Study of the recognition in care managers who handling elderly abuse

本研究的目的是分析护理管理者面对家庭成员虐待老人时所感受到的困难。本研究采用扎根理论方法进行。参加者均为曾处理虐待长者个案的护理经理。她们（n=21）均为女性，平均具有4.3±0.7年的护理管理经验。从数据中提取了两种困难的认知类型。护理管理的难点之一是：被虐待者的悲惨处境不容忽视；长期护理保险服务是这些人的唯一支持；施虐者有权解除合同；有人担心干预可能会增加虐待；优先考虑如何处理施虐者而不是被虐者是不可避免的；施虐者决定被照顾者的需要；唯一的选择就是制定一个看护人可以接受的护理计划。最终提取的更核心的类别是“施虐者对护理管理的隐性控制”。干预施虐家庭的困难之一是：害怕面对施虐者，护理经理来访时不受欢迎的气氛，不得不继续与施虐者的关系，不愿意破坏家庭关系，无法干预家庭关系，这是造成虐待的根本原因，即使在虐待家庭中也想相信家庭纽带。最终被提取出来的核心类别是由于尊重照顾者决定的原则而无法接受施虐者的无力感。从这项研究中可以明显看出，护理管理人员认识到，在虐待案件中构成护理管理基础的合同是造成他们所经历困难的一个因素。建议有必要建立一个支持护理管理人员的系统，以促进适当的护理管理。少

The purpose of this study is to analyze the difficulties perceived by care managers who confront elderly abuse inflicted by family members. The research was executed according to the grounded theory approach. Participants were care managers who had handled elderly abuse cases. They (n=21) were all female, and had a mean of 4.3 ± 0.7 years of experience as a care manager.The cognitions kind of two difficulties was extracted from the data. One of difficulty about care management were as follows: the terrible situation of the people abused cannot be ignored; the long-term care insurance service is the only support for these people; the abusive caregiver has the authority to cancel the contract; there is concern that intervention might increase the abuse; prioritizing how to deal with the abuser rather than the abused is unavoidable; the abusive caregiver decides the needs of the individual requiring care; and the only option is to create a care plan that is acceptable to the caregiver. Th … More e core category that was ultimately extracted was "tacit control of care management by the abusive caregiver".One of difficulty about intervention to abusive families were as follows: fear of confronting the abuser, unwelcome atmosphere to care manager's visit, having to continue the relationship with an abusive caregiver, unwillingness to upset the family relationship, inability to intervene in a family relationship that is the root cause of abuse, and wanting to believe in family bonds even in an abusive family. The core category that was ultimately extracted was the feeling of powerlessness in being unable to take on the abuser due to the principle of respect for caregivers' decisions.It is evident from this study that care managers recognize that the contract that forms the basis of care management in cases of abuse is a factor contributing to the difficulties they experience. It was suggest the need to establish a system that supports care managers in order to promote appropriate care management. Less