Imagine that you are a certified nursing assistant (CNA) on a dementia unit of a nursing home. You are helping a resident with Alzheimer’s disease get dressed and, suddenly, she starts yelling profanities at you, aggressively demanding that you not touch her. As you well know, if you work in a nursing home, such scenarios are all too common. Over the course of their careers, nearly all nursing home caregivers experience what is called resident-to-staff aggression. In the largest study of resident-to-staff aggression to date, nearly 16% of nursing home residents in large New York City nursing homes directed aggressive behavior toward a CNA within a two-week period.
How should a CNA, or any other nursing home staff member, respond to verbal or physical abuse from a resident? The Labor Management Project (LMP) has been helping nursing homes grapple with this pressing question ever since we launched the Workplace Violence Collaborative in fall 2014. At one of the six participating homes, the Kings Harbor Multicare Center in the Bronx, LMP consultants delivered a training last month on how to communicate and intervene with residents who exhibit challenging behaviors. Attending the training were 26 staff from all shifts and disciplines, both managers and union members, including CNAs, nurses, recreation aides, social workers, housekeepers and security guards.
Kings Harbor was one of the first homes to start working with the LMP on this issue, forming a labor-management workplace violence committee and established a Workplace Violence Prevention Program shortly after the launch of the collaborative. As a first step, the committee revised and developed policies for workplace violence, imminent danger and active shooter situations, as well as combative person situations.
Last month, Kings Harbor administration provided coverage for all direct care staff who participated in the training. During the two-day class, staff learned about effective communication, conflict resolution, conditions associated with behavioral challenges (e.g., dementia, schizophrenia), behavior assessment, preventing problem behaviors, intervening with aggressive or violent residents, and the importance of providing person-centered care.
Staff feedback on the training was very positive. In the written evaluations, some noted that learning how to interact with residents with dementia was the most important aspect of the training. Nearly all (96%) agreed or strongly agreed that they had acquired new skills for taking care of dementia residents and that techniques taught by the instructor, Lois Schram, LCSW, will help them de-escalate aggression. One frontline worker wrote that understanding “how to deal and communicate with residents and family in a professional manner” was the most significant learning. Another noted that she learned how “to communicate, to listen, to reason, and to solve problems.” In addition to communicating with residents, some participants reported that learning how to work collaboratively with other staff was an important topic for them. One attendee said she learned how to “develop and build more cohesive teams to improve care at Kings Harbor.”