Being on the front lines of healthcare, nurses have unfortunately needed to report cases of abuse and neglect. As mandated, they are trained to identify signs and symptoms of abuse or neglect and are required by law to report their findings. Failure to do so may result in discipline by the board of nursing, discipline by their employer, and possible legal action taken against them.
- If a nurse suspects abuse or neglect, they should first report it to a physician, nurse practitioner, or physician assistant.
- Notifying a supervisor may also be required, depending on the workplace.
- If the victim is with a suspected abuser, the exam should take place without that person in the room.
- Nurses should provide a calm, comforting environment and approach the patient with care and concern.
A complete head-to-toe examination should take place, looking for physical signs of abuse. A chaperone or witness should be present if possible as well. Thorough documentation and description of exam findings, as well as patient statements, non-verbal behavior, and behavior/statements of the suspected abuser should also be included.
RELATED : What Are Some of the Challenges of Being a Substance Abuse Nurse? The nurse should notify law enforcement as soon as possible, while the victim is still in the care area. However, this depends on the victim and type of abuse. Adults who are alert and oriented and capable of their decision-making can choose not to report on their own and opt to leave.
Depending on the state, nurses may be required to report suspicious injuries to law enforcement whether or not the patient consents or wishes to press charges. Depending on the type of abuse, the nurse is required to call Adult Protective Services or Child Protective Services and follow it up with a written report.
- Contacting additional resources, such as social services, may also be a requirement (depending on the organization).
- RELATED : Abuse and Neglect: NCLEX-RN While not required by law, nurses should also offer to connect victims of abuse to counseling services.
- Many times, victims fall into a cycle of abuse which is difficult to escape.
Offering mental help to cope with abuse can help break the cycle. Nurses should be familiar with their state’s mandated reporter laws. Employers are typically clear with outlining requirements for their workers, but nurses have a responsibility to know what to do in case they care for a victim of abuse.
What does it mean to suspect abuse or neglect?
Suspected abuse or neglect means being based on reasonable cause to believe that a child may have been abused or neglected.
Which of the following are examples of abuse or neglect?
Leaving a child alone, leaving a child in a place that is not safe, lack of attention, not providing food, clothing, shelter for a child, not providing necessary medical attention for a child, not providing appropriate schooling, not providing protection from hazards.
What should a nurse do first when observing another nurse abusing a client?
I witnessed a nursing colleague hitting a client. I intervened and stopped the abuse. When I questioned my colleague, she told me she was tired and frustrated but it will never happen again. She then asked me not to tell our manager. What is my responsibility in this situation? – You are responsible for protecting the client by reporting the physical abuse to the appropriate authority in your organization.
Nurses protect clients from harm by ensuring abuse is prevented or stopped, and reported. If a nurse witnesses any member of the health care team abusing a client, then the nurse must intervene immediately and take action by reporting the event to the employer or authority responsible for the health care provider.
A nurse must also inform the client of their right to contact the police and CNO. For more information, see the Therapeutic Nurse-Client Relationship practice standard, the Preventing Abuse fact sheet, and CNO’s abuse prevention program, One is One Too Many,
What is 1 example of neglect?
Stay alert to the different types of abuse – The word abuse covers many different ways someone may harm a vulnerable adult. Physical abuse is intentional bodily injury. Some examples include slapping, pinching, choking, kicking, shoving, or inappropriately using drugs or physical restraints.
- Signs of physical abuse,
- Sexual abuse is nonconsensual sexual contact (any unwanted sexual contact).
- Examples include unwanted touching, rape, sodomy, coerced nudity, sexual explicit photographing.
- Signs of sexual abuse,
- Mental mistreatment or emotional abuse is deliberately causing mental or emotional pain.
Examples include intimidation, coercion, ridiculing, harassment, treating an adult like a child, isolating an adult from family, friends, or regular activity, use of silence to control behavior, and yelling or swearing which results in mental distress.
Signs of emotional abuse, Exploitation occurs when a vulnerable adult or his/her resources or income are illegally or improperly used for another person’s profit or gain. Examples include illegally withdrawing money out of another person’s account, forging checks, or stealing things out of the vulnerably adult’s house.
Signs of exploitation, Neglect occurs when a person, either through his/her action or inaction, deprives a vulnerable adult of the care necessary to maintain the vulnerable adult’s physical or mental health. Examples include not providing basic items such as food, water, clothing, a safe place to live, medicine, or health care.
Signs of neglect, Self-neglect occurs when a vulnerable adult fails to provide adequately for themselves and jeopardizes his/her well-being. Examples include a vulnerable adult living in hazardous, unsafe, or unsanitary living conditions or not having enough food or water. Signs of self-neglect, Abandonment occurs when a vulnerable adult is left without the ability to obtain necessary food, clothing, shelter or health care.
Examples include deserting a vulnerable adult in a public place or leaving a vulnerable adult at home without the means of getting basic life necessities. Signs of abandonment,
What are the indicators of neglect?
Signs of Sexual Abuse –
- Being withdrawn or isolated.
- Being worried about clothing being removed.
- Personality changes – for example becoming ‘clingy’ or insecure.
- Behaving in an overly affectionate way, or being knowledgeable in a sexual way that is inappropriate to the age of the child.
- Regressing to younger behaviour such as wetting themself, thumb sucking or bringing out discarded cuddly toys.
- Drawing pictures that are sexually explicit.
- Becoming over sensitive to criticism or trying to be ultra perfectly behaved.
- Eating disorders such as compulsive eating or loss of appetite.
- Losing the ability to concentrate.
- Being uneasy or frightened in someone’s company, or not wanting to be alone with them.
- Starting to have day/nightmares.
- Unexplained recurrent bruises, injuries, bald patches or burns.
- Can be aggressive or withdrawn.
- Inability or refusal to explain injuries, or making improbable excuses for them.
- Refusing to get undressed for swimming, gym lessons etc.
- Being afraid of medical examinations.
- Shying away from physical contact.
- Habitual running away.
- Tendency to be self-destructive.
- Confirmation that they are being punished excessively.
- Being frightened about a possible abuser being contacted.
- A fear of physical contact (such as shying away if you raise you arm or touch them).
- Sudden onset of speech disorders.
- Extremes of aggression or passivity.
- Constant self loathing (“I am ugly/stupid/useless/bad” etc.).
- Over-reaction to making mistakes.
- Very fearful of any new situations.
- Extreme lack of confidence.
- Self mutilation/harm.
- Onset of habits such as rocking back and forth, twisting hair, pinching themselves etc.
- Lack of (or slow) mental, emotional or physical development.
- Believing they deserve to be punished.
- Always hungry and/or looking for something to eat.
- Too thin.
- Constantly tired.
- Poor personal hygiene.
- Clothes dirty/in bad state of repair.
- Has untreated medical problems.
- Doesn’t have any friends.
- Appears not to relate to parent/guardian.
- Can be destructive/attention seeking.
: A quick guide to signs and symptoms of neglect and child abuse
Which observation should you report to the nurses?
What’s the legal responsibility to report observations and incidents to a licensed nurse? – A CNA/Nurse Aide is legally obligated to immediately report to a licensed nurse any observation or incident for which the facility or organization might be liable.
What are typical characteristics that the nurse would assess observe in a suspected abuser?
History and Physical – Child Abuse and Neglect History Depending on the age of the child, historical information is often primarily obtained from the caregiver and the comments provided by the patient (especially in older children and adolescents). Children who suffer from abuse or neglect may present with typical presenting complaints (i.e.
Vomiting). Therefore, for the provider who sees pediatric patients regularly, it is important to keep child abuse or neglect in the differential diagnosis during every visit to enhance the likelihood of recognition. The approach to history taking should be structured, systematic, with the flexibility to allow different lines of questions, and thus similar to how a provider obtains a routine history.
This will not only ensure rapport with the patient and the caregiver, but it enhances the ability of the provider to quickly investigate any historical and physical features that are concerning for child abuse or neglect. There are various historical features that should raise the suspicion for abuse.
- Lack of history of trauma in a pediatric patient with severe injuries
- History describing the mechanism of injury inconsistent with the child’s developmental level
- Unexplained delay in seeking care before presenting to a medical provider
- History describing injuries attributed to household pets or other young children
- The initial history is vague or changes among different caregiver accounts
- Significant changes in personality or sleeping/eating habits
Physical Examination The physical examination should be routine, systematic, and focus on findings that may indicate an underlying etiology of the child’s initial complaint, including the possibility of child abuse or neglect. This begins with the general appearance of the patient and how they interact with their caregiver.
- This may include but is not limited to lack of interaction between the patient and the caregiver (i.e.
- Patient not seeking comfort or caregiver not offering comfort), not appreciating the severity of the patient’s condition, assigning blame to the child for their injuries or illness, treating the patient differently than the other children in the room, and if the patient displays fear towards the caregiver present.
There are various presenting features that should raise the suspicion for abuse. These include: Physical Abuse
- Bruises in infants less than six months (infants not yet freely mobile), bruises situated away from bony prominences, and bruises with a unique shape (like the shape of an object) are highly suggestive of abuse
- Human bite marks
- Oral injuries (including frenulum tears, lip lacerations, tongue lacerations, fractures; especially in infants)
- Limping (an indication of the possibility of a fracture)
- Unexplained loss of a tooth
- Unexplained bruising on the abdomen
- Altered consciousness (possibly indicating head injury)
- Intentional burns (scalds from hot tap water, burns that resemble the shape of burning objects, cigarette burns)
- Nonspecific symptoms (abdominal pain, fecal incontinence, constipation)
- Genital bruising or bleeding
- Behavioral or personality changes
- Inappropriate behavior especially of the sexual nature (for example, an unusual interest in genitals of other children or even adults)
Emotional Abuse and Neglect
- Signs of malnutrition (child may refuse meals)
- The child may appear withdrawn with inadequate social interaction
- Developmental milestone delays (such as speech and motor delays)
Adult Abuse and Neglect History Depending on the patient’s underlying health condition, historical information may be obtained from the caregiver and the comments provided by the patient. If possible, it is best to solicit the history from the patient and the caregiver separately.
The approach to history taking should be structured, systematic, and flexible to allow different lines of questions, and thus similar to how a provider routinely obtains a history. This will not only ensure rapport with the patient and the caregiver, but it enhances the ability of the provider to quickly investigate any historical and physical features that are concerning for elder abuse or neglect.
There are various historical features that should raise the suspicion for abuse. These include:
- Mechanism of injury that is implausible based on the patient’s condition
- History is inconsistent, vague or different between the patient and caregiver
- Delay in seeking medical attention
- Past history of frequent injuries or unexplained visits to the emergency department
- Caregiver unable to give details regarding the patient’s medical history or the medications they are taking
- Caregiver answers questions for the patient
- The patient is reluctant to answer questions
Physical Examination The physical examination should be routine, systematic, and focus on findings that may indicate an underlying etiology of the patient’s reason for the visit. This begins with the general appearance of the patient and how they interact with their caregiver.
- Unexplained signs of injury: Bruises, burns, scald, fracture, signs of restraints on the hands and feet
- Bedsores (pressure ulcers)
- Signs and symptoms of dehydration, malnutrition, or unexplainable weight loss
- Emotionally withdrawn and showing signs of depression
- Refusal to take routine medications or drug overdose
- Evidence of trauma on a genitourinary exam or vaginal bleeding
What should be reported to the nurse?
What is Urgent Reporting? – definition Urgent reporting for the CNA includes any change in a patient’s or resident’s condition that might require evaluation or intervention. Examples are bleeding, pain, or injury. Restraints (ordered by a doctor) require reporting to the nurse.
What are three 3 indicators of neglect?
Emotional abuse – The following indicators may indicate emotional abuse:
avoiding home (particularly if the abuser is in the family home)running away or continually staying at friend’s housesfear of the dark, not wanting to go to bed, bedwetting or nightmareslying or stealinglack of trust in adultspoor self-image/self-esteem, poor academic performance, poor peer relationshipssecretive, demanding or disruptive behaviour.
What should you do if you suspect that a client has been abused?
What physicians can do individually – In Opinion 8.10, “Preventing, Identifying and Treating Violence and Abuse,” the Code explains that all patients may be at risk for interpersonal violence and abuse, which may adversely affect a patient’s health or ability to adhere to medical recommendations.
How to detect violence or abuse, including cultural variations in response to abuse. Community and health resources available to abused or vulnerable persons. Public health measures that are effective in preventing violence and abuse. Legal requirements for reporting violence or abuse.
Physicians also should:
Consider abuse as a possible factor in the presentation of medical complaints. Routinely inquire about physical, sexual and psychological abuse as part of the medical history. Not allow diagnosis or treatment to be influenced by misconceptions about abuse, including beliefs that abuse is rare, does not occur in “normal” families, is a private matter best resolved without outside interference, or is caused by victims’ own actions. Offer treatment for the immediate symptoms and sequelae of violence and abuse and provide ongoing care for patients to address long-term consequences that may arise from being exposed to violence and abuse. Discuss any suspicion of abuse sensitively with the patient, whether or not reporting is legally mandated, and direct the patient to appropriate community resources. Report suspected violence and abuse in keeping with applicable requirements.
Discover five ways physicians can identify and help victims of human trafficking, What to consider before reporting
How do people respond to abuse?
Victims of violence or sexual abuse may react in different ways. Sometimes the reaction comes immediately, and sometimes it comes much later. It’s perfectly normal to react emotionally and physically to a victim of violence and threats. People react to violence and threats in a variety of ways.
- Some people react immediately.
- For others, the reaction can take time, sometimes several years.
- You may be surprised by emotions that you weren’t prepared for and that you may not know how to handle.
- Reactions may also be different for people who’ve witnessed violence, or people who are concerned about their own or others’ safety.
If you’re worried about your own or your family’s reactions, remember it’s normal to react differently to difficult situations. Reactions to violence are individual, but some reactions are common to victims of violence, especially in cases of repeated violence.
- Many people feel sadness and shame and take the blame for what’s happened.
- They may also feel anger and resentment, or resignation and despair.
- Being exposed to violence and living under severe stress can lead to what’s known as PTSD, post-traumatic stress disorder.
- Violence can also cause a range of physical reactions such as headaches, stomach problems, sleeping problems, eating disorders and exhaustion.
Intellectual ability may be affected, and you may become confused and have problems with remembering things. Reactions in your relationship may include loss of trust, changes in sex drive or feelings of loneliness and alienation.
How to share information about suspicions or disclosures of abuse or neglect?
Case study: David – David is a 45-year-old man with learning disabilities. He lives in a housing association flat and has support from adult social services to manage his finances. The housing office has received complaints from the neighbours about noise from the flat.
The housing officer, Nimesh, visits David and notices that there are lots of empty alcohol containers lying around. He asks David about the cans and bottles and David says that he has friends who come round in the evening and drink in his flat. Nimesh also notices that there is graffiti on the wall in the living room.
He asks David about this and David says that his friend did it. Nimesh asks about the friends and learns that there are a number of much younger men who appear to have befriended David. Nimesh talks to David about the possible risks and explains that he may be being exploited.
He asks David if he can discuss his concerns with other safeguarding partners such as adult social care and the police. He explains that he wants to make sure that David is safe in his flat. David is insistent that he has the right to make friends and he does not want social services or the police informed.
Nimesh considers David’s mental capacity with regard to his decisions to:
- maintain relationships with the young men
- refuse to share information with the police or adult social care.
Nimesh considers whether David can:
- understand the risk of letting the young men drink in his flat and that the graffiti, cans and bottles suggest a lack of respect for him and his personal space
- retain that information long enough to be able to make the decisions to keep allowing the men into his flat or not to inform the police or adult social care
- weigh up the situation to enable him to make a decision about the possible risks
- communicate his decision about this circumstance and risk.
Nimesh is sure David has an impairment – his learning disability – and he is not sure that he can appreciate that he may be being exploited or understand the possible risks or consequences. He discusses this with his manager and they take the decision, in David’s best interests, to raise a safeguarding concern with adult social services.
- People with care and support needs may be unaware of the dangers of exploitation.
- ‘Mate crime’ is a term used to describe situations where a person is befriended because of the opportunities for exploitation.
- The Mental Capacity Act supports decision-making where someone may not understand the consequences of their actions or the actions of others.
What are the 4 R’s of safeguarding?
The 4Rs of Safeguarding Children is professional practice for how you can recognise, record, report and refer in the situation of child abuse. Our handy infographic details what these 4Rs are and what you need to do at each stage.
What does suspected abuse mean?
Suspected Abuse means reasonable cause to believe that abuse may have occurred.
What are signs of suspected abuse?
Indicators – The lists below contain common indicators of abuse or maltreatment. The lists are not all-inclusive, and some abused or maltreated children may not show any of these symptoms. Indicators of physical abuse can include the following:
Injuries to the eyes or both sides of the head or body (accidental injuries typically affect only one side of the body) Frequently appearing injuries such as bruises, cuts, and burns, especially if the child is unable to provide an adequate explanation of the cause. These may appear in distinctive patterns such as grab marks, human bite marks, cigarette burns or impressions of other instruments. Destructive, aggressive or disruptive behavior Passive, withdrawn or emotionless behavior Fear of going home or fear of parent(s)
Indicators of sexual abuse can include the following:
Symptoms of sexually transmitted diseases Injury to genital area Difficulty and/or pain when sitting or walking Sexually suggestive, inappropriate or promiscuous behavior or verbalization Expressing age-inappropriate knowledge of sexual relations Sexual victimization of other children
Indicators of maltreatment can include the following:
Obvious malnourishment, listlessness or fatigue Stealing or begging for food Lack of personal care – poor personal hygiene, torn and/or dirty clothes Untreated need for glasses, dental care or other medical attention Frequent absence from or tardiness to school Child inappropriately left unattended or without supervision
Why is Recognising and responding to abuse and neglect important?
2.2.1 Introduction – This section sets out the signs of abuse and neglect, the contexts in which this takes place, and details the process for raising safeguarding concerns. Everyone is responsible for preventing abuse by raising any concerns they have – it really is ‘Everyone’s Business’.
- No-one should have to live with abuse or neglect.
- It is always wrong, whatever the circumstances.
- Don’t assume that someone else is doing something about the situation.
- Abuse and neglect could be prevented if concerns are identified and raised as early as possible.
- It is important that everyone knows what to look for, and who they can go to for advice and support.
Changes in someone’s physical or emotional state, or injuries that cannot be explained, may be a sign of abuse.