Some personal care assistants in a residential aged care facility demonstrated inappropriate behaviour towards the residents. Their unprofessional behaviours included, but were not limited to, the following: • Force feeding residents

• Neglecting residents' needs and requests on the assumption that 'they will forget it soon'

• Arguing with residents when there was a delay in receiving a response from them to their (PCAs) questions

• Being impatient and forcing them to mobilise faster

• Performing tasks without seeking consent

• Making statements such as 'older people are boring' and 'older people are so dramatic'.

The residential aged care workforce must possess an understanding of the application of the theories of ageing and physiology of the ageing process as it is related to disease processes and resident behaviours.

Conduct a literature review and submit a writing on this topic, linking it with appropriate examples from the case scenario provided above. Refer to the marking rubrics for further guidelines and marking criteria you must include in your literature review. Word limit:

Answer:

A literature review on the unprofessional behavior of personal care assistants (PCAs) in the residential aged care facility is given in the explanation part. It describes the role of the PCAs, the kind of abusive behavior shown, identification of the abuse, the reason for the abusive behaviors, and the prevention of the abusive behaviors are discussed in detail in the explanation part.

Explanation

In a residential aged care facility, the personal care assistants (PCAs) are involved in providing care and services to the aged residents in their daily activities of life, including feeding, housekeeping, assisting in mobility, dressing, food preparation, maintaining personal hygiene, etc. It is reported that the elders who live in care facilities are more vulnerable to abuse than those who live at home. 

Physical abuse, verbal abuse, psychosocial abuse are the different forms of abuse the elders undergo. Being aggressive with the elderly client, forceful handing, yelling, threatening, using harsh languages, physical abuse like hitting, slapping, etc. are some of the abusive actions used by the PCAs in the aged care facility. Some of the neglect in the aged care facility includes leaving elders without bathing, not attending their call, not giving dental care or wound care, not changing when wet due to incontinence, not ensuring they are hydrated, etc. 

Abuse includes physical harm, causing pain, emotional pain by giving punishment, intimidation, etc., while neglect refers to the non-provision of services and basic needs. Most of the dependent elders are affected by chronic diseases that impair their physical and cognitive functions, which makes dependent. The elders who are dependent on others are mostly affected by abuse and neglect. Also, the dependent elders are not able to report any kind of abuse, fearing that it would adversely affect their living.  An example of abuse includes someone who saw a nurse hitting a lady as the nurse informed the lady not to rely on her the whole day, and when the lady replied with some remark, she was hit by the nurse and said: "shut up".

The presence of bruises, abrasion, bites, fractured bones, etc., are some of the evidence that reports the abuse. Focus groups and interviews with the individual helps the resident to report any form of abuse and neglect. It is reported that verbal abuse is more common, followed by physical abuse. The cause of abuse includes staff shortages, staff burnout due to overtime, resident misbehavior and aggression, poor training in handling aggressive behaviors, etc. 

A thorough understanding of the physiological and psychological processes related to aging minimizes the inappropriate behavior of PCAs towards older adults. The knowledge about the changes in the physiological process with aging helps the PCAs to understand the mindset of aged residents. The stochastic theories and non-stochastic theories are the two categories of the aging theory that explain the physiological changes behind aging. 

The stochastic theories explain that aging is caused due to the life events that incur cell damaged and the accumulation of damaged cells over the period. Free radical theory, Orgel/error theory, connective tissue theory is some of the examples of stochastic theories. The non-stochastic theories emphasize the aging as a set of predetermined events that are ordered in a timed framework, and the examples include programmed theory, biological clock theory, neuroendocrine theory, autoimmune theory, etc. Psychological theories like Erikson's personality development theory helps nurses or PCAs to comprehend about the developmental tasks and problems in older adults.

These theories help to understand that changes in the physiological processes that result in impaired normal physical activity and mental abilities (to understand and comprehend) leading to the development of chronic illness. The combination of muscle mass along with the degeneration of joints affects locomotion in elders. An increase in blood pressure, a decrease in the cardiac output, and an impaired gas exchange in older adults severely affect their normal body functions, perceptions, and thought processes. An understanding of the physiological and psychological activities during the different phases of life helps to understand the problems faced by the elder population.

The behaviors of the PCAs can be enhanced by giving education material, training, audit and feedback, team meetings, etc. The evaluation of various facility management styles and model employee screening, screening the influence of staffing models and patterns, interventions meant to enhance the quality of service, evaluation of staff empowerment model and models of culture change are some of the preventive measures can be implemented to avoid the abuse and neglect in a residential aged care facility. 

References:

https://www.ncbi.nlm.nih.gov/books/NBK98786/

http://samples.jbpub.com/9781284104479/Chapter_3.pdf

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1273316/pdf/westjmed00220-0011.pdf

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4641718/