06.08 Abuse

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Child and Elder Physical Abuse Assessment (Picmonic)

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In this lesson, we’re going to talk about abuse.

Just a heads up, this lesson may be a bit heavy, but you need to understand the importance that you’re going to play for your patients when dealing with abuse.

Abuse is violence or cruelty toward someone, and it usually has to do with power or control. It’s a way that the abuser exerts their power. It affects all ages and genders and it runs this gamut of physical, mental, verbal and emotional abuse, just to name a few.

Now some cultures don’t consider abuse as actual abuse. Corporal punishment, or spanking is sometimes considered abuse. The biggest takeaway from today will be what your role is as the nurse, but we’re going to hit some important points before we do that. Let’s look at types of abuse.

Like I said, abuse is not just physical abuse. It can be mental, verbal or emotional, or even combinations of abuse.

Elder abuse is the abuse the older patient population. Another one is child abuse. Some parents may often say that they’re disciplining their child, but in fact they are abusing them. When I floated to the burn unit occasionally, it wouldn’t be uncommon to see pediatric burn patients with scald burns from extremely hot water to the patient's feet and rear end. The parents, as a way of discipling a toddler, would grab the patient by the knees and sit them in the hot bath to punish them.

So there are some text-book classic signs of abuse that you’ll pick up on as you move along in your career. Neglect is also a sign of abuse. It’s not just that an adult is hurting a child; failure to care for them is abuse too.

Sexual abuse is another. Rape, sexual assault, these are all types of abuse. Domestic violence is a big one too. There’s a ton of research, but you need to recognize it, and you’ll see it in the interactions between the two parties involved in the abuse.

One thing that’s also important to note is patient abuse. This is why restraints are such a big deal. Overexerting your power as the nurse in an attempt to restrain a patient is abuse. Unless you have a legitimate reason for restraining a patient (like they’re threatening to hurt themselves or someone else, or they risk pulling out a tube), then you need to let them be free and figure out other ways to manage them. Exerting power as a nurse because a patient won’t follow commands is abuse.

I think it’s also really important to talk about the signs of abuse. Yeah, we can say what we need to do, but if we don’t recognize them, or hone into those cues, then we may miss something. So let’s go over some. This also isn’t an all encompassing list either, because there are lots more, but these are just some of the more common ones.

Physical injuries will be a huge one. Broken bones, bruises, different injuries in different stages of healing. For sexual abuse, watch out for unexplained bleeding in the patient’s genital areas or blood stained underwear.

Sudden changes in behavior are usually a key that there’s something going on. Especially if the patient is around new people, or if the family reports some strange new behavior. Also, pay attention to how the patient acts around people in the room. If you notice that your patient is really talkative and then one particular person walks in the room, and they shut down, that should be a clue and maybe warrants a little more investigation.

If your patient directly tells you there’s abuse, then take their word for it. It’s not your job to play investigator, but if you suspect abuse, and they flat out tell you they’re being abused, then report it to the necessary people (we’ll talk about reporting it in a minute).

Also pay attention to signs of neglect. If a patient has wounds that look like they aren’t healing or if they look malnourished or if they look unkempt or like they haven’t showered, then consider that a sign of abuse.
Ok, so what do you do?

First off, your assessment is imperative. Do your solid health assessment, checking over skin and looking for injuries, but also pay attention to what the patient says about family members. Or if the patient is a child, then watch the interaction between the parents or other adults and the patient. This also goes for your elderly patients too. Be objective and be sure to remove bias. Just because the injury may be suspicious and that visitor that just walked in the room looks suspect - don’t do that. You start to examine your patient through a different lens, and you can’t be objective. Just watch the interactions between the patient and the other people, and pay attention to nonverbal behavior.

As nurses, we are required to report any abuse to the necessary authorities. Child abuse is 100% of the time required to be reported, and elder abuse is in most states. But before you go getting on the phone with 911, find out what the policy is, talk to your charge nurse and definitely talk to the provider. But just know that you have a responsibility to report, and how you do it varies by facility and by state. Domestic violence isn’t mandatory to be reported, but there are some nuances with it. The best thing you can do is talk to the provider and any resources you have, and if a crime was committed, meaning the abuser used a weapon of some sort, then it’s a crime and it has to be reported. The best thing you can do this to talk to your leadership

This next part - building trust. I can’t begin to tell you about how important that is, and how important the little things are for the patient. Be honest with your patient and if you tell them that you’ll be back in 5 minutes, be back in 5 minutes (unless you have a code or something). When you do that, it shows that you can be trusted and that you’re looking out for them. They’ll open up and then you’ll have the opportunity to talk to them about what’s going on behind the scenes.

This is also key. Don’t ever just ask a patient “Hey, are you being abused?” They will shut down. Once you build up rapport with them, then you can ask them “Hey, so do you feel safe at home?” and you can start to navigate the process. Don’t probe and don’t accuse or blame. Use your therapeutic communication.

If you need to, grab your resources. Your chaplain, mental health professionals, your women’s or children’s advocates...those people are going to help get your patient the information they need.

For our nursing concepts today, we really focused a lot on patient safety and patient centered care. Also, because we are mandatory reporters, this also plays into our ethical and legal practice.
Ok, so let’s recap.

Abuse is about exerting power over someone, and it can be done violently or cruelly.

There’s lots of ways that abuse is inflicted. It can be physically, verbally, emotionally or verbally.

Abuse affects all ages and genders.

Abuse can be domestic abuse, elderly abuse, child abuse, patient abuse or sexual abuse. Learn to recognize them.

Watch your patients, their verbal and nonverbal. Investigate the situation if you have a cause for concern. And if you find out there’s child abuse, know you have to report it.

Sorry for the heavy lesson today guys, but it’s really important. Be sure you check out all the resources attached to this lesson. Now, go out and be your best selves today. And, as always, happy nursing!!
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