Sammendrag
Background: Elder abuse in nursing homes is a complex multifactorial problem and entails various associations
across personal, social, and organisational factors. One way leaders can prevent abuse and promote quality and
safety for residents is to follow up on any problems that may arise in clinical practice in a way that facilitates
learning. How nursing home leaders follow up and what they follow up on might reflect their perceptions of
abuse, its causal factors, and the prevention strategies used in the nursing home. The aim of this study was to
explore how nursing home leaders follow up on reports and information regarding staff-to-resident abuse.
Methods: A qualitative explorative design was used. The sample comprised 43 participants from two levels of
nursing home leadership representing six municipalities and 21 nursing homes in Norway. Focus group interviews
were conducted with 28 care managers, and individual interviews took place with 15 nursing home directors. The
constant comparative method was used for the analyses.
Results: Nursing home leaders followed up incidents of staff-to-resident abuse on three different levels as follows:
1) on an individual level, leaders performed investigations and meetings, guidance, supervision, and occasionally
relocated staff members; 2) on a group level, feedback, openness, and reflection for shared understanding were
strategies leaders used; and 3) on an organisational level, the main solutions were to adjust to available resources,
training, and education. We found that leaders had difficulties defining harm and a perceived lack of power to
follow up on all levels. In addition, they did not have adequate tools for evaluating the effect of the measures that
were taken.
Conclusions: Nursing home leaders need to be clear about how they should follow up incidents of elder abuse on
different levels in the organisation and about their role in preventing elder abuse. Evaluation tools that facilitate
systematic organisational learning are needed. Nursing homes must operate as open, blame-free cultures that
acknowledge that incidents of elder abuse in patient care arise not only from the actions of individuals but also
from the complex everyday life of which they are a part and in which they operate.
Keywords: Nursing home, Leaders, Patient safety, Organisational learning, Elder abuse, Staff-to-resident abuse,
Adverse events
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