Recognizing Patient Abuse and Neglect

1
Recognizing Patient Abuse and Neglect
2

• 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.

3
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.

4
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

5
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.

6
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

7
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

8
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 childs life is in danger.

9
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 long-term 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.

10
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

11
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.

12
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.

13
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
  patients 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

14
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.

15
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

16
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
  victims 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.

17
The End! Take the test and your done!

• Click on the black X in the upper right hand
  corner to close this presentation. Then, follow
  the instructions on the testing site to complete
  the test.