Elder Maltreatment

In residential and or nursing homes, failure to follow nursing standards and procedures
may be evident. Every single nurse is different and unique; even though each and every nurse is
unique they should follow familiar standards on how to care for patients. For some nurses,
nursing is their passion; they go above and beyond to ensure that their patient is at their optimal
wellness in regards to their situation. On the other hand, some nurses are only there to do the
bare minimum and this may result in maltreatment to elders. This kind of neglect was evident
during my clinical placement. During a wound dressing change, the previous nurse failed to put a
new dressing on the wound and left it completely bare. This kind of maltreatment could have
caused so many issues with the patient like decreased skin integrity, infection, and increased pain
to the patient. The article I will be reviewing is Psycho-social Factors Affecting Elders
Maltreatment in Long-term Care Facilities by M. Ben Natan. Natan states that the main reasons
why maltreatment of elders is happening is due to burn out of nurses, rise in patients with
dementia, and the lack of support. This article is useful because it summarizes the cause of elder
abuse with rationales. The second article that will be supporting the topic is Forms of Elder
Mistreatment by Venera Margareta Bucur. Using these articles, CNO, and best practice
guildlines, I will explain how nursing practices care be improved using nursing implications.
There are many causes of elder maltreatment that must be improved.
In the Article, Psycho-social Factors Affecting Elders Maltreatment in Long-term Care
Facilities by M. Ben Natan, Natan discuses the kinds of variables involved in elder abuse.
Natan states that the main reasons why elder abuse is happening is because nurses are
experiencing burn out, and they enter the unit with negative attitudes towards their patients.
Worker burnout was found to be associated with physi- cal and mental violence. Burnout leads to
negative attitudes towards work and lack of empathy towards the elderly. Survey findings

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indicate that a large proportion of assailants in long- term care were unaware that their behaviour,
such as slapping, embarrassing and cursing patients, was wrong, and thus did not think of
changing their behaviour(Natan., et.al. 2010). Most nurses are not aware of the abuse they are
implementing on their patients. This kind of care is completely unacceptable and this is not a
nursing implication. A positive nursing implication is having a therapeutic relationship with the
patient and seeing them as a human being, not work. If a nurse maintains a therapeutic
relationship with a patient, the patient will have respect and trust for the nurse. If a patient trusts
a nurse they will fell more at ease with their care. Nurses need to take care of them selves first
before they can care for a patient. The article states that patients who are more susceptible to
elder abuse are people who suffer from dementia. The reason as to why patients with
Alzheimers or dementia are being abused is because they may be confused or forgetful as to
what they are experiencing. The nurses who are being abusive are increasing their patients
health disparities. The nursing implication that these nurses are not promoting is the reduction of
health disparities. Nurses are supposed to be one of the patients main support system and their
main purpose is to keep their patients at their optimal wellness mentally and physically. Even
though a patient may be cognitively impaired it is a nurses job to stimulate them and encourage
them to think. If a nurse fails to stimulate her patients with dementia they may deteriorate faster,
especially if they are being abused. The article also argues that a major reason as to why elder
abuse may occur is because nurses let out all of their frustration on their patients. The article
suggests that the staff should hold support groups so that the nurses are able to share their
difficulties with each other. If support groups were established in the units then maybe the staff
would learn how to cope with their stress, and go into work with a more positive attitude. A very
important nursing implication is communication. If these nurses communicated with their

Elder Maltreatment

coworkers and patient, they may learn how to better deal with their situations. This article makes
valid points as to why the elderly may be experiencing elder abuse. Other sources agree that
crucial nursing implications are not evident when elders are being maltreated.
The supporting article that has ben chosen for this topic is Forms of Elder Maltreatment by
Venera Margareta Bucur. This article talks about the different types of elderly maltreatment,
whereas, the first article talks about the different variable involved in elder maltreatment. Even
though these articles have different topics in regards to maltreatment, they both agree that
maltreatment can be cause because nurses are exhausted. In care institutions or at home these
failures may occur because of neglect of caregivers providing ergonomic housing, and the lack of
staff, overloaded with tasks and professionally exhausted, who cant monitor the elder
(especially during night) ( Bucur, 2012). Many institutions are understaffed; the nurses who are
working become exhausted having to pick up the slack. These articles support one another
because they both agree that nurses are burnt out therefore cause elderly neglect. Assessing the
situation in a therapeutic manner can easily reverse elder abuse and neglect. Establish and
maintain a therapeutic relationship with older adults, and families as appropriate, when
discussing issues of abuse and neglect (RNAO, 2014). Many nurses are not aware that they are
being neglectful to their patients. If the nurse is confronted in a therapeutic situation with the
patient, family, and the interprofessional team, the situation will be dealt with in a positive
manner. The patient and nurse can then develop a therapeutic relationship with each other.
Therapeutic communication can aid in the prevention of elder abuse by doing the following:
considering the clients preferences when encouraging the client to advocate on his/her own
behalf, or advocating on the clients behalf; providing information to promote client choice and
enable the client to make informed decisions; listening to, understanding and respecting the

Elder Maltreatment

clients values, opinions, needs and ethnocultural beliefs and integrating these elements into the
care plan with the clients help (CNO, 2006). By having therapeutic communication, they can
involve the client in his or her own care plan. This not only stimulates the patient, but it also
builds a therapeutic relationship. Elder abuse may be prevented with therapeutic communication
between the nurse and client or it can be controlled by having a therapeutic meeting with
everyone involved.
There are many variables involved in elder abuse or neglect. According to the two
articles, the main cause for elder abuse is that nurses are dealing with exhaustion or burn out.
Nurses enter their workplace with a negative attitude due to being exhaust. As per Natan, the
other two variables involved in elder maltreatment are that there is a rise in abuse against patients
with dementia, and there is a lack of support for the nurses. The three nursing implications that
can decrease elderly abuse are maintaining a therapeutic relationship with the patient, decreased
health disparities, and communication. The CNO and RNAO recognizes that proper
communication and having a therapeutic relationship minimizes the amount of elder abuse and
health disparities. I agree that elder abuse is greatly influenced by burn out, cognitively impaired
patients, and lack of support. I believe that with nursing implications provided, the impact of
elder maltreatment can be greatly decreased.

Elder Maltreatment

References
Bucur, V.M (December, 2012). Forms of Elder Maltreatment. Social Work Review.
Pg.108.http://web.a.ebscohost.com.rap.ocls.ca/ehost/pdfviewer/pdfviewer?sid=c45faaae-610f42c7-bcda-821dbf0633f1%40sessionmgr4005&vid=1&hid=4209
College of Nursing of Ontario (CNO). (2006). Practice Standard: Therapeutic Nurse-Client
Relationship. Pg. 5. http://www.cno.org/Global/docs/prac/41033_
Therapeutic.pdf
Natan, M.B. Lowenstein, A. Eisikovits, Z. (March, 2010). Psycho-Social Factors Affecting
Elders Maltreatment in Long-term Care Facilities. International Nursing Review.
http://web.a.ebscohost.com.rap.ocls.ca/ehost/pdfviewer/pdfviewer?sid =68bb8277-1e3e-4d7da7c6-c911c2873d94%40sessionmgr4003&vid=1&hid=4209
Registered Nurses Association of Ontario. (2014). Addressing and Preventing Abuse and
Neglect of Older Adults: Person-Centred, Collaborative, System-Wide Approaches. Toronto, ON:
Registered Nurses Association of Ontario. http://rnao.ca/sites/rnao-ca/files/Preventing
_Abuse_and_Neglect_of_Older_Adults.pdf