A moment later, a CNA (certified nursing assistant) came into the room and, observing the bedroom scene depicted on the screen, asked in horror, “What are you watching?” Declaring “I’m going to put on something more appropriate!” she surfed the channels until she found what she thought the residents should be watching. I then left the room to see a patient.
When I returned a few minutes later, “Animal Planet” was playing on the TV screen, and the three patients were fast asleep. This story might be funny if it wasn’t true. If you’re more than 70, you should be able to watch an adult romantic comedy that is R-rated, but this CNA treated those adults as if they were her under-17 children.
Is this a rare instance of infantilizing patients or a common problem in long-term care settings? Research indicates that it is a fairly common problem with a disturbing component: Staff members who treat patients as though they are children are at greatest risk to engage in psychological abuse of those patients (Harris & Benson, 2006). This can lead to yelling, threatening, neglecting, or belittling.
What are some examples of infantilizing speech or behaviors?
Using terms such as “dear” and “honey.” Addressing a stranger or nonfamily member with these and other terms of endearment may be dismissed by staff members who engage in the practice as nothing more than friendliness, but patients may view it as a way to avoid meeting them on an equal adult basis. Using the patient’s name—Mr. Smith, for example—is a sign of respect and says you view that person as an adult.
Responding to events (and referring to supplies) as though one is talking to a child. “You wet the bed again!” or “Time to change your diaper!” can be seen as belittling, or worse if said in the presence of other patients. Acknowledging urinary incontinence as being medically induced and using the term “briefs” rather than “diaper” help preserve the patient’s dignity.
Scolding patients for things out of their control. Again, declaring “You wet your pants again!” or “I just changed you five minutes ago!” is demeaning to adults. Patients in nursing homes have urinary-tract infections, bladder-control issues, and mobility and cognitive issues that affect their ability to reach bathrooms in time or void on demand. We should be aware of these issues. Staff members sometimes feel a patient’s behavior is purposeful and then label or accuse him or her of intentional action: “Ms. Smith was too lazy to use her call bell and get up to the bathroom.” In reality, no patient wants to lie in a wet bed.
Nurses can say a lot to their patients without talking. Pointing at a patient, scowling at them, or using other body movements and gestures that communicate anger or frustration can be regarded as hostile and make a resident feel like a child.
Threatening patients. “If you don’t get your treatment done by 2 p.m., you can’t go to bingo!” or “I’ll call your daughter and tell her what you did!” are threats, and they make the nurse a parent and the patient a child.
Other ways to infantilize patients. Choosing what patients can watch on television, censoring patients who express opinions related to sexuality or want to discuss adult-related issues in groups, and talking about patients who are present as though they are nonentities are other ways we infantilize them.
Why does this occur?
Lack of education about geriatric patients and dementia, burnout, busy units, and stress are just some of the reasons staff members give me for why they treat adult patients as if they were children.
How can nurses be alert to the practice of infantilizing patients?
To change these patterns, nurses need to be aware of cognitions that lead to infantilization. Realizing that we will all be old someday—if we’re lucky—and knowing how we would like to be treated helps put us in our patients’ shoes. We can develop empathy. We can educate our peers and point out better ways to interact with residents. Being up to date on medical and psychiatric diagnoses will help us understand patient behavior better so that reasons for their actions will be attributed more accurately.
Nurses must be aware of negative cognitions that influence their actions toward patients. For example, calling a patient who is incontinent “lazy” and yelling, “You wet the bed again!” are labeling and magnification. Does the world end if you have to change the bed again? No. Is it frustrating and time-consuming. Yes. But it is our job.
Treating elderly patients in ways that consider them as children and deny their maturity can lead to unintentional abuse that is traumatic to long-term care residents. Awareness of this and our own attitudes toward older people can go a long way in helping us deliver the care and respect our elders have earned. RNL
Michael C. LaFerney, PhD, RN, PMHCNS-BC, is a psychiatric clinical nurse specialist at Arbour SeniorCare in Haverhill, Massachusetts, USA.
Harris, D., & Benson, M. (2006). There's no safe place: Maltreatment of patients in nursing homes. Binghamton, NY: Haworth Press.