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Journal Article Review: The Effects of Elder Abuse within a Long Term Care
Setting and the Implications for Nursing as a Profession
Primary Article Chosen for Review:
Psychosocial factors affecting elders Maltreatment in Long Term Care Facilities
By: Nathan, M.B., Lowenstein, A. and Eisikovitis, Z. (2010).
International Nursing Review, 57, 113-120.
Student: Courtney Braithwaite
Student No: 823 144 563
Date Submitted: February 28, 2014
NURS 260: Practical Nursing Theory 2
Professor: Franklin Gorospe
Humber College ITAL

Introduction
Nursing is one of the most trusted and honoured health care professions in todays society.
As
a nurse we are regulated by the College of Nurses of Ontario (CNO) to deliver the highest
standard of quality patient centered care by establishing a Therapeutic Nurse Client Relationship.
Nurses work in many diverse settings where they assist patients coping with illness, promote
health of patients and educate them. Each individual nurse is required to protect our patients
from harm by preventing, stopping and reporting abuse (CNO, 2006, p. 9).
The article that I have chosen for this assignment is titled Psycho-social factors affecting
elders maltreatment in long term care facilities by Natan, Lowenstein and Eisikovits (2010).
The article looked at three factors that influenced maltreatment of elders in the Long Term Care
(LTC) setting. This assignment will entail a review of the article and will analyze three
implications that the maltreatment of elders has for nursing.
Elder abuse is defined as: an action by someone in a relationship of trust that results in harm
or distress for an older person (Nurs260 lecture). The CNO states that abuse can involve the
misuse of power, or betraying the clients trust, respect or intimacy within the therapeutic
relationship (CNO, 2011). I chose this article because I felt that the topic goes against
everything it means to be a nurse. Elder abuse is a serious issue that needs to be addressed to
ensure that all patients, no matter what their condition or state may be, are able to trust the health
care system, and feel safe while being cared for by nurses. Three implications of maltreatment
that will be discussed are as follows: the need for staff well-being to ensure proper care, the
importance of individualized care plans and the mandatory reporting of maltreatment.
Discussion:
Many peoples primary experience within the health care system is directly impacted by the
relationship with the nurse assigned to care for them. Many factors can impede on establishing a

therapeutic relationship resulting in a negative patient outcome. All patients are impacted when
they have a negative experience, but more so when harm has been caused to them.
The primary article I read by Natan et al. (2010) pointed out that elder abuse is often the result
of a variety of factors that influence the quality of care provided to the patient. The authors
focused on three main factors: (a) the patient traits, (b) the staff traits, and (c) the features of the
facility. The authors found that patients with a disability or dementia, patients who were female
and aggressive patients were all more likely to be victims of maltreatment or abuse. With
respect to staff traits, this study that were less ambitious were more likely to victimize a patient.
In addition, the authors found that the more a staff witnessed maltreatment occurring, the more
likely they were to maltreat a patient as well. Perhaps this is because perpetrators set the
example, or because nurses felt that if it occurs that often, than it must be the norm in that
facility, and therefore is acceptable. Lowenstein (2010) stated that staff suffering from burnout
had a negative attitude towards their work and elderly patients, which in turn lowered their
motivation for care and decreased the empathy they felt for their patients (p. 117). The author
also determined that the larger the facility, the more patients there are and therefore the higher
the staff turnover rate is which can lead to a lack of continuity of care and stability of delivery of
care. When there is increased staff turnover in organizations, there tends to be decreased
effectiveness in forming therapeutic nurse-client relationships because nurses do not have the
opportunity to get to know their patients and respect their individualized care needs. Patients
need to have consistency in the delivery of their care and a sense of routine to make their lives
easier to adapt to within the LTC setting. There is a definite need to find the delicate balance
between increased staff turnover and avoiding staff burnout, especially in the long term care
environments.

The second article I read was by Isola, Backman, Voutilanien and Rautsiala, stated that nurses
are more able to care for a residents physical care, rather than their psychosocial needs. Perhaps
this is because the physical health is visible, whereas psychosocial factors such as sexuality,
depression and feelings about death are not exposed on the surface. The author states that
nursing needs to be improved to go beyond the scope of physical care for our patients and
include psychosocial care in order to implement a better quality of life in LTC homes (Isola et
al., 2008). I agree with the author in that it is not enough to just meet half of a residents needs.
We must remember that the individuals in LTC are overwhelmed with feelings, fears and
emotions and that we as nurses are responsible for ensuring their overall well-being and
establishing a therapeutic nurse client relationship.
After reading these two articles, I decided that the three implications that elder abuse can have
on nursing rely on the staffs well-being, the need for an individualized care plan and the
requirement that all incidents of maltreatment are reported. Firstly, we must note that elder
maltreatment is more likely to occur if staff are stressed, suffering from burnout, or have an
unrealistic or unmanageable workload. Therefore, it is important that the nurses well-being.
Providing nurses with additional resources, as well as mental health days could decrease the
number of nurses who lose their motivation or empathy. Also, creating manageable workloads
with an increased staff:patient ration could lead to a decrease in the occurrence of staff burnout.
Secondly, it is important to have facilities that encourage and allow for individualized care
plans (ICPs). ICPs allow the patient to have a sense of autonomy and importance, in that their
care is specifically addressed to them, and their own personal needs. Touhy and Jett mention that
research about abuse in LTC homes has found that elder abuse is less likely to occur in facilities
with person-centred care models (Touhy, 380). Nurses must remember that sola et a. (2008)

stated that good quality of life requires more than just physical care, but also ensuring that
psychological and social needs are fulfilled as well. We cannot assume that all of the residents
are the same and treat them as if they are, because they are all individuals. Establishing
individualized care plans can allow us to better approach the patient and their needs and ensure
they are happy within their environment thus maintaining a healthier nurse client relationship. In
addition, a happy resident will be less likely to be difficult or aggressive, therefore reducing the
risk for maltreatment to occur.
Thirdly, reporting the abuse is an essential requirement to prevent and stop maltreatment from
occurring. Through LTC homes, the CNO and Regulated Health Professions Act (1991) all state
that it is mandatory for cases of abuse to be reported, the reality is that majority of cases are not,
College research has shown that once abuse is reported or an intervention occurs, it usually stops
immediately (CNO, 2006, p. 12). We need to address the reasons for abuse not being reported
whether by family, the victim, or by the staff who witness it taking place. The families probably
fear that if they report it, the perpetrator will make things worse for not reporting abuse.
Anything from them fearing retaliation, to them being unsure of who they can trust to report it to,
neither of which should be the case. Staff fail to report abuse because they do not want to be the
one who tattles or who goes against their fellow co-worker, in an act of betrayal. Abuse is a
silent topic and often nursing peers ignore incidents of abuse for fear of consequences from their
organization. Perhaps if there were more stringent punishments for not only those who victimize
patients, but also the health care practitioners that fail to report it. In my eyes, witnessing abuse
and not reporting it is just as bad as abusing the patient yourself. Allowing it to happen and to
continue means you are causing just as much harm to that person as the perpetrator themselves.
The CNO states that abuse interferes with meeting the clients needs resulting in permanent

damage within the nurse client relationship (CNO, 2011). Nurses need to provide quality care
and establish a therapeutic relationship to ensure that our clients maintain the best quality of life
possible. Family members should trust us, patients should feel safe with us and most of all
health care professionals should not be covering for someone who has inflicted harm upon a
vulnerable resident. Nurses take an oath in the clients best interest, and harming that client
should never be a result.
In summary, this assignment enhanced my understanding of the elements of abuse and how
important it is as a future nurse to prevent abuse from occurring and ensure the clients I look
after receive the highest quality and safest of nursing care. I agree with both articles in that
abuse is usually the end result due to several factors, and that nurses need to first acknowledge
the reasons why it occurs, before they can initiate a movement to both stop and prevent it.
Conclusion:
As nurses, it is our responsibility to establish a therapeutic relationship with our patients and to
provide care that is in the best interest of the patient. Maltreatment of individuals in LTC should never
occur. It is our duty to act within our clients best interests, and no one deserves to be harmed, especially
in their most vulnerable of states. In conclusion, long term care homes need to have the resources that
ensure a safe, effective and healthy environment for both the staff and the residents. As a nurse, we must
remember that we advocate for the patients right to client centered care, no matter what the circumstances
may be.

References
College of Nurses of Ontario (2006). The CNOs Therapeutic Nurse-Client Relationship.
Retrieved from http://www.cno.org/Global/docs/prac/41033_Therapeutic.pdf on February
17th, 2014.
College of Nurses of Ontario (2011). Preventing Client Abuse. Retrieved from
http://www.cno.org/Global/docs/ih/47008_fsPReventAbuse.pdf
on February 17th, 2014.
Isola, A., Backman, K., Voutilanien, P., and Rautsiala, T. (2008). Quality of institutional care of
Older people as evaluated by nursing staff. Journal of Clinical Nursing, 17, 2480-2489.
Retrieved February 14, 2014 from CINHAL database.
Natan, M.B., Lowenstein, A., and Eisikovits, Z. (2010). Psychosocial factors affecting elders
Maltreatment in long-term care facilities. International nursing review, 57, 113-120.
Retrieved February 14th, 2014 from CINHAL database.
Touhy, Theirs, Kathleen Jett, Veronique Boscart, Lynn McCleary, Chapter 22: Economic and
Legal Issues. Ebersole and Hess Gerontological Nursing and Healthy Aging, Canadian
Edition, (p. 380) Mosby Canada, 2012, VitalBook file.