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Is there Abuse in Long Term Nursing Facilities?

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.


Works cited:
Davis, K., et al. “Mirror, Mirror on the Wall: An Update on the
Quality of American Health Care Through the Patient's Lens.” The
Commonwealth Fund, 2006.
Klepper, D. “Medical clinic records sought.” Knight Ridder Tribune Business News, Washington May 22, 2008, p. 1.
Centers for Medicare and Medicaid Services. 2003. Home Page. Retrieved on May 22, 2008, from http://cms.hhs.gov/default.asp?fromhcfadotgov=true.
Cornell School of Law, Legal Information Institute. 2000. State Statutes on the Internet. Retrieved on May 22, 2008, from http://www.law.cornell.edu/topics/state_statutes.html.
McKenzie, P. Guide to Legal Issues in Elder Abuse Prevention. North Vancouver: North Shore Community Services, 1992.
Quinn, M.J. "Elder Abuse and Neglect: Raise New Dilemmas." Generations. Vol. 10, No. 2, 1985, p. 22-25.
Silva, T. “Reporting Elder Abuse: Should It Be Mandatory or Voluntary?” Healthspan. Vol. 9, No.4, 1992, p.13-15.
Spiegel, M. et. al. “Quality of health care delivered to adults in the United States.” The New England Journal of Medicine. Vol. 349 No.19, 2003 p. 1866-1875.
Spevak, C. “The Grand Jury and Health Care Crimes: What Every Physician Executive Needs to Know.” Physician Executive, Vol. 32, No. 1, 2006, p. 68- 70.
United States Department of Health and Human Services. 2003. Home Page. Retrieved on May 22, 2008, from http://www.os.dhhs.gov/.
United States Food and Drug Administration. 2003. Frequently Asked Questions. Retrieved on May 22, 2008, from http://www.fda.gov/opacom/faqs/faqs.html.


 

 
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