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Taking the Hit: Focusing on Caregiver "Error" Masks Organizational-Level Risk Factors for Nursing Aide Assault

University of Saskatchewan, Saskatoon, Saskatchewan, Canada

Margaret F. Crossley

University of Saskatchewan, Saskatoon, Saskatchewan, Canada

Norma J. Stewart

University of Saskatchewan, Saskatoon, Saskatchewan, Canada

Carl D'Arcy

University of Saskatchewan, Saskatoon, Saskatchewan, Canada

Dorothy A. Forbes

University of Western Ontario, London, Ontario, Canada

Sandy A. Normand

University of Saskatchewan, Saskatoon, Saskatchewan, Canada

Allison L. Cammer

University of Saskatchewan, Saskatoon, Saskatchewan, Canada

Beliefs about the causes of events have implications for emotional reactions, distress, expectations for the future, and behavioral responses. In this article we report on two issues: the organizational context that contributes to nursing aide (NA) assault and reporting, and serendipitous findings that arose from investigating unexpected response rates to a survey. Data were collected in 11 rural nursing homes using a structured prospective event-reporting diary to collect detailed information about incidents of physical aggression, followed by focus groups to further explore NAs' perceptions of these events. Here we report on analysis of 19 focus groups conducted with 138 NAs. Participants described organizational-level factors that constrained their practice, affected their interactions with residents, and created a context that put them at risk for physical assault. These factors also affected their willingness to provide written documentation about aggressive incidents. The key issues were frustration at being blamed for causing aggression, lack of action to address the problem, and a desire for respect and involvement in decision making. Organizational changes are needed to modify the contextual factors contributing to assault risk. Researchers must be willing to modify study designs to more fully understand the nature of the problem studied.

Key Words: nursing aides • nursing homes • nursing • work environment • abuse • physical • research • long-term care • rural

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