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The dark side of Norwegian nursing homes: factors influencing inadequate care

Wenche Malmedal (Assistant Professor, based at Faculty of Nursing, Sør-Trøndelag University College, Trondheim, Norway)
Randi Hammervold (Associate Professor, based at Trondheim Business School, Sør-Trøndelag University College, Trondheim, Norway)
Britt-Inger Saveman (Professor, based at Department of Nursing, Umeå University, Umeå, Sweden)

The Journal of Adult Protection

ISSN: 1466-8203

Article publication date: 3 June 2014




The purpose of this paper is to investigate factors that influence the probability that staff will commit acts of inadequate care, abuse, and neglect.


A cross-sectional survey study was carried out in one county in the middle of Norway (Sør-Trøndelag). Random sampling, stratified by size of nursing homes, and location (rural or urban areas), was used to select a variety of nursing homes from a total population of 55 nursing homes. All staff working in 16 nursing homes working were asked to participate in the study. A response rate of 79 per cent was achieved (n=616).


Findings reveal that location and size of the nursing home, age of the staff, education level, job satisfaction, resident aggression, and conflicts between residents and staff predict inadequate care, abuse, and neglect. The most consistent findings are that resident aggression increases the risk for all three types of inadequate care, and that conflicts predict different types of inadequate care depending on whether the conflicts are related to direct care-giving activities or not.

Practical implications

Nursing home care is an important part of care for the elderly, and should be characterized by good-quality services. The relation between inadequate care and resident aggression, conflicts, and other factors shown in this study points to the relevance of further improvements in nursing home practices to minimize the occurrence of episodes of inadequate care, abuse, and neglect.


This study investigated the relationships between 11 specific factors and different types of inadequate care in a nursing home context.



The authors acknowledge the invaluable contributions of the nursing staff and nursing home managers and give special thanks to the coordinators for collecting the questionnaires.

Wenche Malmedal and Britt-Inger Saveman were responsible for the design of the project and the development of the questionnaire. Wenche Malmedal performed the data collection as well as the primary manuscript writing. Randi Hammervold was responsible for the analysis and data interpretation support of the results. Britt-Inger Saveman supervised the study.

Funding for this study was provided by Sør-Trøndelag University College, Norway.


Malmedal, W., Hammervold, R. and Saveman, B.-I. (2014), "The dark side of Norwegian nursing homes: factors influencing inadequate care", The Journal of Adult Protection, Vol. 16 No. 3, pp. 133-151.



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