Gewalt in der Pflege

Violence in care is a serious problem that is unfortunately far too often overlooked. Experiences of violence in care for the elderly are no longer a rarity, but are far too rarely addressed.

 

In everyday nursing care, incidents of violence can easily be overlooked, as they do not necessarily manifest themselves through hitting and screaming, but often remain subtly hidden in daily interactions with patients 

 

The financial exploitation of elderly people in need of care is also a form of violence that is often not given sufficient attention.
 

Mockery, neglect or the use of inappropriate measures are only part of the spectrum. But violence goes both ways. "Nursing staff and carers also fall victim to aggression from those in need of care or their relatives and are too often dismissed as a supposed occupational hazard.

 

 

Violence in everyday care

From the conversation in the break room about Mr. X, who is talking a lot of nonsense again today, to nurse Judith, who is under so much stress today that she can't spend hours helping Mrs. Y with breakfast, to Hubert, who has to wear diapers today because you really can't help him to the loo all the time. Hubert's real name is Mr. Z, but he doesn't realize that anyway. And in the meantime, Maria wet the bed because none of the carers had time for her.

 

Violence in care does not always manifest itself in one way, but has many faces. Violence is not the same for everyone. It always depends on the individual, subjective perception.

 

Social norms and violence

Social and cultural norms play a role here. Sometimes the use of violence is not even intended or is not understood as such. Simply ignoring a patient, dressing the wrong way for the sake of convenience and using unkind language are also considered violent acts.

 

There is often only a fine line between what is permitted and what is prohibited. If patients are at risk of self-harm, measures such as bed restraint may be legally permitted under certain circumstances. Ultimately, however, the top priority is always the physical and mental integrity of the person in need of care and all caregivers.

 

Forms of violence

There are three different parties that can fall victim to violence in care:

 

The following infographic provides an overview of the different forms of violence in care and what both care workers, employers and the care system as a whole can do to prevent and manage violence.

 

 

Violence against people in need of care

According to the World Health Organization (WHO), violence against older people is defined as "a single or repeated act or failure to respond appropriately in a relationship of trust that causes harm or suffering to an older person". In order to prevent violence in care settings, awareness of the various forms of violence must be raised among all those involved.

 

The Stiftung Zentrum für Qualität in der Pflege (ZQP) distinguishes between five forms of violence in care. This also includes recognizing the financial exploitation of older people as a form of violence and taking action against it.

 

Physical violence

The following situations constitute physical violence:

 

The right approach is extremely important, especially for patients with dementia. Neglecting or presumably disregarding this task is also a form of violence

 

 

What are the causes of violence by caregivers?

Just as the expression of violence can look different, the causes of violence can also vary. Especially in nursing, the line between appropriate and inappropriate is very blurred and many nurses do not know that their behavior can be understood as unacceptable.

 

This usually results from insufficient awareness of the topic. Often, several factors from both the professional and private environment add up to drive the carer to violent outbursts.

 

 

Occupational exposure

A major factor that can increase the propensity to violence is the high level of stress that the nursing profession entails. This affects both the body and the psyche of the carer. The care system is also characterized by a major shortage of skilled workers and poor pay, which discourages many people from choosing the profession.

 

In addition to the high level of stress, poor training for the profession of geriatric nurse is also considered to be the cause of violence in the care sector. In the course of this, in addition to the competent transfer of knowledge and extensive professional practice, the focus on violence prevention is also necessary in order to meet the high demands of the profession.

 

Caregivers for the elderly need to master skills such as understanding dementia diagnosis or non-violent communication. They need to know how to deal professionally with challenging behavior from people in need of care and what techniques are available to reduce their ownstress. 

 

These are basic requirements for the profession. Nursing studies show that professionalism and a high degree of self-reflection are extremely important for the prevention of violence.

 

Personal experiences

It has been scientifically proven that personal experiences of violence increase the risk of becoming violent oneself. For example, children who have been abused by their parents are also inclined to repeat these patterns of behavior, albeit unconsciously.

 

As a carer, the profession therefore poses an additional risk of taking violent outbursts out on those in need of care. In addition, addiction and health problems lower the inhibition thresholds and encourage abusive behavior.

 

Prevention and measures

Aggression itself is not yet a cause for concern. To a certain extent, they are part of being human and can be expressed constructively without resulting in violence. If handled correctly, they can even be beneficial, as they help us to assert our will, defend ourselves and express our emotions.

 

Aggression becomes destructive, however, when it arises to an excessive extent and does not find a positive outlet. They then express themselves as violence towards oneself or others.

 

For this reason, in order to avoid violence in care, mechanisms must be learned to be able to process these emerging aggressive feelings.

 

The first step is to sensitize nursing staff to signs of excessive demands. These can manifest themselves mentally and physically. The following are common symptoms:

 

 

It is important to observe these emotional reactions and not to push them aside or trivialize them. That way, you won't learn to deal with them and process them, and sooner or later they will manifest themselves as aggression or violence.

 

 

Meditation, breathing exercises and relaxation techniques can help. These are best practiced regularly. They can often be easily integrated into everyday care routines.

 

Relaxation techniques for caregivers in everyday life

 

 

Violence by family caregivers

Around 80% of all people in need of care in Austria are cared for by relatives. Sudden need for care is not uncommon and in many cases it is not possible to predict how long it will last, if not forever anyway. 

 

In addition to major changes in terms of the living situation, everyday life and finances, the relationship between the carer and the family member providing care often changes too. The relationship changes from mother-child to carer and cared-for.

 

 

Inadequate knowledge of the actual care plays a significant role here. Not knowing what to do or the additional work that inevitably results from intensive research can be both physically and mentally stressful.

 

Another factor that can increase psychological stress is the increasing mix of private life, care and leisure time. This reduces opportunities to switch off. Social contacts also threaten to disappear and loneliness could be the result.

 

Violence against caregivers

While a significant proportion of violence in the care sector is directed against those in need of care, it should not be neglected that the roles can easily be reversed. It is not uncommon for patients with dementia in particular to display personality changes and increasingly violent characteristics.

 

Referring to the above-mentioned change in the relationship between family members, the sudden, unavoidable intrusion into the privacy of relatives is also not well received.

 

However, risks of violence are not only hidden in home care, but also in residential care. For example, a change of residence can have an exacerbating effect.

 

Suddenly you have contact with others, perhaps involuntarily, and your usual daily routine changes. Some people don't cope with this very well. At the same time, inhibitions drop and patients are more prone to violent or even sexual assaults.

 

Unprocessed traumas and experiences can also increase the potential for violence in people in need of care in old age. Furthermore, depression in old age also leads to aggressive behavior in some cases.

 

 

Where can I turn?

When care workers experience violence at the hands of those in need, it is not uncommon for them to remain silent about it. Incidents are trivialized and not reported out of a guilty conscience towards the person in need of care.

 

However, violence is by no means a condition that must be accepted due to the nature of the job. Every incident must be reported to the employer and appropriate measures must be taken. These can go as far as expelling the patient concerned from the nursing home or introducing a visiting ban for violent relatives.

 

What can the employer do?

Not only actual incidents of violence, but also near-accidents and potential hazards due to behavioral patterns must be noticed by the employer. This is made possible by ongoing workplace evaluations, in which particular emphasis should be placed on the psychological evaluation of nursing staff.

 

In addition, situations of violence should not be left to chance, but rather preventative measures should be taken. On the one hand, nursing staff should be continuously made aware of the signs of violence both as part of their training and during their employment and be trained in appropriate self-defence techniques.

 

In addition, technical safety measures such as emergency call buttons must be guaranteed and sufficient staff must be on site at all times to provide assistance.

 

No to violence in care

We at noracares say NO to violence in care. The topic is often taboo and tacitly accepted as an "occupational hazard". Many also do not recognize potential or actual violent situations as such.

 

For this reason, the Chamber of Labor has developed an anonymous test that can be used to assess the potential for violence in the workplace or in a person's personal environment. You can find the test and further information on the topic of violence in care here 
 

 

We don't want to leave such an important topic as violence in care in the dark - that's why we talk and write about it. Have you ever experienced violence in care? Share your experiences with the community and create more transparency and fairness in care - click here to register.