Certified nursing assistants' perceptions of and suggestions to prevent elder abuse in residential aged care facilities: a qualitative study in Hunan Province, China

Abstract

Background: Staff-to-resident abuse in institutional settings demands political attention and evidence-based interventions. Certified nursing assistants (CNAs) views and suggestions on preventing elder abuse can offer practical and policy-relevant insights. This study explores CNAs' perceptions and strategies to address elder abuse in institutional care.

Methods: Sixteen CNAs from residential aged care facilities (RACFs) in Hunan Province, China, were purposively sampled. Semi-structured qualitative interviews were conducted, and transcripts were analysed using content analysis.

Results: CNAs demonstrated a surface-level understanding of elder abuse, including its types, causes, and interventions. However, they provided detailed suggestions through an ecological-systems lens. At the microsystem level, strengthening staff professionalism and empathy was noted as critical, while the mesosystem involved enhancing institutional management. At the macrosystem level, suggested strategies included boosting social support, such as developing the senior care sector, increasing senior benefits, and strengthening legal safeguards.

Conclusion: This study highlights CNAs' limited understanding of elder abuse and presents actionable recommendations for policy and practice. The gap between their perceptions and the ability to ensure abuse-free care underlines the need for evidence-based training and standardised reporting systems. Strengthening staffing quality, institutional leadership, and community support within an ecological-systems framework is essential to reduce elder abuse and promote safe, respectful care environments for older adults.

Keywords: Elder abuse; Mistreatment; Nursing home; Nursing staff; Older adults.