Elder Abuse in Healthcare Settings

Assault

• Assault is an intentional act that creates a fear of imminent harm in another person.
• Aggravated assault involves a weapon.
• Extreme forms of assault may result in homicide.

Types of Abuse

• Intimate Partner Abuse: Includes spouse abuse, domestic violence, battering, husband/wife battering.
• Child Abuse: Includes physical, emotional, sexual, and neglect.
• Elder Abuse: Includes physical, financial, psychological/verbal, and neglect.
• Sexual Assault: Includes rape, statutory rape, and marital rape.

Intimate Partner Violence (IPV)

• The CDC reports that 1 in 5 women and 1 in 7 men have been victims of IPV.

Profile of the Victim

• May rationalize the abuse.
• May fear leaving due to threats.
• May view relationships as male-dominant.
• May be isolated from friends and family.
• May experience feelings of inadequacy and self-blame.
• May act in ways to avoid provoking their partner.
• May experience feelings of powerlessness.
• May engage in ETOH/drug use.
• Often experiences depression and suicidal thoughts.
• May experience anxiety and nightmares.

Profile of the Abuser

• Often was abused as a child.
• May have low self-esteem.
• May be extremely jealous and possessive.
• May be socially isolated.
• May have poor impulse control.
• May have poor coping mechanisms.
• May abuse drugs or ETOH.
• May be rigid and obsessive about maintaining control.
• May be narcissistic.

Cycle of Battering

• Tension-Building Phase: May last weeks, months, or years. Minor battering may occur. Jealousy and possessiveness may increase.
• Acute Battering Phase: The most violent phase. The abuser loses control. May last up to 24 hours.
• Honeymoon Phase: The batterer is contrite and loving. The victim may want to believe in their partner.

Physical Signs of Battered Women

• May have injuries on the head, neck, and shoulders.
• May have black eyes.
• May have injuries during pregnancy.
• May have sprains, dislocations, or broken bones.
• May have object patterns left on their bodies.
• May have repeated ER/healthcare facility visits.
• May have multiple injuries in various stages of healing.
• May have Traumatic Brain Injury.

Rape-Trauma Syndrome

• A syndrome that presents a range of emotional, psychological, and physical reactions to rape.

Rape-Trauma Syndrome: Major Symptoms

• Re-experiencing the trauma.
• Social withdrawal.
• Avoidance of behaviors and actions.
• Increased physiological arousal characteristics.

Rape-Trauma Syndrome: Phases

• Acute Phase: Occurs within hours of the rape:
  • Expressed Response: May include crying, sobbing, restlessness, tension.
  • Controlled Response: May include calmness, a composed demeanor, and a subdued affect.
• Outward Adjustment Phase: The victim tries to resume normal life, but may still be experiencing emotional and psychological distress.
• Underground Phase: The victim may suppress their emotions, but may still be experiencing physical symptoms like nightmares and flashbacks.
• Reorganization Phase: The victim begins to cope with the trauma and rebuild their lives.
• Renormalization Phase: The victim has integrated the trauma and developed coping mechanisms.

Nursing Diagnoses for Sexual Assault Victims

• Powerlessness.
• Risk for delayed development.
• Rape-trauma syndrome.
• Ineffective coping.
• Interrupted family processes.
• Hopelessness.
• Risk for self-abuse.

Nursing Care for Sexual Assault Victims

• Provide privacy.
• Create a non-judgmental relationship.
• Allow the patient to have a sense of control.

Trauma-Informed Care

• A foundational approach to treatment for survivors of abuse or neglect.

Nursing Diagnoses for Abusers

• Ineffective individual coping.
• Knowledge deficit.
• Noncompliance.
• Altered role performance.
• Self-esteem disturbance.
• Impaired social interaction.
• Risk for violence.
• Spiritual Distress.

Planning for Victims and Abusers

• Victims may strive to maintain a safe home environment, receive treatment for injuries, and remain free from violence.
• Families may seek assistance and follow through with referrals.
• Abusers may establish and maintain impulse control, practice coping strategies, cooperate with recommended or court-ordered treatment programs, and refrain from violence against others.

Implementation of Interventions

• Separate the victim from the perpetrator.
• Help the patient develop an escape plan.
• Report to law enforcement as required.
• Follow guidelines for collecting and preserving evidence.
• Ensure sensitive and compassionate care.
• Collaborate with the team for interagency referrals.
• Assist with locating therapy and other resources.

Evaluation of Interventions

• Monitor safety levels for the victim.
• Assess for signs of the victim demonstrating self-empowerment and improved self-esteem.
• Assess the victim's utilization of community resources to improve coping.
• Evaluate whether the abuser has accepted responsibility for their violent behavior.
• Assess the abuser's success in refraining from violence against others.

Recognizing Abuse in Hospital Settings

• Strongest indicator of abuse: Unexplained injuries or inconsistent explanations for wounds, particularly if the patient is unable to communicate effectively.
• Nurse's first action: Immediate reporting of suspicions to the appropriate authorities.
• Challenge in recognizing neglect: Determining whether the patient's condition is due to involuntary neglect or underlying health conditions.
• Legal obligation: Mandatory reporting of suspected abuse or neglect to the proper authorities.
• Barrier to reporting abuse: Fear of retaliation from the abuser or the patient.

Factors Influencing Aggression

• Modeling: Observing aggressive behavior in others, particularly significant figures, contributes to its development.
• Intentional act of assault: Purposeful infliction of physical harm or threat of immediate harm.
• Neurophysiological risk factor for aggression: Dysfunction in the prefrontal cortex, responsible for impulse control.
• Socioeconomic factor influencing violence: Poverty and social deprivation, creating an environment conducive to violence.
• Psychodynamic theory of aggression: Frustration and unmet needs, provoking aggressive impulses.

Violence and Peer Influence

• Peer influence in high-risk groups: Peer pressure and group dynamics can encourage and escalate violence.
• Least likely influencer of violence: Individual's religious beliefs, while playing a role, are not universally predictive.
• Neurobiological theory of aggression: Imbalances in neurotransmitters like serotonin and dopamine can contribute to aggression.

Abuse Dynamics

• Common characteristic shared by both victims and victimizers: Power imbalances and a history of trauma or adverse experiences.
• Psychological effects of abuse on victims: Depression, anxiety, low self-esteem, and post-traumatic stress disorder (PTSD).
• Nursing intervention goal: Ensuring safety and providing support for the victim's emotional and physical well-being, empowering them to break free from the abusive cycle.

Resources and Ethical Considerations

• Resource for domestic violence victims: National Domestic Violence Hotline.
• Ethical dilemma in nursing advocacy: Balancing patient confidentiality with the need to report abuse and protect potential victims.
• Least common sign of intimate partner abuse: The victim's family members disbelieving the victim's claims, while possible, is not a definitive indicator.

Intervention and Abuse Types

• Effective evaluation strategy for interventions: Collecting data on outcomes, such as decreased severity of abuse or improved victim safety, to assess impact.
• Abuse primarily affecting vulnerable adults: Neglect, leading to physical deterioration and emotional distress.

This quiz explores critical aspects of recognizing and reporting elder abuse in hospitals. It highlights indicators of abuse, challenges in identifying neglect, and the legal responsibilities of healthcare workers. Test your knowledge on this important topic affecting patient safety.