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Factors associated with the prevalence of violent behaviour among residents living in nursing homes
Umeå University, Faculty of Medicine, Department of Nursing.
Umeå University, Faculty of Medicine, Department of Nursing.
Umeå University, Faculty of Medicine, Department of Nursing.
Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation.
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.

Place, publisher, year, edition, pages
2009. Vol. 18, no 7, 972-980 p.
Keyword [en]
Environment, job satisfaction, nurses, nursing home, violence, working climate
National Category
URN: urn:nbn:se:umu:diva-22236DOI: 10.1111/j.1365-2702.2008.02440.xPubMedID: 19284432OAI: diva2:213905
Available from: 2009-04-29 Created: 2009-04-29 Last updated: 2011-12-07Bibliographically approved
In thesis
1. Våld mot vårdare i sjukhemsvård
Open this publication in new window or tab >>Våld mot vårdare i sjukhemsvård
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.
Umeå University medical dissertations, ISSN 0346-6612 ; 1154
personlighetsdrag, sjukhem, uppfattning, upplevelse, utbrändhet, våld, vårdare, vårdtagare
National Category
urn:nbn:se:umu:diva-1558 (URN)978-91-7264-495-3 (ISBN)
Public defence
2008-03-14, Aulan, Vårdvetarhuset, Vårdvetarhuset 901 87, Umeå, 09:00 (English)
Available from: 2008-02-22 Created: 2008-02-22 Last updated: 2010-01-27Bibliographically approved

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Isaksson, UlfAström, StureSandman, Per-OlofKarlsson, Stig
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