Hi. I need to write reaction or reflection paper. I don't need to write a summary about it.
You can briefly describe the topic in general but you are expected to critically assess a problem or solution within the reading and describe as reactions to or reflections of the reading. (good, bad, eye opening, questions you may have, etc.).
The majority of these reaction or reflection papers should focus on this.
This paper should be Two pages. Double spaced. 12-point Times New Roman font, 1 inch margins. It must be complete page in length.
INPERSPECTIVE DON?S CORNER by Betty MacLaughlin Frandsen, RN, NHA, MHA, CDONA/LTC, C-NE Hidden cameras N ewspaper headlines shocked readers
recently by declaring that 14 nursLong-term care facilities
ing home workers from one New
that keep the lines of
York facility near Albany were arrested and
charged with neglect. Eight others were arbetween residents and
rested in a Western New York nursing home.
families and that respect
These actions resulted from the use of hidden
their rights will go far in
cameras installed with consent of residents?
preventing abuse and
family members. Attorney General Andrew
other inappropriate actions
Cuomo reported conducting a six-week
investigation using all necessary tools to watch
over the vulnerable who cannot advocate for
In the Albany area facility, hidden cameras revealed
the following: At a glance... ? Staff often left residents in the same position
for an entire shift, failing to turn and position an
? Nurses failed to administer medication and
treat bed sores.
? Staff failed to check for incontinence or change
undergarments for long periods of time.
? Staff falsified medical records to conceal this
? A physician?s assistant created a false record of
an annual physical that was never performed. In all, six licensed practical nurses (LPNs) and
seven certi?ed nurse aides (CNAs) were charged
with felony ?rst-degree multiple counts of falsifying
business records and misdemeanor willful violation
of public health law. The physician?s assistant was
charged with one count.1
The Western New York investigation revealed
? Staff routinely failed to properly transfer a
resident in and out of bed. Instead of using a
mechanical lift with assist of two caregivers, 48 ? JUNE 2010 they put the resident at risk of injury through
? One aide failed to provide range of motion
? Two LPNs failed to administer insulin, failed to
provide skin and wound treatment, and failed to
check vital signs.
? The employees falsified medical records to
conceal the neglect and mistreatment.1 Falsifying business records is a Class E felony
punishable by up to four years in prison. The other
charges are misdemeanors with varying maximum
prison terms of up to one year.1
WWW.LTLMAGAZINE.COM DON?S CORNER
INPERSPECTIVE While this ?sting? operation may catch
many by surprise, use of hidden cameras
and similar ?ndings are not new. Consider
these other cases:
? In Texas, first-degree felony abuse
charges were filed against a nurses?
aide captured by a hidden camera
striking a woman to get her out of her
wheelchair and then throwing her into
bed. The resident, paralyzed from a
stroke, also suffered from dementia. When the facility failed to act on
complaints from her husband, stating
the woman ?could not identify her
abuser,? he took action and installed
? In Ventura County, California, a family
noticed unexplained bruises on their
70-year-old loved one admitted to
the facility following a stroke. Family
notified administrators, but there was
no investigation. The family set up a
hidden camera and captured what
they could not believe. A CNA was
seen slapping the resident, violently
bending her fingers, wrists, and neck,
and pulling her by her hair. An investigation showed the nursing home
knew this was a problem employee.
Other families had complained of
suspected abuse, and one named the
CNA in writing, but she was allowed
to continue to work with residents.
The family was awarded $7.75 million
by a jury after facility owners refused
to settle out of court for $500,000.3
? In an Illinois nursing home, seven
patients were admitted who had
criminal backgrounds after the facility
failed to conduct background checks.
Two deaths resulted from neglect,
and cameras showed mentally ill patients were out of control and elderly
residents lived in fear. Two workers
and three patients were arrested,
and the administrator?s license was
suspended.4 to meet the needs of residents.
? Staff falsely documented that the
care was provided.
? Staff members intentionally abused
or neglected residents.
? Staff failed to report what they saw
others do or fail to do. ? Administration did not adequately
investigate family concerns. In each case, the installation of hidden
cameras was the vehicle by which neglect
and abuse was substantiated. In most of
the examples, family members ?rst tried In our examples several key things happened:
? Staff failed to provide care designed
WWW.LTLMAGAZINE.COM LONG-TERM LIVING ? 49 INPERSPECTIVE
to work with administration to gain resolution, but when they
perceived they were not heard, they resorted to other means.
None of us want to believe that our sta? could be involved
in neglect or abuse, but we must remain vigilant in overseeing
resident care. Attorneys and investigators are waiting to step
in to right these wrongs, and the lesson for us is clear: As nurse
leaders we must take all possible steps to prevent similar occurrences from happening in our settings, and we must make time
to listen to our residents and their family members. Once they
have shared their concerns, it is imperative that we follow up
until they agree that they are satis?ed with our response.
The Centers for Medicare & Medicaid Services (CMS) provides us with guidelines to help us organize our protocols and
direct our sta?. F-223 Abuse states, ?The resident has the right
to be free from verbal, sexual, physical, and mental abuse, corporal
punishment, and involuntary seclusion.? This means residents are
not subjected to abuse by anyone, whether they are sta?, other
residents, consultants, volunteers, agency personnel, family
members, legal guardians, friends, or any other individuals.
F-224 Treatment of Residents & their Property addresses mistreatment and neglect. The following de?nitions apply:
? Abuse?The willful infliction of injury, unreasonable
confinement, intimidation, or punishment with resulting
physical harm, pain, or mental anguish or the deprivation
by an individual of goods or services necessary to attain or
maintain physical, mental, and psychosocial well-being.
? Neglect?failure to provide goods and services necessary
to avoid physical harm, mental anguish, or mental illness.5 F-226 Policy & Procedure on Abuse instructs us to develop
and implement written policies and procedures containing the
following seven components:
1. 2. 3. 4. Screening?Potential employees must be screened for
a history of abuse, neglect, or mistreatment through attempts to obtain information from previous/current employers, appropriate licensing boards and registries, and law
enforcement agencies who conduct criminal background
Training?Employees must receive orientation and ongoing education on dealing with aggressive and/or catastrophic reactions of residents; reporting knowledge of
allegations; and recognizing signs of burnout, frustration,
and stress that could lead to abuse and explanation of
what is considered abuse and neglect.
Prevention?Procedures should provide information to
residents, families, and staff on how to report concerns,
incidents, and grievances without fear of retribution; how to
identify, correct, and intervene in situations where abuse or
neglect are most likely to occur; and state the importance
of giving feedback.
Identification?Procedures must instruct staff in identify- 50 ? JUNE 2010 DON?S CORNER 5. 6. ing events needing investigation, such as suspicious bruising,
patterns, or trends.
Protection?Procedures must explain how to immediately
protect residents from harm while an investigation is conducted.
Reporting/response?Procedures should guide reporting of
alleged or substantiated incidents to appropriate agencies,
require corrective actions based on investigation results,
and include reporting action by a court of law that indicates
an employee is unfit for service to the appropriate agency,
registry, or licensing authority. Also consider what changes to
make to prevent future occurrences.5 Whether the individuals in our examples receive prison sentences or not, they will no longer work in nursing homes. Careers
of many years were ended by bad choices and bad actions. In the
long run, future residents will be protected from the substandard
care delivered by these individuals.
Any facility without a policy on use of cameras in resident areas
should develop one, with input from legal counsel. By following
CMS guidelines for abuse and neglect prevention, nursing homes
will establish a foundation for protecting residents from negative
events. Reporting of inappropriate behavior must be the facility
standard. Families should be listened to, even if they previously
reported what administration deemed to be unsubstantiated
Administration in our examples, for whatever reason, failed to
protect their residents. Nursing homes that establish open lines
of communication and feedback with residents and families, and
that respect their rights will go far in preventing inappropriate
activity from happening. They may, in fact, avoid the arrival of
hidden cameras in their own neighborhood. ?
Betty MacLaughlin Frandsen RN, NHA, MHA, CDONA/LTC, C-NE, has more than
30 years of experience in long-term care as a Director of Nursing, Administrator, and Regional Consultant. She is currently Vice President of Education and
Regulatory Affairs for AANAC. To send your comments to the editor, please e-mail
1. Twenty-Two Arrested in Hidden Camera Nursing Home Probe, April 1, 2010. Available at:
2. Rosenfeld, J. Hidden Camera Catches Nursing Home Worker Abusing Paralyzed Stroke Patient.
Available at www.nursinghomesabuseblog.com/2010/01/articles/nursing-home-abuse-1/
3. Jeffcoat, M. Hidden Camera Evidence Helps Jury Measure Damages at $7.75 Million Dollars,
February 18, 2010. Available at: www.southcarolinanursinghomelawyerblog.com/2010/02/
4. Two Surefire Ways to Catch Nursing Home Abuse with Hidden Cameras. Available at: www.
5. The Long Term Care Survey (September 2009 Edition). Published by American Health Care
Association, Washington D.C. WWW.LTLMAGAZINE.COM Copyright of Long-Term Living: For the Continuing Care Professional is the property of Vendome Group LLC
and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright
holder's express written permission. However, users may print, download, or email articles for individual use.
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