Caregiver perceptions of unmet needs that lead to resident -to -resident violence involving residents with dementia in nursing homes

Abstract

Background. Resident-to-resident (R-R) violence is a particular threat to the well-being of older Americans in nursing homes. To date, few studies have focused on the phenomenon.

Aims. The specific aim of this qualitative study was to describe the direct caregivers' perceptions of the unmet needs that lead to R-R violence in nursing homes, including background and proximal factors that influenced the violence. Methods: The researcher selected a qualitative feminist approach to permit exploration of R-R violence from the perspective of the caregiver. The researcher recruited certified nurses' assistants (CNAs) employed by a nursing home in the rural Mississippi Delta region of Arkansas and conducted semi-structured interviews.

Findings. Eleven racially diverse CNAs participated in the study. The mean length of employment at the nursing home was 5.25 years. The researcher used content analysis and constant comparison to analyze the qualitative data. Specific triggers (proximal factors) and resident characteristics (background factors) were identified by the CNAs as influencing the development of R-R violence. The most prominent trigger of R-R violence identified was intrusion into the private space of other residents. Other triggers included taking another resident's belongings, loud and/or repetitive speech, uncomfortable environmental conditions, violent acts by other residents, boredom, competition for attention and/or resources, and difficult communication. Resident characteristics that participants believed influenced R-R violence pertained to degree of cognitive impairment, ability to move around in the environment, inability to effectively communicate, tendency to easily lose one's temper, earlier life teachings, including prejudices, and overall disposition. Interestingly, the CNAs did not perceive the factors influencing R-R violence as unmet needs.

Discussion. This study provided an opportunity to explore R-R violence from the perspective of those who spend the most time with residents in nursing homes. These results indicate that there are factors within the nursing home environment that, once identified, may be altered to prevent violence between residents.