NRS 429 Topic 5 DQ 2
What characteristics would lead a provider to suspect domestic violence, child abuse, or elder abuse is taking place within a family? Discuss your facility’s procedure for reporting these types of abuse.
Although it is generally agreed that there is no specific ‘type’ of person who is more likely to be abused, and the different types of abuse include physical abuse, psychological abuse, sexual abuse, verbal abuse, financial abuse, etc. There are general characteristics which people in an abusive situation tend to have in common and this includes the follow:
Low self esteem
Emotional and economic dependency
Continued faith and hope abuser will “grow up”
Stress disorders and/or psychosomatic complaints
Accepts blame and guilt for violence
Socially isolated, e.g. avoids social interaction, never seems to be alone
Believes social myths about battering
Believes in stereotypical sex roles
Has poor self image
Contemplates or attempts suicide, or self-harms
Participation in pecking-order battering
Appears nervous or anxious
May defend any criticism of abuser
May have repeatedly left, or considered leaving the relationship
Broken bones, bruises, marks on the body, or bite, burn or scald marks.
Frequent injuries that are unexplained or inconsistent with the account of what happened.
Anybody may fall victim to abuse, with all adults (those aged 18 and over) potentially being affected. However, there are some situations that increase an adult’s vulnerability and therefore put them at increased risk. For example, people with particular care and support needs, such as dementia or a learning disability, may struggle to communicate what is happening to them, or their communication may be misinterpreted as a symptom of their condition. Sadly, abusers target these vulnerable adults knowing this. This is why it’s so crucial for you to know the signs. At my facility, It is every nurse’s duty to report any type of abuse whether they are sure it happened or not to the supervisor who then goes to the manager and it finally gets reported to the Texas department of family and protective services.
I agree with your part that the vulnerable individuals are at higher risk of abuse mainly because abusers mainly target these particular individuals because they may have dementia or other underlying illness that prevents them from speaking up and reporting the issue themselves. We as nurses indeed need to be very mindful of this fact and fully assess our patients for signs and symptoms of abuse as you mentioned in your post.
Yeah I agree with you that anyone can be a victim of abuse. Statistics have shown that the female folks have a higher rate of domestic violence and sexual abuse although some men have been seem to have experienced domestic violence. Like you stated, those more vulnerable for abuse such as people with dementia and learning disabilities. This sometimes occurs as a result of burn out from thier care givers and significant others. As nurses we should learn ways to deal with this group of people to prevent abuse on them
Domestic violence is not always easily detected. This is because abuse within families is often concealed by the abuser. Registered Nurses are mandated reporters. This means that the nurse must report the suspected abuse to APS (Adult Protective Services) or CPS (Child Protective Services). (Rakovec-Felser, 2014.)
I work in an Emergency Department as a Complex Care Manager. I am often asked to consult with patients who mention domestic violence, child abuse, and/or elder abuse. Some patients or their Caregivers are ready to share this information with the nursing staff. We have a specific ER Triage question which asks the patient if they currently feel safe at home. This question can help a victim of violence to have an opportunity to speak openly with the nurse about the things that they are experiencing.
Domestic violence can be quite complex. Beyond bruises, this type of abuse has physical, emotional, mental, and even spiritual components. A Provider might suspect domestic violence when a patient has had multiple injuries without plausible rationale. Multiple ER visits can also provide a clue. Patients often invent a “cover story” and things do not always seem to add up. Another interesting factor is being new to the area, with a recent and unexpected move, with no connection to or knowledge of, resources. The patient appears to be a refugee, because they truly are one.
Child abuse is suspected when a child has non-accidental trauma, or unexplained marks on the skin. Child abuse can also take many forms. In addition to physical injuries, children can also be chemically restrained by parents who are not interested in engaging in parent training. Again, the presentation of these children can be quite concealed and convoluted, because most abusers have a degree of understanding that they can be prosecuted for child abuse. One of the most disturbing situations is found when children are not fed a nutritious diet and therefore, have failure to thrive. These children are literally starving in this country of wealth and abundance. (Towler, et al, 2020.)
The most common type of elder abuse that I witness is financial exploitation. Adult children live with patients and expect them to pay all of the expenses while they refuse to work or refuse to pay for items that the elderly patient needs to survive, such as food and clothing. Social security checks can be diverted away from patients. Financial exploitation is one of the most difficult forms of abuse to prosecute, even though it is very common. We also see neglect of personal care and nutrition, which causes adult failure to thrive.
It is important for the nurse to be aware of the unspoken and subtle signs of abuse. Does the abuser allow the patient to speak for themselves, or do they try to speak for them? Does the patient appear withdrawn or afraid? Is the patient trying to give you a subtle sign of abuse or pass a note to you? It is so important for nurses to remain fully awake and aware of the unspoken in every patient care environment. This is because lives are truly depending on us for help. Sometimes the nurse is the only one who can help a patient to take back their Voice and speak up. Sometimes the nurse becomes the Advocate and Voice for the patient.
Rakovec-Felser Z. (2014). Domestic Violence and Abuse in Intimate Relationship from Public Health Perspective. Health psychology research, 2(3), 1821. https://doi.org/10.4081/hpr.2014.1821
Towler, A., Eivers, A., & Frey, R. (2020). Warning Signs of Partner Abuse in Intimate Relationships: Gender Differences in Young Adults’ Perceptions of Seriousness. Journal of Interpersonal Violence, 35(7–8), 1779–1802. https://doi.org/10.1177/0886260517696869
“Family and domestic violence including child abuse, intimate partner abuse, and elder abuse is a common problem in the United States. Family and domestic health violence are estimated to affect 10 million people in the United States every year. It is a national public health problem, and virtually all healthcare professionals will at some point evaluate or treat a patient who is a victim of some form of domestic or family violence.” (Huecker, et al., 2022, p.1) It is extremely important that nurses and healthcare providers are educated on the signs of domestic violence.
Huecker, M. R., King, K. C., Jordan, G. A., & Smock, W. (2022, January). Domestic violence. National Center for Biotechnology Information. Retrieved October 27, 2022, from https://pubmed.ncbi.nlm.nih.gov/29763066/
Some warning signs of physical abuse include:
Bruising, welts or burns that cannot be sufficiently explained, particularly bruises on the face, lips and mouth of infants or on several surface planes at the same time
Unusual bruising patterns that reflect the shape of the instrument used to cause injury (e.g., belt, wire hanger, hairbrush, hand, human bite marks)
Clusters of bruises, welts or burns, indicating repeated contact with a hand or instrument
We should always be attentive and on the look out for any type of abuse and report it immediately.
Your post is very well written. I think it is so sad that people steal from elderly financially. What is really sad it is usually the own family member or a close friend. The government provides help to them and sadly its not enough. Its very important to be able to trust whoever taking care of them. They already stress about their health I am sure.
Domestic violence is beyond physical injuries and its a complex situation. So many people are going through various forms of abuse but it doesn’t get to be reported. Example is sexual abuse among spouses. So many people experience sexual abuse in thier marriage and its not reported because the society sees it as the right of the partner to have sexual satisfaction from the spouses without taking into consideration the consent of the other spouse. When a spouse have sex with the other without the partners consent then it’s an abuse
Domestic violence, child abuse, and elder abuse are critical and prevalent issues in society today. According to Herrenkohl et al. (2022), millions of Americans are affected each year by these forms of abuse. Many warning signs may lead a provider to suspect that abuse is taking place within a family. For example, if a patient has bruises or injuries inconsistent with their explanation, this may be a sign of abuse. Other warning signs may include changes in behavior, such as becoming withdrawn or agitated, or changes in appearance, such as wearing long-sleeved shirts in summer to cover up bruises. They can all be suspected when there is a pattern of one family member being controlling, aggressive, or violent toward another family member. It can include physical violence, sexual violence, emotional abuse, and financial abuse.
If a provider suspects that abuse is occurring, it is important to report it immediately to the relevant authorities. In many states, healthcare providers are required by law to register suspected cases of abuse to the appropriate authorities. In other cases, the provider may make a voluntary report. The provider should also contact the police, local child protective services, or adult protective services, if applicable. When making a report, the provider should give as much information as possible, including the patient’s name, address, and other relevant details. The provider should also describe the nature of the suspected abuse, such as the type of injuries observed and any other suspicious circumstances. After a report is made, the authorities will investigate the abuse allegations and take appropriate action (Wißmann et al., 2019). It may include removing the victim from home, filing for a restraining order, or pressing criminal charges. Domestic violence, child abuse, and elder abuse are serious issues that require prompt attention. By being aware of the warning signs and knowing how to report suspected cases of abuse, healthcare providers can play a vital role in protecting the victims and bringing the abusers to justice.
Herrenkohl, T. I., Fedina, L., Roberto, K. A., Raquet, K. L., Hu, R. X., Rousson, A. N., & Mason, W. A. (2022). Child maltreatment, youth violence, intimate partner violence, and elder mistreatment: A review and theoretical analysis of research on violence across the life course. Trauma, Violence, & Abuse, 23(1), 314-328.https://doi.org/10.1177/1524838020939119
Wißmann, H., Peters, M., & Müller, S. (2019). Physical or psychological child abuse and neglect: Experiences, reporting behavior and positions toward mandatory reporting of pediatricians in Berlin, Germany. Child Abuse & Neglect, 98, 104165. https://doi.org/10.1016/j.chiabu.2019.104165
It is imperative that nurses report any signs of domestic violence that they may assess. “Like all healthcare professionals, every nurse bears the ethical and legal responsibility of following regulations as mandated reporters in their state. What nurses are required to report — and the legal forms — also vary by state.” (Carlson, 2022, p.1) It is the nurse’s ethical duty to ensure that their patients are not harmed or put in situations that may cause them harm.
Carlson, K. (2022, August 2). Understanding a nurse’s role as a mandated reporter. NurseJournal. Retrieved October 29, 2022, from https://nursejournal.org/resources/understanding-nurses-role-as-a-mandated-reporter/
It’s very important to be careful and act quickly when one notices any type of sign of abuse. If you feel someone you know is showing signs of being abused, talk to them to see if you can help. If they’re being abused, they may not want to talk about it straight away, especially if they’ve become used to making excuses for their injuries or changes in personality. It’s imperative that we are proactive because we never know whose life we could be saving.
Signs and symptoms of abuse vary and depend on the type of abuse. Some signs and symptoms of abuse are seen, and some are observed. Still others are expressed during interactions with the victim and family members. Common signs and symptoms of abuse include unexplained bruises, burns, or broken bones; injuries that don’t match the explanation given, sexually inappropriate behavior, social withdrawal, depression, decreased school performance, poor growth and hygiene, hoarding or stealing food, and lack of appropriate medical, dental or psychological care (Mayo Clinic, n.d.). Other common signs and symptoms include frequent headaches, chronic pain, insomnia, gastrointestinal problems, eating disorders, and suicide attempts (Bosch et al., 2015). Behavior of family members also alert health care providers of possible child abuse, intimate partner violence, or elder abuse. These could include blaming the child, elder, or partner for problems, consistently criticizing or calling the victim negative names (e.g., stupid, worthless, or evil), severely limiting contact with others, and demanding attention from the victim (Mayo Clinic, n.d.). Any combination of these signs and symptoms should prompt the nurse or health care provider to investigate the situation further.
I currently work in an assisted living facility. Elder abuse may be physical, sexual, financial abuse or neglect. If any of these are suspected, the staff person would fill out an incident report. This would then trigger notification by nursing staff and administration to the Department of Health and Human Services. They would decide if local authorities needed to be involved. The Wellness Director or director of nursing would cooperate with DHS to conduct an investigation. After that, DHS would then consider the documentation and decide what course of action is needed. Sometimes the police department is involved early to protect the client/victim and assist with the investigation. Not all investigations lead to prosecution but do protect the client/victim involved.
Bosch, J., Weaver, T.L., Arnold, L.D., Clark, E.M. (2015). The impact of intimate partner violence on women’s physical health: Findings from the Missouri behavioral risk factor surveillance system. Journal of Interpersonal Violence, 32(22). https://doi-org.lopes.idm.oclc.org/10.1177/0886260515599162
Mayo Clinic. (n.d.). Child abuse. https://www.mayoclinic.org/diseases-conditions/child-abuse/symptoms-causes/syc-20370864
Thousands of seniors are abused, neglected, and exploited each year, but very few come forward. They are more vulnerable than most, and at a time in their lives when they should be treated with respect and kindness, they are instead subjected to atrocities that no human being should experience. Grossly underreported or ignored by facilities more interested in profits than providing proper care, nursing home abuse is a growing problem in the United States.
The 7 types of elder abuse are:
2. Physical abuse
3. Sexual abuse
5. Emotional or psychological abuse
6. Financial abuse
All types of elder abuse can lead to devastating consequences, including physical and/or emotional harm and even death.
Per the California BRN: “Registered nurses are among the health practitioners who must report known or observed instances of abuse to the appropriate authorities. This mandate applies to those situations that occur in the RN’s professional capacity or within the scope of employment. Registered nurses must also be aware that failure to report as required is also considered unprofessional conduct and can result in disciplinary actions against the RN’s license by the BRN.” I am sure it is the same in each state that we are mandated reporters as it is our professional duty to protect our patients and their families. Though our direct reporting may vary from state to state I am sure it is similar.
Abuse and domestic violence is a common problem in the United States. As a nurse, it is our duty to report any suspected abuse to the proper authorities. Domestic violence is an abusive behavior used by one partner in a relationship to gain or maintain control and power over another. Domestic abuse can be physical, psychological, or sexual. Domestic abuse abusers are possessive, suspicious, and paranoid over controlling their partner. Domestic violence abusers typically consume high amount of alcohol and illicit drugs. According to The Federal Child Abuse Prevention and Treatment Act (n.d.), child abuse and neglect is an act on part of a parent or caregiver which results in physical or emotional harm, sexual abuse or exploitation, or death to a person who is younger than age 18. Child abuse victims may look malnourished and unkempt. Children that were abused may be withdrawn, shy, or poor communication skills when questioned. Common injuries in child abuse victims are bruises and fractures in the head, neck, or face area. While elder abuse is an act or failure to act that causes, or creates harm to an older adult (CDC, n.d.). Elder abuse victims appear dirty, untidy, and may seem depressed or withdrawn, and has unexplained bruises, burns or scars (National Institute on Aging, n.d.).
At my institution, when abuse is known or observed, it is our duty to report it to the unit supervisor. A telephone report shall be made immediately to the local law enforcement agency and a written report shall be made within two working days. All health care professionals are required to report suspected abuse or neglect as mandated reporters.
Centers for Disease Control and Prevention. (n.d.). Fast facts: preventing elder abuse. https://www.cdc.gov/violenceprevention/elderabuse/fastfact.html
Child Welfare Information Gateway. (n.d.). Definitions of child abuse & neglect. https://www.childwelfare.gov/topics/can/defining/
National Institute on Aging. (n.d.). Spotting the signs of elder abuse. https://www.nia.nih.gov/health/infographics/spotting-signs-elder-abuse
Family and domestic violence (including child abuse, intimate partner abuse, and elder abuse is a common problem in the United States and Florida… and it is a national public health problem (Houseman, 2022). Domestic violence is any assault, aggravated assault, battery, aggravated battery, sexual assault, sexual battery, stalking, aggravated stalking, kidnapping, false imprisonment, or any criminal offence resulting in physical injury or death of one family or household member by another family or household member. Abuse could be physical, economic, emotional or psychological. It affects the victims and their families, and the community. Some domestic violence is difficult to identify and nurses should be look-out and know the signs to report.
Some of the signs that victims may suffer are emotional, physical, or psychological in nature. Nurses should look for signs of physical abuse like bruises, sprains, blue circle around the eyes and ask how such injuries were sustained. Identify any defensive behaviors especially when a patient is asked about her relationship with their partners or when asked questions about the injury they sustained. For child abuse, look for physical injuries in their body that does not match the explanation given by their care takers. Injuries like bruises, broken bones, burns, and injuries not common for their age group. Look for signs of poor personal cleanliness, poor growth, depression, anxiety, anger. For signs of elder abuse, look for physical signs like bruises in different stages, lacerations broken glasses, dirty look with body odor, malnutrition. Elder abuse is so inhumane. The Adult Protective Services (APS) provides for the “reporting of a reasonable suspicion of abuse, neglect, or exploitation of a vulnerable adult, not necessarily based on eyewitness, but also based on any reasonable suspicion” (Elder Abuse alliance, 2022).
No one deserves to be abused. The hospital I work mandates that anyone who knows, or has reasonable cause to suspect, that anyone is abused or neglected, shall report such knowledge or suspicion and order for social work consult. All health care workers are required to report anyone with certain injuries that is suspected to be caused by violence. Nurses must document any history or physical examination findings of trauma and report to the nurse administrator in charge, report to the doctor, and order a social worker to evaluate the patients. The social worker will see the patient and follow-up by calling the domestic violence hotline or the appropriate agency. Nurses must take a two hour CEU on domestic violence at every third Florida nursing license renewal.
Elder Abuse Alliance, (2022). Indicators of abuse, Neglect, or Exploitation. https://www.elderabusealliance.org/resources/indicators-of-abuse/
Houseman, B., & Semien, G. (2022). Florida Domestic Violence. National Library of Medicine. https://www.ncbi.nlm.nih.gov/books/NBK493194/#article-40660.s1
In California, registered nurses’ failure to report knowledge of suspected abuse can result in disciplinary actions by the California Board of Registered Nursing. According to the Penal Code 11160, health care professionals who has knowledge or suspect abuse must make a report via telephone immediately and must complete a written report within two working business days to the local law enforcement authorities (State of California Department of Consumer Affairs, n.d.). If a suspected abuse occurred in a long-term care facility, a report may be made to the local ombudsman. The local ombudsman then report the suspected abuse ot the State Department of Public Health and the Bureau of Medi-Cal Fraud and Elder Abuse.
State of California Department of Consumer Affairs. (n.d.). Abuse reporting requirements. https://www.rn.ca.gov/pdfs/regulations/npr-i-23.pdf
See Also: NRS 429 Topic 4 DQ 2