What’s the evidence 4.2 (online only)

Malmedal et al. (2014) undertook a survey of 16 nursing homes in Norway and obtained a 79% response rate (n= 616). Participants from a range of professional backgrounds were asked to indicate how often they had committed any of 15 behaviours identified as indicators of inadequate care (e.g. ignoring residents and failing to meet nutritional needs). Demographic details concerning participants and information regarding the homes (including staffing levels) were also gathered. The study findings indicated that the location and size of the home, age, education and job satisfaction of staff, resident aggression and conflict between residents and staff are predictive of inadequate care. They conclude that improvements are needed to practices within nursing homes to minimize abuse and neglect.

What actions do you feel might be needed to improve practice and to minimise abuse and neglect in such settings?

You may have explored actions at both an organisational and at an individual level. In terms of the organisation then actions such as improving leadership, monitoring, complaints / reporting procedures, staffing, stress management, sickness and morale, accountability and person centred care are some of the effective strategies known to reduce the likelihood of abusive practice occurring. Creating an open environment where staff can raise concerns without feeling threatened and incurring penalties is also a helpful action.

At an individual level nurses can take action to truly embrace reflective practice in order to learn from instances of poor practice. For example, exploring why on occasions they may ignore patients and why nutritional needs have not been met. Nurses should also identify skill deficits and make efforts to improve their practice by updating their knowledge and skills through training, education and personal study. This is now a requirement for all registered nurses in order to revalidate every three years. Chapters 1, 2, 5 and 10 may be particularly helpful and also the NMC Code (2015) for ideas on further actions to take.