Staff Experiences in Managing Incidents in Nursing Homes: A Descriptive Qualitative Study

Abstract

Rista Fauziningtyas,1– 3,* Mei Chan Chong,1,* Herley Windo Setiawan,4 Maw Pin Tan5,* 1Department of Nursing Science, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia; 2Faculty of Nursing, Universitas Airlangga, Surabaya, Indonesia; 3Center of Excellence Patient Safety and Quality, Universitas Airlangga, Surabaya, Indonesia; 4Department of Pulmonology and Respiratory Medicine, Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia; 5Department of Medicine, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia*These authors contributed equally to this workCorrespondence: Mei Chan Chong, Department of Nursing Science, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, 50603, Malaysia, Tel [phone], Email [email protected]: Adverse incidents in nursing home (NH) may occur as the result of inadequate monitoring for signs of unobservable initial complications, medical errors, improper nursing interventions, lack of communication, and inadequate reporting.Purpose: This study explores incident types, causes, handling, and documentation in Indonesian NHs through a qualitative approach.Patients and Methods: In-depth interviews were conducted with 23 NH staff members, including managers, nurses, and support staff.Results: Five themes and 17 sub-themes emerged, with falls and resident-to-resident abuse as common adverse incidents. Causes included older adults’ conditions, environment, and misunderstanding. Follow-up action included first aid, hospital referrals, and assertive communication. Adverse incidents were actively reported through verbal and written reports or WhatsApp groups. Reports and documentation remain unstructured, however, as there were no standard operating procedures regarding incident reporting, documentation, and the types of adverse incidents that staff should report.Conclusion: Improvements in management, documentation, and reporting adverse incidents are highlighted in this research. Practitioners, nurses, and social workers should develop guidelines for handling, reporting, and documenting adverse incidents in NHs.Plain Language Summary: This study aimed to explore adverse incidents and events in nursing homes (NHs) in Indonesia, particularly focusing on falls and resident-to-resident abuse (RRA). With a growing older adult population and an increasing demand for long-term-care (LTC) facilities, the study aimed to understand the types of adverse incidents, their causes, approaches for handling them, incident reporting, and documentation practices within NHs.The study employed qualitative methods, conducting in-depth interviews with 23 staff members from four NHs in East Java, Indonesia. Falls and RRA were found to be the most commonly encountered adverse incidents. Falls were primarily caused by older adults’ physical conditions and environmental factors. Strategies for fall prevention included initial treatment, coordination with nursing staff, referrals to health services, and minimizing falls risk. RRA incidents were typically triggered by misunderstanding related to daily activities. Incident reporting methods varied, including verbal, written, and WhatsApp-based reporting, with varying levels of documentation practices.The study underscores the need for effective incident management and prevention strategies in NHs. Falls and RRA are significant concerns that demand attention. The findings highlight the importance of standardized protocols, comprehensive reporting systems, and structured documentation practices to enhance the safety and well-being of older adults in NHs. These insights can inform the development of strategies to improve incident handling, thus improving the quality of care provided to older adults in LTC facilities.Keywords: handling adverse incidents, reporting, fall, safety, older adult, quality of life

Keywords

• handling incidents
• reporting
• fall
• safety
• older adult
• quality of life