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there Abuse in Long Term Nursing Facilities?
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Within the topic of Abuse, there are an abundance of issues.
These issues, or areas of focus, are often points of interest
for society. While exploring such points, arguments occur.
In order for these arguments to be reliable, research, analysis,
assessment, and judgment must take place. For the sake of
society's future, it is important to dwell on the question:
Is there Abuse in Long Term Nursing Facilities? While one
side says that, yes, there is Abuse in Long Term Nursing Facilities
, the opposition believes this isn't true. They feel that
there is not Abuse in Long Term Nursing Facilities. It's important
to explore both sides in order to fully answer the question
being debated.
According to Dictionary.com Abuse is defined as to use wrongly
or improperly: misuse: to abuse one’s authority, to
treat harmful, injurious, or offensive way. To speak insultingly,
harshly, and unjustly to or about; revile; malign. To commit
sexual assault upon. Obsolete. To deceive or mislead. Wrong
or improper use; misuse: the abuse of privileges. Harshly
or coarsely insulting language. Bad or improper treatment;
maltreatment; a corrupt or improper practice or custom: rape
or sexual assault. Obsolete, deception.
In addition Abuse is described by The American Psychological
Association http://www.apa.org/pi/aging/homepage.html as the
infliction of physical, emotional, or psychological harm on
an older adult. Elder abuse also can take the form of financial
exploitation or intentional or unintentional neglect of an
older adult by the caregiver.
Point 1: The spread of abuse in long term nursing facilities
The current situation in long term nursing facilities is characterized
by the growing tension between opposing parties in relation
to the problem of abuse in long term nursing facilities. In
fact, views on this problem are antagonistic. At the same
time, the problem of abuse evokes numerous arguments even
concerning its existence, which is questioned by some specialists
and is perceived as a widely spread problem by other specialists.
Side A. The problem of abuse in long term nursing facilities
evokes numerous discussions because specialists cannot agree
on the scale of the progress of this problem in the modern
long term nursing facilities. In fact, views on this problem
are almost antagonistic. On the one hand, this problem is
perceived as widely spread and it is considered to be one
of the major burdens of long term nursing facilities (Spevak,
133). Such a position is supported by the growing number of
reports which indicate to the increasing number of cases of
abuse of patients in long term nursing facilities (Davis,
76).
Side B. On the other hand, there is a different view on this
problem, according to which, the problem of abuse in long
term nursing facilities is exaggerated dramatically (Davis,
78). At the same time, the increasing number of reports concerning
abuse of patients can be explained not by actual facts of
abuse but rather by interpersonal conflicts between patients
and healthcare professionals. In such a context, reports on
abuse in long term nursing facilities can be viewed as an
inadequate interpretation of actions of healthcare professionals
by patients and their inability to evaluate actions of healthcare
professionals adequately (Davis, 79). However, such arguments
naturally raise the question whether the conflicts between
patients and healthcare professionals are not a form of abuse.
Moreover, such conflicts do not only fail to deny the facts
of abuse, but also raise another important question –
the question of the professional level and qualification of
healthcare professionals and nurses working in long term nursing
facilities.
Point 2: The impact of staff levels and staff training on
abuse in long term nursing facilities
On analyzing the problem of abuse in long term nursing facilities,
it is necessary to underline the fact that this problem in
inevitably involves two parties. Firstly, there are patients
who need long term care services and who need to stay and
receive treatment in long term nursing facilities. Secondly,
there are healthcare professionals, nurses, who actually provide
long term care services and who are supposed to take care
of patients in the course of treatment. In such a context,
abuse in long term facilities should be viewed as a conflict
between patients and care givers, when the latter undertake
inadequate and unacceptable actions or have a negative attitude
to patients that result in abuse of patients either physical
or moral. Obviously, in such a context, the qualification
of healthcare professionals is crucial because the problem
of abuse it is, above all, the question of professional level
and qualification of nurses and other healthcare professionals.
Side A. In this regard views of specialists on the problem
of abuse in long term nursing facilities are not homogeneous
at all. Some specialists (Spevak, 157) argue that the staff
levels and staff training are extremely low. As a result,
nurses and other healthcare professionals cannot provide long
term care services of the high quality. What is even more
important in the context of abuse in long term nursing facilities
is the incompetence of nurses and other healthcare professionals
which prevents them from non-abusive relationships with patients
and adequate treatment of patients. What is meant here is
the fact that nurses and healthcare professionals having a
low professional level are unable to perform their duties
well because they do not have a sufficient professional background,
knowledge, skills and abilities which could allow them finding
proper approaches to patients and their treatment (Silva,
13). In such a situation, the lack of training of nurses and
healthcare professionals may be another determinant factor
that increases the risk of abuse in long term nursing facilities.
In actuality, training is clue to the increase of the professional
level of nurses and other healthcare professionals. It is
through the training they can improve their professionalism
and find new, more effective approaches to patients. At the
same time, trainings contribute to the formation of a critical
attitude of nurses to themselves because they learn more during
training courses and realize the fact that their work can
be improved even further. Finally, training is also an excellent
opportunity for nurses and other healthcare professionals
to better understand themselves because through training they
focus not only on their abilities and knowledge but also on
their internal world. In such a context, it is extremely important
that training involved special programs or courses which could
teach nurses and other healthcare professionals to avoid abuse
and develop positive relationships with patients (Silva, 15).
Side B. However, not all specialists share such a view of
staff levels and staff training. In contrast to this position,
some specialists (Davis, 85) argue that professional level
of the personnel working in long term nursing facilities is
sufficient for the provision of service at the high level.
At any rate, they underline that professionalism does not
really matter when such issues as abuse in long term facilities
are concerned. The reason for such a conclusion is based on
the idea that the personal qualities and characteristics of
an individual, including healthcare professionals, are of
the utmost importance and affect the work of healthcare professionals
consistently, to the extent that personal qualities and characteristics
can outweigh professional ones (Davis, 87). For instance,
an individual who tends to aggressive behavior is likely to
abuse patients even though his or her professional level and
qualification are high. Nevertheless, such a view of staff
professional level and its correlation, or, to put it more
precisely, the lack of it, with abuse in long term nursing
facilities does not deny the necessity of training of nurses
and other healthcare professionals. To put it more precisely,
training is apparently an essential condition of the professional
growth of healthcare professionals. Otherwise, they will be
doomed to a gradual degradation that will naturally put under
a threat the health of patients who need a long term care.
In this respect, it is possible to presuppose that the risk
of abuse in long term nursing facilities from the part of
such healthcare professionals increases substantially (McKenzie,
221).
Point 3: Regulatory policies, facility practices and training
programs and minimization of abuse
Obviously, the problem of abuse needs the interference from
the part of the state as the major institution which is able
to regulate relationships between citizens and which is responsible
for the protection of basic human rights and liberties of
all people, including patients, while abuse in long term nursing
facilities should be viewed as a form of the violation of
human rights and dignity.
Side A. Specialists do not always agree on the extent of the
state regulation and regulatory policies at large. In this
respect, it should be said that some specialists (Spevak,
173) argue that regulatory policies can play the key role
in the prevention of abuse in long term nursing facilities.
In fact, the introduction of strict regulation from the part
of the state will protect the rights of patients and the risk
of legal action against offenders working in long term nursing
facilities and abusing patients, including lawsuits against
not only these professionals but also healthcare organizations
will discourage abuse and will make healthcare organizations
more concerned with the quality of long term care services
and facility practices (Silva, 14).
To put it more precisely, the state regulatory policies can
put under a threat the functioning of healthcare organization
if cases of abuse are reported. Naturally, in order to survive
and function normally, healthcare organizations will be forced
to improve their facility practices to minimize the risk of
abuse. At the same time, they will pay more attention to the
staff levels and training of the personnel of long term nursing
facilities that will also have a positive effect on the problem
of abuse in long term nursing facilities. In this respect,
specialists (Spiegel, 1871) underline the importance of psychological
training of healthcare professionals in order to prepare them
to work with people who have a strong need in long term care.
Healthcare professionals should be able to use effective methods
of treatment of such patients and they should be able to communicate
with these patients and develop positive interpersonal relations
that can minimize not only the risk of abuse but also the
risk of any conflicts or tension between healthcare professionals
and patients.
Side B. There is a contrary view on regulatory policies and
the effect of facility practices and training programs on
abuse. In fact, regulatory policies are not always positive
and, what is more, they can produce a negative impact on the
performance of long term nursing facilities (Davis, 91). In
this respect, it is necessary to underline the fact that regulatory
policies inevitably lead to the strengthening of the state
impact on healthcare services. It proves beyond a doubt that
the growing state regulation can lead to the bureaucratization
of long term care services and, hence, the decrease of their
effectiveness (Davis, 98). In such a context, strict regulatory
policies can hardly produce any positive effect on the prevention
of abuse, while they can undermine the normal functioning
of long term nursing facilities. Consequently, the strengthening
of regulatory policies seems to be doubtful and, what is more,
it can contribute to the formation of the new problem –
the problem of corruption which often accompanies any regulatory
processes.
Point 4: Ethical codes as the basis of the prevention of abuse
in long term nursing facilities
Naturally, the problem of abuse in long term nursing facilities
involve a number of ethical issues since, if abuse does exist
than it is not only human rights of patients are violated
but their human dignity is affected. Obviously, abuse in long
term nursing facilities is absolutely immoral in relation
to patients. At the same time, this problem also involve professional
ethics since healthcare professionals are supposed to avoid
offending their patients pointblank. However, if the problem
of abuse does not exist or is absolutely insignificant or
cases of abuse are rather exceptions than a norm, then there
should not be any ethical issues involved.
Side A. In this respect, specialists insisting on the existence
of abuse in long term nursing facilities (Spevak, 163) argue
that any form of abuse inevitably involves ethical issues
which are very harmful for patients’ psychology and,
therefore, the problem of abuse needs to be solved. On analyzing
possible solutions of the problem of abuse or minimization
of the risk of abuse of patients in long term nursing facilities,
it is worth mentioning the idea of the creation of Ethical
codes, which could regulate the relationships within long
term nursing facilities and regulated norms of behavior of
nurses and other healthcare professionals in such facilities
(Spiegel, 1872). The creation of Ethical codes implies a kind
of agreement between a healthcare organization and the personnel
which complements the employment contract and clearly defines
basic demands the healthcare organization poses on its employees.
These should clearly define the behavior of healthcare professionals
and define the major moral and ethical values which are fundamental
for the healthcare organization. If a nurse or another healthcare
professional are unable to meet the demands or disagree with
the major principles of the organization than the latter should
critically evaluate and assess the professional level of such
an employee and take a decision concerning his or her further
work within the organization or changing the place of employment.
Side B. However, the opponents (McKenzie, 127), who stand
on the ground that the problem of abuse in long term nursing
facilities is extremely exaggerated or does not exist at all,
argue that if there is no problem then there are no ethical
issues involved. At the same time, they agree that ethical
issues always play an important role in the work of healthcare
professionals, especially those who work in long term nursing
facilities (McKenzie, 149). Nevertheless, these specialists
(Quinn, 24) are very skeptical about the introduction of Ethical
codes because they believe that such codes will never work
since they do not have any legal significance or value. Hence,
such codes will not lead to the punishment of those professionals
who violate principles and norms defined in the codes.
Point 5: Conclusion
Thus, taking into account all above mentioned, it is possible
to conclude that the problem of abuse in long term nursing
facilities cannot be denied. This problem exists and it needs
an immediate solution. It is impossible to ignore this problem
and argue that it does not really matter in the contemporary
long term nursing facilities. Even if this problem is not
widely spread, the ignorance of this problem can stimulate
its rapid and irrevocable progress. Anyway, it is necessary
to minimize the risk of abuse in long term facilities and
prevent the problem from the further expansion. In this respect,
the introduction of strict regulatory policies, accompanied
by the improvement of facility practices, training programs
for healthcare professionals, and introduction of Ethical
codes can be effective enough to prevent abuse in long term
nursing facilities. On the other hand, it is necessary to
keep the balance in order to avoid too strict regulatory policies
which can undermine the normal performance of long term nursing
facilities.
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Quality of American Health Care Through the Patient's Lens.”
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