Module 5 Nurse Responses to Elder Mistreatment An IAFN Education Course

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Module 5Nurse Responses to Elder
MistreatmentAn IAFN Education Course

• Ethical Issues in
• in Elder Mistreatment Cases

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Patient-Centered Care

• Patients play an integral role in clinical
  decision-making process
• Customize nursing responses in each case based on
  patient needs and concerns

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Learning Objectives

• By the end of this module, participants will be
  able to
• Discuss key ethical issues in nursing responses
  to elder mistreatment (EM)
• Patient-centered care
• Timeliness of response
• Compassionate care
• Safety planning
• Patient self-determination
• Informed consent and confidentiality
• Describe how to facilitate safety planning

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Case Mrs. Martin

• Issues/actions needed in case related to
• Suspected mistreatment and timeliness of
  response?
• Compassionate patient care?
• Patient safety?
• Patient self-determination, informed consent and
  confidentiality?
• Nursing responses adapted to patients needs and
  circumstances?
• Nursing skills to address presenting medical
  conditions?

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Case Mrs. Martin (cont.)

• How would changes to scenario impact needed
  actions?
• The patient has no delirium
• The patient is younger and less frail
• There are indicators that the patient is also
  being sexually abused
• A husband rather than son is involved

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Focus on Patient

• Patients are central participants in EM cases

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Timeliness

• Regardless of practice setting, suspicions of EM
  must be acted on in timely fashion

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Compassion

• Being compassionate with patients can make a
  critical difference in outcomes of nursing
  response in these cases
• Help older patients be as comfortable as possible

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Patient Autonomy

• Respect patients right to self-determination
  related to medical care and reporting, to extent
  possible
• Seek informed consent for assessment, treatment,
  evidence collection and other interventions
• Follow related practice setting policies and
  procedures

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Patient Lacks Decision-Making Capacity?

• Follow practice policy and procedures
• When patient is temporarily incapacitated, it may
  be proper to render usual nursing care unless
  there is evidence that the person would not want
  it
• In other situations, there is a legal
  determination that the person is incompetent and
  a guardian is appointed
• Last two bullets S. Westrick, S. Westrick
  Killion K. Dempski, Essentials of nursing law
  and ethics, 2008

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Challenges Related to Decision-Making

• Talking with patients in private to hear their
  account of what happened/assess decision-making
  capacity
• Locating guardian/surrogate to act on patients
  behalf

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Challenges Decision-Making (cont.)

• When no prior determination of capacity or legal
  guardian assigned, legal process takes
  significant time
• Concern that guardian is not making decisions in
  best interest of patient
• Suspect guardian of mistreating patient

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Confidentiality

• Maintain confidentiality of medical records by
  not releasing information about patient unless
  required to do so (e.g., mandatory reporting) or
  patient/legal guardian gives permission

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Additional Ethical Issues

• Ask patient questions and look and listen to
  understand unique needs and circumstances and
  then tailor care
• Develop geriatrics expertise
• Know community resources
• Actively participate in multidisciplinary team
  responses to elder mistreatment

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Safety Planning

• A process where helper and victim together create
  plan to enhance safety
• National Clearinghouse on Abuse in Later Life,
  Anticipate Identifying victim strengths and
  planning for safety concerns , 2003

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Safety Plan Mrs. Kennedy

• Prevention strategies?
• Protection strategies?
• Notification strategies?
• Referrals/services?
• Emotional support strategies?

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Safety Planning

• Begins with first encounter with patient through
  discharge/care transition
• Prompt safety planning questions at appropriate
  times
• Follow agency policy if there is concern about
  safety while patient is in your facility

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Patient-Driven Planning

• Patients should develop their own safety plans,
  to extent possible
• A process, not a one-time activity
• Nurses should be willing to help patients with
  planning and/or connect them with professionals
  with expertise in safety planning process

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Safety Planning Steps

• Build rapport and listen to patients
• Help patients identify fears, obstacles, threats,
  barriers to safety, and effective past safety
  strategies
• Ask what patients want to do to be safer and why
• Together, think creatively about a variety of
  options and ideas, keeping in mind that patients
  need to consider their safety in numerous
  situations
• Build a plan that is patient-centered, regardless
  of circumstances
• B. Brandl, C. Bitondo Dyer, C. Heisler, J.
  Marlatt Otto, L. Stiegel R. Thomas, Elder abuse
  detection and intervention A collaborative
  approach, 2007 National Clearinghouse on Abuse
  in Later Life, Anticipate, 2003 and National
  Clearinghouse on Abuse in Later Life, Interactive
  training exercises on domestic abuse in later
  life, 2003

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Closing Assessment

• What have you learned from this module that you
  can apply to your practice setting?