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Våld mot vårdare i sjukhemsvård
Umeå University, Faculty of Medicine, Nursing.
2008 (Swedish)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

This thesis aimed to explore factors related to the prevalence of violence towards caregivers working in a nursing home context. The aim was also to describe caregivers’ perceptions and experiences of violence in a nursing home context. The thesis comprises four studies. Study I includes data regarding environmental and organizational factors, residents’ and caregivers’ characteristics, and violence. Data concerning job satisfaction and working climate were also obtained. In study II, questionnaires were used to collect data concerning caregivers’ exposure to violence and their personal characteristics. Data concerning personality traits, coping resources, and burnout were collected by means of instruments. In order to illuminate caregivers’ perceptions of violence (III) and experiences of being exposed to violence (IV) interviews were performed. Quantitative data were analyzed by means of comparative and descriptive statistics. The interviews were transcribed and interpreted using a qualitative content analysis method.

The results showed that 15 percent of the residents exhibited violent behaviour during the week of in-vestigation. A significant higher proportion of male residents were assessed by the caregivers to present violent behaviour compared to female residents. A discriminate analysis showed that the prevalence of behavioural symptoms and psychiatric symptoms, residents needing assistance with dressing, the caregivers’ psychological workload, and job satisfaction were the strongest discriminators between nursing home wards with a high versus low proportion of residents with violent behaviour (I).

The results from study II showed that among the 196 caregivers participating in the study, 68 % re-ported exposure to violence during the previous year. Twenty-two percent reported exposure several times per week, and 51 % reported exposure at least once during the previous month. A higher proportion of caregivers 50 years or younger were exposed to violence compared to older caregivers. A higher proportion of caregivers with a work experience of three years or more reported exposure to violence compared to less experienced caregivers. A higher proportion caregivers who reported exposure to violence assessed symptoms on burnout and motherly rejection. No significant differences between the two groups were found concerning coping resources, defence mechanisms, temperament, and character.

Study III showed that caregivers’ perceptions of violence are subjective and in the eye of the beholder. The caregivers perceive violence as challenging and expressed that caring situations had to be solved even though their own safety is perceived to be in danger. The caregivers perceive violence as intentional when the residents are judged to have a good cognitive capacity and are perceived to be conscious. However, the care-givers perceive violence as excusable when the residents are described as old and sick. The caregivers perceive violence as ordinary and as a part of the work situation. The caregivers also perceive violence as contextual since similar violence is accepted at the work place but not outside it.

The result from study IV showed that the caregivers’ experiences of exposure to violence range be-tween being overwhelmed by contradictory emotions and being resigned. The caregivers have preconceived ideas towards the violent behaviour and describe being on guard in order to avoid being exposed to violence. The caregivers experience that they lose the control over a violent situation and strive to regain the control. They are overwhelmed by emotions such as surprise, anger, and repulsiveness and describe a resignation hav-ing to care for violent residents. Caring for violent residents is described as a constant struggle and the care-givers express a disappointment over insufficient support. The caregivers strive to regain the control by means of seeking excuses for the violent behaviour or by support from colleagues.

The conclusions from this thesis are that the prevalence of violence is related to factors among the residents as well as the caregivers, that caregivers’ perceptions of violence are subjective and caregivers’ experi-ences varies between being overwhelmed by contradictory emotions and resignation. There is a risk that vio-lence in nursing homes becomes a norm, is accepted, and in this way is maintained. The boundary between what is acceptable and what is not acceptable becomes erased, the caregiver resigns, and the violence is not looked upon as a divergence but becomes a part of the working situation. It is therefore important that the problems with violence at nursing homes are attended to and that the caregivers are supported in their work.

Place, publisher, year, edition, pages
Umeå: Omvårdnad , 2008. , 74 p.
Series
Umeå University medical dissertations, ISSN 0346-6612 ; 1154
Keyword [sv]
personlighetsdrag, sjukhem, uppfattning, upplevelse, utbrändhet, våld, vårdare, vårdtagare
National Category
Nursing
Identifiers
URN: urn:nbn:se:umu:diva-1558ISBN: 978-91-7264-495-3 (print)OAI: oai:DiVA.org:umu-1558DiVA: diva2:141372
Public defence
2008-03-14, Aulan, Vårdvetarhuset, Vårdvetarhuset 901 87, Umeå, 09:00 (English)
Opponent
Supervisors
Available from: 2008-02-22 Created: 2008-02-22 Last updated: 2010-01-27Bibliographically approved
List of papers
1. Factors associated with the prevalence of violent behaviour among residents living in nursing homes
Open this publication in new window or tab >>Factors associated with the prevalence of violent behaviour among residents living in nursing homes
2009 (English)In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 18, no 7, 972-980 p.Article in journal (Refereed) Published
Abstract [en]

AIM: The aim of this study was to investigate the associations between environmental and organisational factors as well as resident and caregiver characteristics in nursing home wards with a high respectively low prevalence of residents with violent behaviour. BACKGROUND: Earlier studies have indicated that different factors are related to violent behaviour among residents living in nursing homes, such as environmental and organisational variations, and resident and caregiver characteristics. However, few studies have simultaneously examined the relationship between these factors. DESIGN: A cross-sectional descriptive survey design. METHODS: The study was performed in 10 nursing homes consisting of 33 wards. Data were collected using the Multi-Dimensional Dementia Assessment Scale and the Geriatric Rating Scale. Variables concerning organisation and environment were gathered by means of a questionnaire. Differences between wards with high (HPW) or low prevalence of violence (LPW) were analysed. RESULTS: In HPWs, the prevalence of behaviour and psychiatric symptoms, residents needing assistance with dressing and psychological workload were found to be higher, while job satisfaction was lower compared to LPWs. This study has also shown that caregivers in HPWs had less experience of working with older people and they experienced their working climate as less positive. Furthermore, HPWs had more residents, lower caregiver-to-resident ratio and longer corridors, and caregivers in these wards experienced more difficulties to supervise the residents. CONCLUSION: This study has shown that the prevalence of residents with violent behaviour is significantly associated with other behavioural and psychiatric symptoms and ADL (activities of daily life)-functions, as well as caregivers' experiences of job satisfaction and psychological workload. RELEVANCE TO CLINICAL PRACTICE: This study underlines the importance of a multifactorial approach to understand the prevalence of violent behaviour, including the physical environment, organisational factors, as well as characteristics of the resident and the caregiver.

Keyword
Environment, job satisfaction, nurses, nursing home, violence, working climate
National Category
Nursing
Identifiers
urn:nbn:se:umu:diva-22236 (URN)10.1111/j.1365-2702.2008.02440.x (DOI)19284432 (PubMedID)
Available from: 2009-04-29 Created: 2009-04-29 Last updated: 2017-12-13Bibliographically approved
2. Exposure to violence in relation to personality traits, coping abilities, and burnout among caregivers in nursing homes: a case-control study.
Open this publication in new window or tab >>Exposure to violence in relation to personality traits, coping abilities, and burnout among caregivers in nursing homes: a case-control study.
Show others...
2008 (English)In: Scandinavian journal of caring sciences, ISSN 1471-6712, Vol. 22, no 4, 551-559 p.Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Although violence toward caregivers occurs often and caregivers' ability to interact and deal with difficult situations is relevant in preventing such violence, few studies have been conducted that focus on caregivers' characteristics. AIM: This study explores the relationship between perceived exposure to violence and demographical factors, parental rearing, personality traits including coping abilities, defence styles, and burnout among caregivers working in nursing homes. METHOD: A total of 196 caregivers working in nursing homes were included. They were asked to complete questionnaires concerning demographical factors and exposure to violence. One group of female caregivers reporting no exposure to violence (n = 20) was matched with one group of exposed to violence (n = 20). Both groups were asked to complete questionnaires concerning parental rearing, personality traits, coping abilities, and burnout. RESULT: Around 68.4% of the caregivers had been exposed to violence during the previous year and 22.4% several times a week. Caregivers 50 years of age or younger and employed in geriatric care for more than 3 years were more frequently exposed to violence. Inter-group differences were found regarding 'maternal rejection' and 'burnout'. No statistical differences could be found concerning defence styles, coping ability, temperament, or character aspects. CONCLUSION: Violence toward caregivers occurs frequently and appears to be influenced by several factors. 'Maternal rejection' and 'burnout' among caregivers exposed to violence might influence the communication between caregivers and residents, rendering more violence. However, personality traits among caregivers do not seem to be associated with exposure to violence.

Identifiers
urn:nbn:se:umu:diva-19060 (URN)10.1111/j.1471-6712.2007.00570.x (DOI)18801017 (PubMedID)
Available from: 2009-03-03 Created: 2009-03-03 Last updated: 2010-01-27
3. Violence in nursing homes: perceptions of female caregivers.
Open this publication in new window or tab >>Violence in nursing homes: perceptions of female caregivers.
2008 (English)In: Journal of clinical nursing, ISSN 1365-2702, Vol. 17, no 12, 1660-6 p.Article in journal (Refereed) Published
Abstract [en]

AIM: This study illuminates how female caregivers in nursing home perceive violence. BACKGROUND: Previous studies have focused on prevalence and types of violence and injuries in various settings and among various professionals. There are, however, few studies that examine how caregivers perceive violence. METHODS: Forty-one female caregivers at nursing homes were asked to reflect on a vignette containing a situation where a female caregiver is exposed to violence from a male resident. The reflections were analysed by qualitative content analysis. FINDINGS: The main finding indicates that perceiving an action as violent is in the eye of the beholder. Caregivers perceive violence to be challenging, intentional, excusable, ordinary and contextual relative to their own experience and attitudes. CONCLUSION AND RELEVANCE TO CLINICAL PRACTICE: As the perception of violence is subjective, there is a risk that violent incidents will be under-reported as well as over-reported. To avoid this, it is important to construct a well-defined operationalised definition of violence for research purposes. Our findings also indicate the need for individually structured and adjusted support for caregivers. To explore the complexity of violence, further research should focus on how caregivers and residents experience violence in a nursing home.

Identifiers
urn:nbn:se:umu:diva-19039 (URN)10.1111/j.1365-2702.2007.02196.x (DOI)18482127 (PubMedID)
Available from: 2009-03-03 Created: 2009-03-03 Last updated: 2010-01-27
4. Female caregivers' experiences of exposure to violence in nursing homes
Open this publication in new window or tab >>Female caregivers' experiences of exposure to violence in nursing homes
2009 (English)In: Journal of Psychiatric and Mental Health Nursing, ISSN 1351-0126, E-ISSN 1365-2850, Vol. 16, no 1, 46-53 p.Article in journal (Refereed) Published
Abstract [en]

Although earlier studies have examined caregivers' experiences of exposure to violence, few have investigated female caregivers working in nursing homes with a specific focus on experiences throughout the entire scenario of a violent situation. This study illuminates female caregivers' experiences of being exposed to violence in nursing homes. Twenty caregivers working in three nursing homes located in northern Sweden were asked to narrate about a situation in which they had been exposed to violence. Their narratives were analysed by using qualitative content analysis. We found that the caregivers had preconceived ideas about violent behaviour, that they experienced a loss of control over the situation, and that they then strove to regain control. Experiences such as these may influence caregivers' interactions with residents who display violent behaviour. As a result of violent interactions, caregivers may distance themselves from the residents, an attitude that may decrease the quality of care. There is a risk that violence in nursing homes is accepted and normalized as a part of the job and hence persists.

National Category
Nursing
Identifiers
urn:nbn:se:umu:diva-19071 (URN)10.1111/j.1365-2850.2008.01328.x (DOI)19192085 (PubMedID)
Available from: 2009-03-04 Created: 2009-03-04 Last updated: 2017-12-13Bibliographically approved

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