Dr. Taketoshi Ozawa of the Japan Hospice Association has repeatedly reminded everyone in his speech, "People hurt others or themselves when they feel pain." ”
I thought he was talking about the human tragedy of a child who has been suffering from caring for their parents for many years and then kills their parents, but that's not all – the incident of a caregiver who can't bear the pressure of care and kills also happens in a care facility!
In 2017, a nursing staff at the Nippon Medical Center, Japan's largest care company, drowned an elderly resident. The caregiver said that the elderly resident would stain the sheets immediately after changing the diaper, and he would not listen to what he said, and he would drown him in the shower when he couldn't stand it.
In the face of this tragedy, none of the fellow practitioners fell into the trap of the Japanese Medical Center, and said that this is not just a single incident, and everyone must investigate the reasons to prevent the tragedy from happening again.
After the legal investigation, although the Japanese medical center itself was not punished, in view of the lack of early detection of the psychological problems of the caregivers, it was decided to strengthen the mental health safety of the caregivers, in addition to the routine annual psychological stress testing of the caregivers, and also required the implementation of "physical restraint prevention meetings" and "caregiver meetings" every month to ensure that the managers and caregivers can communicate with each other, exchange opinions on work, and solve interpersonal conflicts in the workplace.
Although a lot of time is spent in meetings, in order to prevent caregivers from abusive behavior towards the elderly due to emotional overwork, caregivers should not feel isolated even if they are busy at the care site.
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Abuse: Acting against the will of the person without their consent
Before we talk about preventing abuse by the elderly, we need to know what abuse is.
Japan divides abuse into five types: physical abuse, abandonment abuse, psychological abuse, sexual abuse, and financial abuse.
Specifically, changing diapers in front of everyone, or deliberately talking to elders in the same tone as talking to children, can be classified as abuse, which means "acting against the will of the person without the consent of the person."
Japan law also imposes an obligation on agencies to notify if abuse is detected. If you sit idly by knowing that there is a suspicion of abuse, the manager will be held legally responsible.
Past cases of abuse can often be seen in everyday small things before they become major incidents. Therefore, the early notification is also to prevent tragedy from happening.
However, there are still cases where elders attack the caregivers at the care site and must be restrained. Many people will wonder if caregivers have a safety crisis, so is treating elders like this also considered abuse?
The Japan government has also made it clear that elders may be restrained in urgent situations where there is an urgent threat to the life, body, or power of the elders themselves or their caregivers.
However, the premise is that such disposal is "irreplaceable by other means and is for the sake of exigencies and not prolonged restrictions on movement". To add up, restraint is not only physical bondage, but also excessive use of psychotropic drugs and isolation in a single room are considered a type of bondage.
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Only by respecting each other can we create a safe and caring environment
In the event of unavoidable restraints, it is the responsibility of the organisation to document all the processes and review afterwards to see if they can prevent such occurrences.
For example, it is most often mentioned that creating an environment where the elder is at ease and reducing his aggression. In many cases, bedridden elders attacked caregivers and yelled loudly, only to find out later that they were unable to see or hear someone approaching, and they reacted in self-defense out of anxiety. Think about yourself suddenly feeling someone touching you in the dark, and everyone will want to defend themselves first!
Therefore, when the caregiver enters the room, he must knock on the door first and notify the bedridden elder that he has come in. Before taking care of the body, it is necessary to enter the field of vision of the elders and confirm that the person is in a state of peace of mind before announcing the next service. Consent is obtained before taking care of the child.
If you have been to the hairdressing and massage industry, you will know that each service staff will explain the service items and service content to the customer before the service, so that the customer has a sense of security.
The same is true for the service scene in Japan. Even bedridden or dementia elders should go through the same process, and the caregiver is reminded of the respect for the elders, which can make the other person feel kindness and reduce their uneasy aggression against others in a ritual-like process.
In order to provide quality care, in addition to the efforts of individual caregivers, it is also important for those responsible for the organization to create a friendly workplace. In particular, caregivers not only provide labor and mental energy, but also provide emotional labor, and managers should pay attention to whether employees have a tendency to emotional fatigue in addition to their obvious fatigue.
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Care work involves physical, mental, and emotional labor
All along, we have only talked about physical and mental labor. With the development of modernization and the tertiary industry, Japan began to mention "emotional labor". Emotional labor is said when the nature of the work satisfies the three conditions of "contact with people", "the emotional control of the worker will affect the emotional changes of the customer", and "the emotional management of the worker is related to the operation of the organization".
The most common example is that flight attendants must provide comfortable services according to the customer's state when facing customer requests, and some airlines even believe that the emotional value provided by employees is a commodity, so they train flight attendants in etiquette, expression management skills, and speech skills.
Similarly, in the work of care services, in addition to assisting the elders in bathing, excretion and other physical labor, analyzing the life experience and personality of the elders, and when facing the elders, it is necessary to respond appropriately according to the emotions of the other party, and this kind of performance behavior that suppresses one's true feelings is emotional labor.
Because of the special nature of the care work, workers often encounter aggressive elders, or are harshly criticized by family members, and are more often infected with the grief that pervades the elders' death when they die. Without emotion management training, inexperienced caregivers can easily fall into negative emotions and even develop depression.
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Knowing how to relieve emotional stress is also to prevent occupational injuries
How to deal with the emotional fatigue of caregivers, like occupational injuries such as low back pain, is a prerequisite knowledge that needs to be obtained before entering the workplace.
For example, when facing an elderly person with dementia who has aggressive tendencies, you don't have to hypnotize yourself with "it's okay, he can't do anything when he's sick", but you have to admit that you are hurt and angered by the other person.
There is no shame in admitting that you have negative emotions, and the first step to properly dissipate negative emotions is to face his existence. Besides, we are all human beings, so it is normal to have joys, sorrows, and sorrows!
Once you realize that you are experiencing emotional stress, you need to know how to relieve it. In addition to listening to music, eating food, and doing what they like during the holidays, the state also provides psychological counseling resources to give these emotional workers an outlet for stress.
The 2015 Occupational Safety and Health Law stipulates that companies with more than 50 employees must conduct regular stress testing surveys on their employees, and are obliged to report the test results to their employees. If an employee's stress index is found to be exceeded, there will be a professional counselor such as an industrial doctor to provide psychological counseling assistance.
Workplace managers should also consciously communicate with employees on a regular basis, especially because a lot of pressure comes from excessive demands for perfection, leaving room for mistakes, maintaining a balance between commuting and commuting time, and creating a space for caregivers to chat naturally can relieve employee stress and prevent employees from leaving.
From childhood to adulthood, we spend a lot of time memorizing essays, writing test papers, and spelling grades, but we rarely have the opportunity to evaluate our emotional management index or systematically train our interpersonal skills.
I believe that this kind of educational background has led most people to mistakenly think that the service industry, which is dominated by emotional labor, is a job that does not require learning and is not of high value.
Long-term care work in Japan belongs to the "service industry" in the industry, and has the nature of physical, mental, and emotional labor. In order to provide the best service to the elderly, caregivers need to learn not only physical care skills, but also interpersonal relationships and customer complaints (family members or elders) to cope with each other.
In the face of high-pressure caregivers on the front line, organizational managers must create a safe and comfortable working environment for employees. After all, human beings only exude a true smile when they are rich in their hearts. Rather than wearing a ceremonial mask, a caregiver who is happy from the bottom of her heart can provide the best care service.
The happiness of caregivers is directly related to customer satisfaction, and before explicitly prohibiting abuse on site, we must create a happy workplace so that the organization, employees and elders can enter a win-win situation.