Download Recognizing Patient Abuse and Neglect

Recognizing Patient
Abuse and Neglect
Staff education for child, adult, and elder abuse is a Joint Commission
Requirement for all staff on hire and annually. Lake Regional Health
System ensures patients are not subjected to any form of abuse,
neglect, harassment, exploitation, involuntary seclusion, or
misappropriation of property. Further, in the state of Missouri,
mandatory reporting of actual or suspected abuse is required of anyone
who provides any type of physical or mental health care.
Staff participates in the prevention of abuse through assessment, care
planning, and monitoring patients with needs and behaviors that might
lead to conflict or abuse.
Staff is trained to identify any inappropriate behaviors by anyone
interacting with patients to include staff, students, volunteers, other
patients, visitors, or family members.
If a potential victim is identified, observations are to be communicated
to a physician, nurse, or Social Services.
Child Abuse and Neglect
Each year, approximately 3 million children are reported abused or neglected in the U.S.;
3 children die each day from abuse and neglect. Physical abuse includes:
Bruises, welts, or cuts; may be present in various stages of healing
Head injuries
Poisoning: unexplained, repeated poisoning, especially drug overdose; unexplained
sudden illness, such as hypoglycemia from insulin administration.
Fractures, sprains: skull, nose or facial structures. Injury may denote some type of
abuse, such as spiral fracture or dislocation from twisting of an extremity, multiple new
or old fractures in various stages of healing.
Burns or scalds; on soles of feet, palms of hands, or buttocks.
Internal injuries: Unusual symptoms such as abdominal pain , swelling, and vomiting
from punching
Electrical shock
Death
Although not recommended, spanking is not abuse. However, a spanking which leaves
marks or bruises on a chills might be abuse. Bruises anywhere on a baby are serious.
Behavioral Indicators of Child
Abuse
BEHAVIOR INDICATORS:
Wary of physical contact with adults
Apparent fear of parents or going home
Lying very still while surveying the environment
Inappropriate reaction to the injury, such as failure to cry from pain.
Lack of reaction to frightening events
Apprehensive when hearing other children cry
Indiscriminate friendliness and displays of affection
Superficial relationships
Acting-out behavior, such as aggression, to seek attention
Withdrawal behavior
Other Types of Abuse
Drug affected babies:
Methamphetamine use during pregnancy is the most prevalent and
dangerous drug related to child abuse and neglect. Other
pregnancy- abused drugs include alcohol, cocaine, marijuana,
heroin and other narcotics, and prescription drugs.
Shaken baby syndrome:
This syndrome describes a head injury caused by holding a child by
the arms or trunk and shaking the child severely and repeatedly. The
most common injuries are blood clots around the brain,
hemorrhages of the retina, fractures in the growing portion of the
bone, injury to the brain, bruises on the extremities, or bruising and
injury of the chest.
Other Types of Abuse
Sexual abuse:
Physical Indicators:
Bleeding, bruising, or lacerations of external genitalia, anus, mouth, or throat
Torn, stained, or bloody underclothing
Pain on urination, or pain, swelling, and itching of the external genitalia
Vaginal or penile discharge
Venereal disease in young child
Pregnancy in young adolescent
Behavioral indicators:
Withdrawn
Preoccupied with fantasies, especially in play
Demonstrates infantile behavior
Poor relationships with peers
Bizarre, sophisticated, or unusual sexual knowledge or behavior.
Seductive behavior
Sudden changes, such as nightmares, anxiety, loss or gain of weight, clinging
behavior, regression
In incestuous relationships: excessive anger at mother for not protecting daughter
Other Types of Abuse
Emotional abuse and neglect:
Neglect is the most common form of abuse seen in children
and may have long-term effects. Neglect is failure to
provide adequate parenting, love, guidance, food, clothing,
shelter, supervision or medical care. Neglect includes
exposing a child to illegal activities such as:
Encouraging a child to participate in drug sales or theft
Exposing a child to parental drug abuse
Encouraging a child to use drugs or alcohol
Other Types of Abuse
Medical neglect is when a parent or
caregiver does not provide adequate
medical, dental, or mental health care
services. Religious beliefs about medical
care are generally honored, except when a
child’s life is in danger.
Other Types of Abuse
Failure to thrive:
Failure to thrive is a syndrome characterized by chronic malnutrition
of an infant or young child. Growth is delayed. Mental retardation,
learning difficulties, and delay in language skills are some of the longterm consequences. Characteristics include:
A weak, pale, listless appearance; loss of body fat
Staring vacantly, instead of smiling and maintaining eye contact
Sleeping in a curled up, fetal position with fists tightly closed
Rocking back and forth in bed as he lies on his back or banging his
head repeatedly against his crib
Obvious delays in developmental and motor function.
Other Types of Abuse
Mental Injury includes:
Rejecting, abandoning, or extensive ridiculing of a child
Terrorizing by threatening extreme punishment against
the child or his pets or possessions
Ignoring a child over time by refusing to talk or show
interest in her daily activities. This must be so extreme
there is no traditional parent-child relationship between
the two.
Corrupting a child by teaching inappropriate behavior
such as aggression, sexuality, or substance abuse.
Exposing a child to violence
Indicators
Behavioral indicators of emotional and mental abuse
include:
Unusual fearfulness; suicide attempts
Antisocial behavior, such as destructiveness, stealing,
cruelty
Extremes of behavior, such as over compliant and
passive or aggressive and demanding
Self-stimulatory behavior, such as finger-sucking or
rocking
Absenteeism from school (in older child)
Drug or alcohol addiction
Vandalism or shoplifting.
ADULT ABUSE VICTIM/ DOMESTIC VIOLENCE/
INTIMATE PARTNER VIOLENCE.
Domestic Violence is the willful intimidation,
physical assault, battery, sexual assault, and/or
other abusive behavior perpetrated by an intimate
partner against another. Domestic Violence results
in physical injury, psychological trauma, and
sometimes death. Statistically, one in every four
women will experience domestic violence in her
lifetime; 85% of domestic violence victims are
women. Almost one-third of female homicide
victims that are reported in police records are killed
by an intimate partner and intimate partner
violence results in more than 18.5 million mental
health visits annually.
ADULT ABUSE VICTIM/ DOMESTIC VIOLENCE/
INTIMATE PARTNER VIOLENCE.
Signs suggestive of adult violence/abuse:
The injury does not match the described mechanism or history
Unusual patient behavior, including distant or vague responses to questions, jumpiness when in
the presence of a nurse, poor eye contact, or flinching in the presence of spouse or significant
other
Multiple injuries or injuries in different stages of healing
Patient complains of seemingly insignificant trauma for an emergency setting
Substantial time delay between time of injury and time treatment is sought
History of abuse as a child
Jealous or chemical abusing significant other
Vague references to “having had a bad time lately” or other comments that could be the patient’s
attempt to encourage further questions
Multiple somatic complaints
Pregnancy (domestic violence and battering often increase during pregnancy)
Records showing past Emergency Department visits for various physical problems or chronic
somatic complaints
Significant other is very attentive, seems reluctant to leave, or answers questions for patient
Clothing may be torn, marked, or stained suggestive of physical abuse
Suicide attempts may suggest possible abuse; anxiety and depression are also suggestive
Elder Abuse
According to the National Center on Elder Abuse, elder
abuse refers to intentional or negligent acts by a caregiver
or “trusted” individual that causes (or potentially causes)
harm to a vulnerable elder. According to the best available
estimates, between 1 and 2 million Americans age 65 or
older have been injured, exploited, or otherwise mistreated
by someone on who they depended for care or protection.
It is estimated that for every one case of elder abuse,
neglect, exploitation, or self-neglect reported to authorities,
about five more go unreported.
Adult children are the most frequent abusers of the elderly;
other family members and spouses ranked the next most
likely abusers.
Elder Abuse
The most common categories of abuse are:
Neglect: Failure of a caregiver to meet the needs of an older adult who is unable to meet these
needs alone. It includes behaviors such as denial of food, water, medication, medical treatment,
therapy, nursing services, health aids, clothing, and visitors. Observable sins include malnutrition,
dehydration, poor hygiene, lack of medical care, insufficient clothing, over sedation.
Physical abuse; involves inflicting physical discomfort, pain or injury. It includes behaviors such as
slapping, hitting, punching, beating, burning, sexual assault, and rough handling. Observable
signs include: tufts of missing hair, broken bones that cannot be explained, bruises, burn marks,
rope burns, inappropriate use of medications to restrain.
Sexual abuse: non-consensual sexual contact of any kind. Observable signs include torn, stained,
or bloody underclothing; difficulty walking or sitting; bleeding in the genital area; thumb or
fingerprint bruising on the body.
Financial abuse and exploitation involves the misuse of money or property. Examples include
stealing money or possessions, forging a signature on pension checks or legal documents,
misusing power of attorney, and forcing or tricking an older adult into selling or giving away his or
her property.
Emotional or psychological abuse and neglect (including verbal abuse and threats). This type of
abuse diminishes the identity, dignity, and self-worth of the older person. Examples include name
calling, insulting, threatening, imitating, swearing, ignoring, isolating, excluding from meaningful
events, and deprivation of rights. Observable signs include fearful or anxious behavior around
certain individuals; unexplained desire not to visit or be visited by family or friends.
Abandonment
Self-neglect
Elder Abuse
Who is at risk for abuse, neglect, and exploitation?
Women and “older” elders (80 years old and older) are more likely to
be victimized, and mistreatment is most often perpetrated by the
victim’s own family members
The victim has dementia
The perpetrator and/or the victim has mental health or substance
abuse issues
Social Isolation
Poor physical health which increases vulnerability and thereby may
increase risk
Older adults who live with someone or in a care facility
If a potential abuse/neglect victim of any age is identified,
communicate your observations to a physician, nurse or Social
Services staff member.
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