Journal Article Review

Merav Ben Natan. Psycho-social factors affecting elders Maltreatment

in long-term care facilities. International Nursing Review, 57(1), 113-120.
Collins, K.A. (September 2006). Elder Maltreatment: A Review.
Archives of Pathology & Laboratory Medicine.

Mark Kevin D. Sadiamona

N01036081

NURS 150
Mary McGrory
March 5, 2015

Journal Article Review

Maltreatment is treating someone in a cruel way, it can be experienced by anybody in the

society. Maltreatment among elderly patients is one of the biggest problems in long-term care
facilities (International nursing review, pg. 114). I selected Psycho-social Factors Affecting
Elders Maltreatment in Long-term Care Facilities by Merav Ben Natan, Ariela Lowenstein, and
Zvi Eisikovits and Elder Maltreatment by Kim Collins because they share the same idea that
maltreatment in the elderly population especially in long-term care facilities is recognized as a
widespread and growing social problem. Both authors seems to be a well balanced team to tackle
this particular issue. The two articles explores the current medical and psychological
understanding of elder maltreatment. Both authors have their own style of introducing these
factors. M.V Natan uses researches and studies to solidify all his points while K. Collins uses a
real life situation based from personal experience. Based upon theories and researches, these two
articles provide strong evidences that maltreatment are caused by different factors in the society
like peoples attitude around the long-term care facility, different types of abuse, and facility as a
big factor for maltreatment.
The only people that nursing home patients rely on are health care providers like PSWs,
practical nurses and registered nurses. Nursing home patients expect that these health care
providers will give them the maximum care that they can get. But according to Psycho-social
Factors Affecting Elders Maltreatment in Long-term Care Facilities by M.B Natan, the
researches and studies that have been done regarding maltreatment say otherwise. MannWhitney test was held in order to examine differences between professional training and
maltreatment of elderly patients of long term care facilities (International Nursing Review,
pg.116). As a result, positive correlations were found between worker burnout (emotional
fatigue, depersonalization) and the various types of maltreatment. The research says that more

Journal Article Review

than half of the health care providers population use their professional seniority, experience
working, knowledge, and attitudes towards elder maltreatment (International Nursing Review,
pg.116). Another factor that contributes to maltreatment is the patients traits. According to the
article, same test was conducted between the patients traits. The result turned out that the reason
why health care providers act differently or rudely when giving care is because of the patients
attitude towards them. But there is also a reason behind these patients attitude. Most of these
elderly patients have mental issues and experiencing dementia that is a serious factor of mood
swings and bad attitudes. (International Nursing Review, pg.116). As a nursing student, I feel like
this article by M.B Natan is biased toward the patients. Even though he provided some
researches and studies, there are more questions to ask regarding his article. He did not say when
and where the tests were conducted and also how many patients participated in the study. Also
for my own perspective as a nursing student, the health care providers are the only people to
blame for maltreatment in long-term care facilities. This article helps me realize that nurses must
show accountability by taking responsibility for their decisions and actions, taking appropriate
action when needed and ensuring that practice is consistent with entry-to-practice competencies
(CNO Practice Guidelines). Also effective communication is a big factor to prevent
maltreatment. Therapeutic communication can promote relationship and trust between the patient
and nurse (CNO Practice Guidelines). In conclusion both health care providers and patients have
responsibilities toward maltreatment. The health care providers should consider the patients
situation and the patients should cooperate to the healthcare providers.
Any kind of abuse should not be tolerated especially in long-term care facilities. Elder
Maltreatment by K. Collins provides information regarding different types of abuse. According
to Collins, there are four types of abuse; physical, verbal, sexual, and neglect. Physical abuse is

Journal Article Review

an act carried out with the intention of causing physical pain or injury. Physical abuse is
generally considered the most extreme form of elder maltreatment. (Elder Maltreatment,
Physical Abuse). Physical abuse can cause multiple injuries and can lead to death. One example
of this is hitting the head of the patient, it can cause subdural hemorrhage and it is a common
cause of death in elder adults. Another type of abuse is verbal. Verbal is the most powerful abuse
of all of the types of abuse. Worst pain in the world is emotional, which is caused mainly by just
a few words arranged in such a way that it will actually send a bolt of emotional distress straight
through the patients feeling. Verbal abuse can be done in different ways like cursing, calling
names, telling them that they are going to die anytime soon, etc. Another type of abuse is sexual
abuse. Sexual abuse, or molestation, consists of contact with the genitalia, anus, breast, or mouth
(Elder Maltreatment, Sexual Abuse). This is the most underreported type of abuse because it is
hard to assess sexual assault in elder patients. Sexual relations between a nurse and patient
are always unethical and abusive, and are considered a serious breach of trust (CNO, Sexual
Abuse of Patients). It is the nurses responsibility not to develop a sexual relationship towards the
patient even though the patient agrees, because it is an abuse and professional misconduct. It
does not matter if the patient agreed to the sexual act. Last type of abuse would be neglect. The
most common form of elder maltreatment is neglect, the failure of a caregiver to provide basic
care to a patient and to provide goods and services necessary to prevent physical harm or
emotional discomfort (Elder Maltreatment, Neglect). The main goal of a nurse is to provide the
best care as possible for the patient. For me, assisting patient during a time of need is the reason
why people enter the field of nursing. Being a part of the helping professions is difficult and
demanding. Nurses are stuck between caring the patient and balancing the time for other tasks.
Negligence is never been in the nursing vocabulary. The whole article by Kim Collins is very

Journal Article Review

helpful. I agree to Collins point of view because it tells me basically everything about abuse and
maltreatment. Her explanations of different types of abuse helps me know that a verbal abuse is
the strongest abuse among all of them. Emotion and stress are connected to each other that is
why elderly people should not be treated as if they do not have feelings. After reading this
article, I changed my view of what abuse is. I thought abuse is only done sexually and physically.
Also I learned that even though the client cannot communicate, that does not mean that a nurse
has the right to abuse him or her.
The last topic that the two articles share is that facility is the biggest factor that causes
maltreatment. According to Psycho-social Factors Affecting Elders Maltreatment in Long-term
Care Facilities by M.B Natan, analysis of research findings regarding the effect of facility
features on the risk of maltreatment shows significant positive correlations between the number
of beds at the facility, number of nurses, number of aides, staff turnover (International Nursing
Review, pg. 118). Natan is basically saying that the larger the long-term care facility the bigger
the chances of maltreatment because a lot more patients have to be treated. Also the bigger the
number of the patients, the quality of care is low because it is too much for the caregivers to
handle. On the other hand, Elder Maltreatment by K. Collins tells that the main problem why the
long-term care facility is one of the reasons of maltreatment is because of the patients. Collin is
saying that most of the people that are coming to long-term care need help regarding
psychosocial services. It also states that almost half of the patients suffer dementia and are
unable to seek help because they are unable to voice out their abusive situation. I agree to both of
the articles regarding this topic. Most of the nursing homes are lack of resources yet lots of
patients are in the facility. In some long-term care facilities, one caregiver provides care for 1015 patients. Imagine how hard it is for him or her to give the assistance that every patient needs.

Journal Article Review

Especially in the morning care where complete care is needed and the caregiver has to be done
by a certain time. Also, psychosocial factor is obviously a big component that causes
maltreatment. In the real life clinical setting, if a patient with dementia refuses to receive any
help, a caregiver cannot do anything about it because the patient has the right to refuse. In
conclusion, the facility is one of the reasons for maltreatment because of lack of resources, too
much work for the caregivers, and psychosocial needs of patients.
As the years go by, more and more elderly patients will need help. Maltreatment can be a
result of this increased percentage of population because health care facilities and providers can
not provide the demand that is needed. Caring is at the heart of a nurse ability to work with
people in a respectful and therapeutic way. To avoid maltreatment caring should always be
specific and relational for each nurse-patient encounter. Psycho-social Factors Affecting Elders
Maltreatment in Long-term Care Facilities by Merav Ben Natan, Ariela Lowenstein, and Zvi
Eisikovits and Elder Maltreatment by Kim Collin teaches me a lot of things to prevent and
improve my theoretical approach as a nursing student. Attitudes of the patient toward the
caregiver is a big part of avoiding maltreatment, if the patient is cooperative then proper care will
be given. Next is any types of abuse should not be tolerated in any long-term care facilities.
Lastly, lack of resources and psycho social problem causes maltreatment.

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References
Natan, M.B., Lownstein,A., & Eisikovits,Z. (2010). Psycho-social factors affecting elders
Maltreatment in long-term care facilities. International Nursing Review, 57(1), 113-120.
Collins, K.A. (September 2006). Elder Maltreatment: A Review.
Archives of Pathology & Laboratory Medicine.
Sexual abuse. CNO. (January 23, 2015). Retrieved March 5, 2015,
from http://www.cno.org/protect-public/sexual-abuse-of-patients/
RN and RPN Practice: The Client, the Nurse and the Environment. CNO. (June 2014).
Retrieved March 5, 2015, from http://www.cno.org/Global/docs/prac/41062.pdf
Ethics. CNO. (June 2009). Retrieved March 5, 2015,
from http://www.cno.org/Global/docs/prac/41034_Ethics.pdf