National Preventive Mechanism Such cases are a clear warning that the potential for violence arising out of conflicts between people and from mental illness has to be taken seriously. XX In order to guarantee a good quality of life for residents, good working conditions must be secured for staff, along with the necessary staff management skills on the part of managers. XX High staff turnover should be perceived by home operators and supervisory authorities as an alarming indication of inadequate nursing. XX The ability of nursing staff to act with confidence must be guaranteed by regular nursing rounds and controls of nursing documentation along with targeted training in nursing processes. XX An important task of management is to promote the acceptance of supervision by staff and to support reflection on work within the facility 5.1.3 Violence in nursing care Violence in nursing care may arise in a variety of different situations and forms. Structural deficiencies such as inadequate resources and rigid procedures that leave too little scope for individuality can be found as often as e.g. inappropriate mealtimes and bedtimes. Situations where care is provided by an overburdened nurse working under time pressure are stressful, especially for persons with dementia. Frequently, there are escalations simply because it is not possible to convey a calm and relaxed demeanour. People who are seriously ill are often unable to express themselves quickly and clearly when they should take a decision. As a result they are often ignored when their consent to special nursing measures or medical treatment would be needed. Interference with fundamental rights and personality rights, including in particular measures that restrict freedom, are frequently inadequate responses to problems for which no other solutions have been found. Various forms of violence in everyday nursing Violence may however also arise in a subtler form, such as by contempt, insults and the refusal of communication. It is occasionally apparent from derogatory entries in nursing documentation that persons needing care run the risk of no longer being perceived as individuals but rather as a “problem”, especially if they are unable to adjust to framework conditions. Entries such as “resident stubborn again today”, “resident unbearable” or “resident not cooperative” are objected to by the NPM also because this implies that residents must adjust to nursing structures. Derogatory attitude During the early stages of dementia, many of those affected are still able to state their needs and wishes but also to refuse consent. This ability declines over the course of the disease and persons with dementia become increasingly The meaningful occupation of persons with dementia helps to prevent violence 107