New Brunswick RNs promoting PEACE: Prevention of Elder Abuse Centers of Excellence.

The New Brunswick scene: seniors constitute one of the fastest growing population groups in Canada. Statistics Canada (2007) reports that 6.1 percent of all seniors over the age of 75 in New Brunswick are residing in one of the licensed nursing home beds throughout the province. In NB, as of March 31, 2011, there were 4,330 occupied nursing home beds, which represent a 13 percent increase from March 31, 2005, (Nursing Home Services Annual Report, 2011).

Healthcare providers are viewed as supportive and caring professionals; however, recent Canadian and Provincial news media have highlighted instances of abuse of seniors in long term care facilities at the hands of staff. RNs are often the ones who must address the issue of elder abuse. It is seldom easy. People are often reluctant to speak about the issue of elder abuse and signs that abuse is occurring are often missed.

It is estimated that 4 to 10 percent of older adults will experience one or more forms of abuse at some point during their senior years (Statistics Canada, 2010). Because of the RN's unique position in healthcare settings, it is important that RNs know what constitutes abuse, how to prevent abuse from occurring and what to do when abuse does occur. NANB's Practice Standard: The Therapeutic Nurse-Client Relationship highlights that, it is an RN's legal and professional responsibility to address and report abuse and/or neglect. In addition, the registered nurse protects the client from harm by ensuring that abuse is prevented or stopped.

In July of 2010, the Canadian Nurses Association (CNA) and the Registered Nurses Association of Ontario (RNAO) formed a steering committee of stakeholders (of which NANB is a member) that developed a five-module curriculum with an accompanying facilitator's guide covering the topics of: understanding elder abuse, recognizing elder abuse, learning the law, intervention and strategies and healthy work environment for staff of long term care facilities. The intent of the national project was to promote dignity and respect in the care of older persons. As part of the project, ten long term care settings across Canada applied and were selected to be pilot sites for "Prevention of Elder Abuse Centers of Excellence" (PEACE sites). Two long term care facilities in New Brunswick were selected: The Department of Veterans Affairs (DVA) unit in Fredericton, which is part of the Horizon Health Network and York Care Center, a 204 bed nursing home also located in Fredericton.

Beth Harris, RN, MN, Clinical Nurse Specialist, Geriatrics, Horizon Health Network Zone 3 at the DVA and Gail MacFarlane, RN, the Staff Educator at York Manor, were recently asked:

How has taking part in the PEACE initiative, as a pilot home, impacted the nursing home environment and delivery of nursing care in your work setting?

BETH'S RESPONSE: "At Veterans' Health Unit, we have always taken a zero tolerance approach to elder abuse. Being part of this national initiative has served to raise awareness of the many types of elder abuse and neglect. We delivered the modules to all staff, not just nursing, and this helped to emphasize the importance of every member of the team in the prevention of elder abuse. The curriculum highlighted the importance of a healthy and supportive work environment and has given us concrete suggestions as to how staff can support one another on a daily basis to deliver excellent care.

I think perhaps the most important aspect of participating in this project was actually being able to have a conversation with staff on the subject. Elder abuse is one of those emotive issues that no long term care facility wants to be associated with. By educating staff on the many subtle and pervasive forms of elder abuse and assisting them to recognize and identify elder abuse, we empower our staff. Through participation in this project, we have shed light on a delicate subject and this knowledge has translated into the old adage--'When we know better, we do better'."

GAIL'S RESPONSE: "I feel that taking part in the PEACE initiative has brought the topic of abuse and neglect to the forefront for everyone in all departments. It has come out of the shadows of secrecy and is being discussed openly without fear of retaliation and/or punishment. Staff have learned about the types of abuse, how prevalent it is and what is considered neglect. Results from surveys completed before education and then again after education was provided, show staff feel more comfortable about how to address the issues and how to access information on elder abuse." McFarlane also identified that York Manor was able to raise community awareness of the prevalence of elder abuse by offering the PEACE modules to volunteers and students of York Manor, by doing presentations about the initiative at the New Brunswick Nursing Home Association Annual meeting and by profiling the initiative on World Elder Abuse Awareness Day. In addition, York Manor has hosted an education session for other long term care facilities in New Brunswick, attended by staff from eight nursing homes. Rayma O'Donnell, Director of Care at York Manor, summed up York Manor's involvement with the PEACE initiative in the following quote, "It is my personal perception that there is a sense of pride at all levels of the York Care Center organization, that we are part of this initiative and helping other organizations to become more aware".

Elder abuse is a serious societal issue, not only in long term care facilities but in all health care settings. Seniors account for one-third of all hospitalizations and more than one-half of all hospital days. RNs within all health care settings are in a position to address the issue of elder abuse.

For more information on the PEACE initiative: www.rnao.org/Page.asp7PageID=924&ContentID=3445

REFERENCES

Branch, L. (2000). "Assessment of chronic care need and use". The Forum, 40 (4), 390-395.

CNA and RNAO. "Promoting the Awareness of Elder Abuse in Long Term Care". www.rnao.org/Page.asp?PageID=924&ContentID=3445.

Department of Nursing Home Services. (2011). Nursing Home annual report. www2.gnb.ca/content/dam/gnb/Departments/sdds/pdf /StatisticalReports/NursingHomes/NursingHomes11-e.pdf.

Kao, H., Travis, S., & Acton, G. (2004). "Aging matters. Relocation to a long-term care facility: working with patients and families before, during, and after". Journal of Psychosocial Nursing & Mental Health Services, 42 (3): 10-6, 48-9.

Statistics Canada. "Population projections: Canada, the provinces and territories". The Daily, May 26, 2010. www.statcan.gc.ca/daily-quotidien/ 100526/dq100526b-eng.htm

Nurses Association of New Brunswick (2011). Practice Standard: The Therapeutic NurseClient Relationship. www.nanb.nb.ca/downloads/Practice% 20Standard-Nurse-Client%20Relationship_E.pdf