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Add whistles to your caregiver's toolkit

August 6, 2008
by Kevin Kolus
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People are emotional. Others are downright angry. Then there’s a small amount that can even be violent.

And some inhabitants of nursing homes—well, they just can’t help themselves, according to recent findings that suggest an increased amount of residents are committing acts of rage against themselves and their caregivers.

Last year in Ontario, CBC News reported that violence had tripled compared to the previous few years in the province, with residents biting, choking, and in one case, murdering each other. One nurse from a local facility was quoted saying she has to regularly break up fights.

I doubt her employers listed refereeing in the job description.

Cornell University released a study in June stating resident aggression is much more common than widely believed, and in a single eight-hour shift, observers witnessed 30 episodes of aggression—defined as shouting matches or physical contacts.

Also in June, Swedish researchers penned the study Violence in nursing homes: perceptions of female caregivers, exposing the potential risk in staff member’s overreporting—or worse, underreporting—violence brought onto them by residents. The main finding of the study, researchers say, is that “perceiving an action as violent is in the eye of the beholder.”

It’s hardly a groundbreaking discovery, and an even sorrier summation of a terrible problem. What worries me is that with any violent action comes a reaction: Disciplinary recourse and self defense come to mind. The Swedish researchers say caregivers are subjectively analyzing the violent act for themselves, and then decide whether or not to report it. Yet I refuse to believe this is a decision caregivers caught in the middle of a resident brawl should make. It seems to me there would be a set protocol to follow in an instance of violence, especially with it being so prevalent. As the lady from Ontario said to reporters, recalling a previous fight in which one resident had torn off the scalp of another, “It's what I go to every day. It's what I live.”

These studies tell us that people with cognitive impairments will not cease to have the potential for being violent. There is a bigger stake, then, in developing sound methods to appropriately handle violence in nursing homes. Caregivers should at least be told by their superiors when to blow the whistle on aggressive behavior, and unfortunately, when things get violent, how to intervene.

Certainly, there is a legal and moral obligation for nursing homes to provide a safe environment for residents. But that same promise of protection also exists for staff who are being abused by residents. If you have any policies, recommendations, or stories on how to deal with resident violence against caregivers and themselves, please discuss them. Sharing your insights may help to create safer facilities.

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Comments

While I didn't intend to say whistles should be used literally, you are right in that some form of emergency communication during a violent event is necessary in a LTC facility. However, I wonder what the effects of a loud noise would be on those with dementia.

My grandfather, toward the end of his life in the nursing home, strayed from the gentle man he once was to a confused, dementia-suffering man who lashed out with his hands for no reason at all. I'm wondering if a distressed nurse, blowing hard on a high-pitched whistle, or manipulating some other high-frequency device, would have agitated, confused, and angered my grandfather even more.

Kevin,

Using a whistle would probably agitate residents. There are many types of alarms in LTC now. That is why walkie talkies or cell phones would be better.

As I began to read this posting, I was taking it literally. I thought of all the times I have seen aides pull a call light on because of a difficulty with a resident, whether it's a fall or a resident being very upset. But other aides cannot always respond quickly enough. Sometimes aides even yell for help and get no response. That is why I thought that the article was referring to the whistle being a necessary piece of equipment for an aide to carry with them.

I brought this up with an aide here and she remarked that she would not dare put a whistle on a cord around her neck because a resident could strangle her with it. I laughed and suggested that she should not put it on a cord, but in her pocket. It seems it would be a good way for aides to know that other aides are in trouble and need assistance. As you know staffing is not optimum and sometimes it really does not matter if there are enough staff. Resident demand always seems to exceed the supply of nurses' aides.

I do realize that the issue that you are bringing up is resident violence and rage at nurses' aides. I have observed these incidents for years living in this nursing home. Residents have beaten nurses with walkers and pulled carpeting from nurses' stations out of frustration or anger. Sometimes it is very difficult for the staff to get these residents under control without hurting the resident or themselves.

The aides need an emergency communication tool. Some residents and most aides think they should have walkie-talkies. Aides could then contact each other when they are in other rooms or in the shower room. An intercom system would be a great addition tool.

In the future, cell phones will probably be used as the main communication device in nursing home by residents and staff. But in the meantime a whistle might do the job for the aides.

Kevin Kolus

Kevin Kolus

@longtermliving

www.ltlmagazine.com/blog/kevin-kolus

Kevin Kolus wrote for Long-Term Living when he was an editor. He left the brand in 2012...