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

Abstract

Introduction

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

Data Sharing Statement

All data is included in this article and no further data will be available.

Acknowledgments

The authors express gratitude to Universiti Malaya, Universitas Airlangga, and all contributors to this research for the facilities and assistance provided. Many thanks to the respondents and nursing homes involved in this research. Finally, thanks to Proofed for their help in checking for corrections.

Author Contributions

Each author played a substantial role in the research presented, encompassing aspects such as conception, study design, data collection, analysis, and interpretation. They collectively engaged in drafting, revising, and critically evaluating the manuscript, ultimately granting their endorsement for publication. Consensus was reached on the choice of journal for submission, and the authors acknowledge their responsibility for the entire spectrum of the study’s execution.

Disclosure

The authors report no conflicts of interest in this work.

Additional information

Funding

This study was funded by Rector Scholarship of Universitas Airlangga.