along with the triggers of aggression identified in other studies, and what nurses can do to help and soothe combative situations.  

Nurses and staff are often the first to see fights occur. They can often identify the cause of the fight, and are then subject to assisting in mitigating the situation. 

In order for nurses to assist in these types of situations, it is important to have the right information and to know strategies and resources that can help. The following includes effective strategies specifically for nurses in event of aggression, and more resources will be listed for additional information.  

The most common staff strategies for managing resident-to-resident aggression as described by staff and other participants include:  

1. Notifying social services or changing a resident’s room,  
2. Physically intervening or separating residents,
3. Removing a resident from a dining room or public area or to change seating arrangements,
4. Trying to convince residents to compromise,
5. Redirecting or distracting residents,
6. Explaining to residents the nature of communal living, etc. (Rosen et al., 8).  

Additionally, understanding and following the SEARCH nine-step model may help most to nurses and staff.  The model, provided by the National Center on Elder Abuse (NCEA), includes:  

1. Support: Support injured residents until help arrives, listen to all involved residents’ perspectives on situations, and validate resident fears and frustrations when aggression occurs. 
2. Evaluate: Evaluate what actions are needed, monitor resident behavior, and evaluate and support residents involved in or who have observed an event because resident aggression can be upsetting to all. 
3. Act: Verbally try to stop the incident, call for other staff/security to help, move or separate individuals, and seek medical treatment when indicated. 
4. Report: Notify the nurse supervisor and administrator, contact families if appropriate, document the event in the resident care plan, and initiate facility protocol for reporting resident-to-resident elder mistreatment care plan.  
5. Care plan: Consider both the initiator and the victim, form a care plan to prevent aggressive situations in the future, get medical or psychiatric evaluation, and monitor residents to avoid future incidents. 
6. Help to avoid: Check for adequate staff in congregate settings, check for crowding, educate residents about dementia specific behaviors, and separate residents with a history of negative interactions with one another.  

Within the context of the SEARCH model, a study includes a review of nine steps to manage and curb resident-to-resident mistreatment (Teresi):  

1. Know your institution’s resident-to-resident mistreatment policies and procedures. These may be different from policies for other forms of abuse. 
2. Recognize that residents’ actions have the potential to be abusive. Certain medical conditions, like dementia and depression, may be linked to aggressive behaviors. 
3. Review best practices for immediate interventions that can be used during the most common mistreatment incidents. 
4. Seek help from other staff and supervisors if necessary. 
5. Document all resident-to-resident mistreatment. 
6. Make sure any victim of resident-to-resident mistreatment gets the support that he or she needs. Unresolved mistreatment can severely decrease one’s quality-of- life. 
7. Discuss resident-to-resident mistreatment behaviors in a team meeting in order to develop a treatment approach that would become part of a resident’s care plan. This allows for ongoing oversight and monitoring. Repeated instances that are not resolved through care planning may require formal, external reporting. 
8. Care of the resident is the top priority. Report all injuries to the supervising nurse to insure appropriate follow-up care. 
9. In cases of physical harm, it is required that you report the resident’s act immediately. The director of nursing services and the administrator must be informed. Some forms of abuse may require formal reporting as outlined in state regulations, and families may need to be notified. Staff is responsible for following their facility’s abuse protocols in order to promote the safety and well-being of all residents.  

Additional resources will be included in the next post, which will be the final blog post in this series concerning bullying within long term care facilities to highlight Domestic Violence Awareness Month.

 

References:

Rosen, T., Lachs, M. S., Bharucha, A. J., Stevens, S. M., Teresi, J. A., Nebres, F., & Pillemer, K. (2008). “Resident-to-resident aggression in long-term care facilities: Insights from focus groups of nursing home residents and staff”. Journal of the American Geriatrics Society, 1–10. doi: 10.1111/j.1532-5415.2008.01808.x

Schoen, Julie and Pillemer, Karl. (2016). “Resident-to-Resident Elder Mistreatment in Nursing Homes: Findings From the First Prevalence Study.” The National Consumer Voice for Quality Long-Term Care. 

http://theconsumervoice.org/uploads/files/issues/Feb22016_Webinar_Slides.pdf 

Teresi, J. A., Ramirez, M., Ellis, J., Silver, S., Boratgis, G., Kong, J., . . . Lachs, M. S. (2013). “A staff intervention targeting resident-to-resident elder mistreatment (RREM) in long-term care increased staff knowledge, recognition and reporting: Results from a cluster randomized trial.” International Journal of Nursing Studies, 50(5), 644–656. 

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3677710/