"Not matter how good the care in a nursing home is, placement in an institution is often traumatic and emotionally difficult for the family and the new resident," according to two registered nurses who have worked for several years in area nursing homes.

The two women, Martha D'Erasmo of Bethesda and Sarah Greene Burger of Northwest Washington, said they have found that the health of a nursing home resident can be adversely affected by the inability of the resident, his family or the nursing staff to cope with the problems created by the move to strange environment.

"We were working at a good facility, a home giving excellent care, but we kept seeing people come in and bang their heads against the same wall. These people were unprepared for institutional life. Families didn't understand the anger of their relatives at being placed in the home or their relatives reaction to the staff, or their own guilt feelings."

After checking with national groups working on problems of the aged, the two nurses said, they decided to write a guide for prospective nursing home residents and their families. Their book, "Living in a Nursing Home," is based on their experiences in Washington area facilities.

"There are many wonderful, wonderful people working in nursing homes," said Burger, "but turnover among nursing assistants is around 74 per cent. It's understandable. What are the rewards you get from a job? Financial, career advancement, positive feedback. Well, nursing assistants are paid the minimum wage, there is no career ladder and there is very little communication between patients, their families and the nursing assistant. It's very difficult for the staff person and, in addition, they've had no training in how to cope with the angry feelings of the residents."

Nursing home residents have special needs, and people who care for them should have special training, said Burger. "The average nursing home resident, for instance, is suffering from three to four disabilities - they have lived long enough to have that many illnesses. They also have enormous strengths: Many have lived long enough to suffer great losses and have come through upright. So, these are people with some stuff in them. That's the kind of thing people forget when they talk about older people."

Their book, which is a guide to both the emotional pitfalls of institutional placement and a discussion of the various services and care provided by nursing homes, was published recently.

"The most important thing for a family to do is to help the person in the home maintain his dignity and feeling of self-worth," said the nurses. "The person in the home should still feel like an important part of the family. When you visit, ask his opinion about decisions to be made or include him in family discussions. Keep him filled in on current events. There's also nothing wrong with discussing family difficulties. He will appreciate having been consulted."

Visits, especially in the beginning, are often difficult because the new resident often reacts to placement in a nursing home with anger and despair.

"The anger of residents is not hard to understand," said D'Erasmo. "After all, here is a person who is used to being responsible and in charge. We take them away from everything they know; they have to adhere to someone else's schedule; they're told what they can and cannot do and have. And then we tell them they're going to love it here. Well, they're not."

The anger of residents is most often directed at staff members who work directly with them. These are generally nursing assistants who, according to D'Erasmo and Burger, have no training for their jobs and who come from very different cultural and life style backgrounds.