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Vol 5 No 3 June/July 2016
Australian Journal of Dementia Care
17
T
he culture in any organisation is
fundamental in determining how the
service is delivered and the
importance of positive care cultures in
preventing the abuse of adults at risk has
been highlighted in recent reports.
Organisational culture impacts directly
on how much staff feel valued or cared
for. It sets standards of how care is
viewed and whether all staff understand
the need to show kindness and
compassion. Creating and maintaining
positive and open cultures of care is a
cornerstone of prevention in
safeguarding and leaders need to
understand the links between cultures of
care and organisational abuse in order to
prevent negative cultures from
developing.
This article, the second in our series of
three articles on safeguarding, explores
links between organisational culture and
abuse with a focus on care homes for
people living with dementia. It
highlights some indicators of abuse along
with some obstacles to positive culture
and offers suggestions on how leaders
and staff can promote positive cultures
for prevention in adult safeguarding (see
Phair 2015).
Organisational culture and abuse
Key attributes of a strong care culture
were identified in a report by the abuse
prevention research initiative PANICOA,
Respect and protect
(Lupton and Croft-
White 2013), as follows:
• person-centredness, for residents,
families and staff, is a core value
• capability for change is strong
• leadership is strong, visible and
proactive at all levels
• staff are valued, supported and
motivated; a culture of trust and
openness exists
• the physical resource is effectively
managed
• the organisation is connected, having a
strong team ethic and links to the wider
health or social care community
• active learning culture is maintained.
When a care culture is not strong,
routine systems can degenerate, resulting
in inadequate standards of care and
ultimately in organisational abuse as
systems become centred on the needs of
the staff or the organisation rather than
those of the residents.
All organisations need some routines,
systems, policies and procedures and
whether the routines of a particular
home constitute organisational abuse is
determined by the overall impact they
have on individual residents. Leaders
should be constantly mindful of
whether the demands of the
organisation are adversely affecting the
occupants.
They also need to be vigilant that
practices do not become labelled as
‘policy’ by the staff. This can easily occur
when ritualistic practices are passed on
from one staff member to another,
explanations for the practices are not
given or reasons are not explored. If the
team leader is not alert to the real reasons
for the practices, and if they do not
remain reflective about why everything
is done, organisational abuse could
develop. If the risks are recognised early
and dealt with, a positive care culture can
be restored before harm occurs.
Indicators of abuse
During the development of the PIECE-
dem observational framework, part of
the PANICOA research program, Brooker
et al
(2011) identified key indicators of
possible neglect and abuse in an older
person living with dementia in a care
home as:
• withdrawn, depressed behaviour
• increased emotional distress
• care giver’s response to the resident
tends to be negative
• facial expression of the resident shows,
for example, anxiety, depression or
hopelessness
• there is reduced dietary and fluid intake
• quality and quantity of interaction
between staff and residents is poor
• resident has reduced levels of physical
activity and social engagement
• resident has few opportunities to
participate in activities of daily life
• resident’s privacy is not respected
• there are locks on doors and other
restraints.
A review of more than 250 individual
assessments of the needs of older people
completed as part of safeguarding
investigations in organisational settings
(Phair and Manthorpe 2011) pinpointed
the most common and/or repeated signs
of people who were neglected as:
• dehydration
• inadequate nutrition
• infections, including thrush, acquired
in the care setting
• constipation/faecal incontinence
• intractable pain and/or poor pain
management
• insomnia coupled with the resident
often appearing to be in a twilight state
or excessively drowsy
• confusion not linked to the resident’s
diagnosed mental condition
• resident showing a sense of
hopelessness and/or resignation
Adult safeguarding: creating
positive care cultures
Positive care cultures are key to ensuring effective safeguarding in care organisations, say
Lynne Phair
and
Hazel Heath
. In the second of three articles, they explore the links
between organisational culture and abuse
Lynne Phair is an expert witness and
independent nurse adviser and Hazel
Heath is an independent nurse adviser.
Lynne’s new book, Adult Safeguarding:
A Care Leader's Guide, is published by
Hawker Publications
When a care culture is
not strong, routine
systems can degenerate,
resulting in inadequate
standards of care