1

Developed by the Canadian Nurses Association and the Registered Nurses’ Association of OntarioAdapted for use by [name of PEACE site]

2

MODULE 4: INTERVENTION

and STRATEGIES

3

• Two-year national project between Canadian Nurses Association and the Registered Nurses’ Association of Ontario from April 2010

– March 2012

• A series of education sessions implemented in 10 PEACE Sites across Canada

• Topics included are recognizing elder abuse; when and how to report elder abuse; how to intervene; and what you can do to

prevent elder abuse

• Resources and materials on NurseONE

Promoting Awareness of Elder Abuse in Long-Term Care Homes

What have we learned so far?

ObjectivesBy the end of this module, the learner will be able to:1. Explain the de-escalation strategy as an immediate

intervention2. Discuss Next Step intervention strategies3. Apply resident centred care and the therapeutic

relationship as preventative strategies for elder abuse

5

Understanding Intervention• Definitions:

– Intervene: To involve yourself in a situation with the intention of influencing the outcome

– Intervention: The act of intervening

• Each situation must be looked at with its own contributing factors and the individuals involved

• Think about the needs and desires of the Resident• Team based, interprofessional approach

6

Immediate Intervention:De-escalation

Defined here as: “Use of a phrase to break the flow of an abusive or potentially abusive situation”

• It serves to alert the individual that the situation appears to be abusive and helps keep the Resident safe

• Example: Can I help you?Can I see you for just a minute?

7

If you walked into this situation, what would you do/say to de-escalate:

Alternate Exercise

Example 1

Staff A goes by a resident’s room and sees a co-worker, Staff B, heaving a resident onto the bed.

What should happen next?

Should this be reported as abusive behaviour?

9

Example 1Staff A enters the room to first ensure the resident is

all right, then offers support to Staff B in order to break the abusive situation.

Presuming the resident is all right, Staff A says to Staff B, “Can I help you?” or “Can I see you for just a minute?”

10

Example 2

Staff C passes by Staff D’s office and hears Staff D shouting at a resident.

What should happen next?

Should this be reported as abusive behaviour?

11

Example 2

Staff C enters the office and asks the resident if he or she was all right and does a quick assessment to determine if the resident is in danger.

Then Staff C asks Staff D “Can I see you for a minute?”

12

Next Step Intervention• Does your long-term care setting have a zero

tolerance for abuse?

• Who must the incident(s) be reported to?

• What internal supports can be drawn on?

• What external supports exist in your community?13

Strategy: Therapeutic Relationship

• A therapeutic relationship requires reflective practice• Self-awareness• Self-knowledge• Empathy• Awareness of ethics• Boundaries and limits of the professional role

• Show respect, talk to residents as you would like to be talked to.

14

Strategy: Resident Centred Care

15

• Respect for residents• Residents deserve to be treated with dignity• Residents are experts on their own lives• Residents are leaders (they can help us as we provide care)• Residents’ goals should coordinate the way that the health

care team provides care• Residents deserve continuity and consistency of care and

caregiver• Resident care should be timely and responsive• Residents deserve fair/proper access to care they need

Strategy: Interacting with the Resident

16

• Resident focused• Respectful• Provided with dignity• Your behaviour may help you give better care

to residents• Quality talking is a good way to reduce or

prevent elder abuse

Case Scenario Comparisons• Scenario 1 Resident Mrs. E seeks

out resident Mr. F to sit with him and hold his hand. Mr. F greets her warmly and ensures there is room for her to sit beside him.

• Scenario 2 Resident Mrs. E seeks

out resident Mr. F to sit with him and hold his hand. Mr. F pushes her away and shouts for staff to intervene.

17

Optional Case StudyAn 80 yr old female resident has had a long standing intimate

relationship with a younger man. This relationship started prior to her admission to LTC.

The relationship was primarily sexual in motivation with consent Resident was cognitively intact and told staff to “mind your own

business” when asked about visits As time passed, the resident’s condition deteriorated and staff

noticed that she was more confused and withdrawn after his visits

How would you explore this resident’s rights and wishes?

18

Key Points

• Establish a word or phrase to use in situations that may appear to be abusive

• Consider appropriate Next Step interventions• Using resident centred care values, beliefs and

therapeutic relationships may help prevent elder abuse from occurring

19

Questions?

Resources

21

What’s Next?

• Module 1: Understanding Elder Abuse• Module 2: Recognizing Elder Abuse• Module 3: Learning the Law• Module 4: Strategies and Interventions

Module 5: Healthy Work Environments

22