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Study Roots Out Context of Resident Aggressive Behavior

      A new study has identified modifiable context and care worker factors associated with aggressive behavior of nursing home residents toward staff.
      According to Karin Stutte, MScN, of Solothurn’s Hospital AG, Switzerland, and fellow researchers, aggressive behavior from nursing home residents against care workers is a distressing and often unacknowledged experience.
      “Previous studies have linked differences in prevalence not only to the individual histories of the residents, or the details of their injuries, psychological states, or dementia, but also to a range of context factors (i.e., factors related either to the nursing home setting or to individual care workers),” Stutte and colleagues wrote (Geriatr Nurs 2017;38:398–405).“Identifying context and care worker factors’ relationships with aggressive behavior would support recommendations for interventions to reduce residents’ aggression.”
      Their study detailed the prevalence of three types of aggressive behavior by residents toward care workers in Swiss nursing homes, and examined the relationship of context and care worker factors with the aggressive behaviors. The researchers defined aggressive behavior as any nonaccidental overt act involving the delivery of noxious stimuli toward an object, oneself, or another person. The types of aggression could be verbal, physical, or sexual.
      The researchers performed a secondary data analysis of the Swiss Nursing Homes Human Resources Project, a representative multicenter study with a cross-sectional design. They collected data from May 2012 to April 2013 and surveyed care workers by use of a self-report questionnaire.
      The analysis included 155 nursing homes that housed 402 units and employed 3,919 care workers. The mean age of the residents was 85 years, with 62% displaying symptoms or having a diagnosis of dementia. The mean care worker was 43 years old, and 92% were female.
      During the 4 weeks preceding the survey, the researchers found that 66% of care workers had been verbally assaulted, 42% had been physically assaulted, and 15% had been the focus of sexual aggression. For the care workers who were exposed to aggression, most experienced it less than once a week.
      The care workers reported a lower likelihood of experiencing verbal, sexual, or physical aggression if they were older or they worked in non–special care units versus special care units, or if they perceived their facility to be well staffed, with adequate resources.
      Sexual aggression was less likely to be experienced by male workers or by staff who characterized their working style as autonomous. Verbal aggression was more likely to be experienced by workers who perceived they had good or very good collaboration among team members. Both verbal and physical aggression were more likely to be experienced by staff who were emotionally exhausted. Compared with tertiary-level care workers, certified nursing assistants and nurse aides had an increased likelihood of reporting physical aggression.
      “Intervention studies should assess whether strategies that modify context factors (e.g., campaigns to tackle the roots of low perceptions of staffing and resource adequacy, or to increase work autonomy) should also facilitate aggression reduction,” the researchers wrote. “Since our study points to the higher exposure of care workers on [special care units] to aggressive behavior, it is vital to choose care workers whose personal characteristics best match the needs of specialized units, and to adequately train and supervise them in aggression management.”
      Brian Ellis is a freelance writer and editor based in NJ.