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Different Forms of Elder Abuse

Question:

Discuss about the Implications Of The Process For Registered Nurse.

Older people have all the right to be treated with respect and dignity whether they are being cared for in home or aged care setting. However, elderly people living in residential setting are often vulnerable to risk for abuse and neglect. The elderly abuse may be seen in different forms such as physical abuse, sexual abuse, abandonment, passive neglect and exploitation and perpetrators of abuse may be either family members, health care or assisted living staffs and children. Health care workers may come in contact with elderly people who may disclose them about harm or experiences of abuse and in such case it would be necessary for the health care staffs to report about the issue in a legal and professional manner (Lachs and Pillemer 2015). This essay particularly discusses the legal and professional reporting that occurs post the disclosure of abuse or harm by elderly people. It also discusses the implications of the process for registered nurse and the delivery of nursing care.

There are difference explanations for abuse in elderly people. It may take various forms such as physical, social, sexual, psychological abuse and neglect. For instance, physical abuse is inflicted by hitting, pushing or striking elderly people with any object. Secondly, elderly people are also vulnerable to psychosocial or verbal abuse where intention pain or distress is given to people in the form of humiliation or intimidation through verbal or non-verbal acts. In addition, the neglect of older person is seen when a care giver fail to carry out all obligations related to care of older person and come in the way of well-being of the person (Bond and Butler 2013). Hence, it can be said that elder abuse is multifaceted and a major public health issues and it has become paramount for health care worker to report about such issues to adults protective service. As nurses spend maximum time with elderly people, the compulsory reporting document by the Australian Nursing & Midwifery Federation (ANMF) gave the position statement for nurse and assistants in nursing to compulsory report about abuse in age care setting (ANMF Position Statement 2017).


According the Aged Care Act 2007, compulsory reporting is necessary in case of unlawful sexual contact and unreasonable use of force in elderly people living in age care home. Compulsory reporting is the response that nurses must take on identification of abuse in elderly people and the key action is taken in accordance with the organization policies and protocol present at particular aged care setting or nursing home. Another legal obligation is to make the person report about alleged abuse so that adequate investigation and action is taken to protect individuals. Another key responsibility of the reporting person is to ensure that the person is not victimized due to the reporting process (ANMF Position Statement 2017). Ensuring this is important because elderly abuse is always associated with psychological distress, hence it warrants more attention be given to affected person as the negative experience lead to depression, anxiety and loneliness (Dong 2015). The key implication of identifying and reporting about abuse in elderly person is that it will lead to improvement in education for health care professionals.  This enable them to understand all the cultural and psychological nuance associated with abuse and improve the quality of care delivered to elderly people (Dong et al. 2013).

The Need for Reporting Elder Abuse in Order to Safeguard Elderly People

There is no comprehensive legislation for adult prptection in Australia, however the Aged Care Act 1997 gives a framework for provision of elderly care. The requirement for health care staffs regarding the reporting about abuse in elderly people also given by the National Legal Response report of the Australian Law Reform Commission. To protect the elderly people, it mandates that care gives or other support staffs should be encourages to report about abuse to adult safeguarding agencies (Reporting abuse | ALRC 2017). However, as people disclosing about elder abuse resist doing so because of fear of breaching confidentiality laws or fear of reprisals from employers, the Public Guardian Act 2014 gives the mandates that head of an organization should be responsible for protecting whistleblower  and ensure that they are not subjected to adverse consequences (Falk and Hoffman 2014).

For health professionals like nurses and others staffs who have come to know about elder abuse in particular patient, they have variety of ways to report about the abuse.  As per the mandatory reporting law, they can report about abuse to Adult Protective Services. There are also different protocols present in residential care centre or geriatric facility for report about abuse. However, the care giver or other professional must be aware about reporting elder abuse in a safe and efficient manner (Queensland Government 2017). Following is the stepwise procedure used to safely report about elder abuse:

To report about abuse situations professionally, it is necessary that the reporting person must keep all documents to prove abuse in affected person. For this, proper assessment of the elderly person is required. For instance, they need to consider cognitive capacity, health and functional status of the person. Secondly, they need to preserve signs of abuse by taking photographs of injuries in patients. Changes in behavior of older adults might also be an indication of abuse cases (Rankine 2017). The most important and crucial think is getting written statement of patient related to experience of abuse as this legally important to prove suspicions and start legal actions against the perpetrator quickly (Piel 2015). In addition, identifying the type of relationship between the abuser and older adult to understand whether the client wish to protect the person or retain the relationship. On the basis of this information, safe and effective reporting process can be planned.

The caregivers act of responding to abuse may differ by analyzing whether the situation is an emergency or not. If the situation is an emergency which may cause life threat to the person, the staff need to initiate emergency service without delay. In this situation, the main focus should be on protecting the evidence and not asking too much question from client. After taking adequate emergency action for patient, it will be necessary to debrief and document about incident in accordance with the agency protocol and policies (Rankine 2017).

Implications of the Reporting Process for Registered Nurses

If there is no emergency situation during the identification of abuse, one necessary step by the health care staff will be to assess whether the client has capacity or impaired capacity. According to the Guardianship and Administration Act 2000, the capacity of the person is determined by checking the capability of the person for understanding effect of decision, voluntary decisions and communicating decisions (Barry and Sage-Jacobson 2015). Hence, if the client lacks capacity, then psychogeriatric assessment is required and after consultation with the Office of the Public Advocate, appropriate actions regarding safeguarding client may be taken (Cohen 2016). If there is serious issues, the caregiver can also propose shifting the client to alterative care unit. If a person has capacity, then counseling support may be given to them. They can also contact the Aged Rights Advocacy Service (ARAS) to discuss possible actions needed to address abuse in elderly adult (Rankine 2017).

It will be necessary for staff to document client’s consent or no consent to contact police and take legal actions against the perpetrator of abuse. From a legal perspective, taking consent regarding appropriate action is necessary in accordance with people’s right to self-determination. In times emergency, the reporting person gets the liberty to contact police without client’s consent, however in other situation taking consent is crucial for maintain good relationship with client (Falk and Hoffman 2014). There is a need to balance the organizational duty of care and client’s right to self determinant to avoid conflicting situations. In case of no content situation, it is necessary to follow agency protocol and stay away from reporting process (Hoover and Polson 2014). However, duty of care needs to be implemented such as determining the possible intervention to protect the elderly people.

Based on the client’s capacity and consent parameters, if it is confirmed that reporting and taking legal actions is necessary, there can be two options for client. Firstly, the reporting person may inform the client about the option of civil intervention or criminal intervention. In case of civil intervention, the case may be brought into the court and in case of criminal intervention, the police can intervene to take actions against the abuser and protect the person (Rankine 2017). Based on the severity of abuse, different actions can be imposed on the abuser. For instance, a protection order may be given by which conditions will be set against the action of the abuser. If the abuser is a close relative of elderly client, then the formal strategy will be to avoid reliance on the person for support and shifting the person to private aged care service. Informal support options may include encouraging client to take part in community activities to overcome the shock of abuse (Du Mont et al. 2015).

Options for Clients Based on Capacity and Consent Parameters

The process of responding and reporting about elder abuse cases also has many important implications for registered nurse. This is also comprehensively mandated in the compulsory reporting document for abuse in aged care setting. In the context of responding to elder abuse, registered nurse act as the frontline health care staffs for assessment of signs of abuse in elder people and providing preventive care and interventions to them. At the stage of documenting about abuse, they play a critical role in interview with patients and finding signs of unexplained injuries (Corbi et al. 2015). Secondly, after all the legal procedures related to reporting and documenting about abuse had been done, the nurse plays a role in empowerment of patients and addressing signs of depression in patient. Some elderly client experience social isolation due to abuse. In such situations, registered nurse acts as the main source for emotional support by speaking with them and counseling them. They also play a role in referring them to community related activities where they get the chance to interact in fun filled activities and removed the emotional scarring that has occurred due to experience of elder abuse (Friedman et al. 2015).


As part of the duty of care and professional responsibility in nursing practices, nurses plays a major role in addressing health and psychological issues related to abuse in elderly people. They must have the skills of surveillance and constantly monitoring patients to ensure their safety. This is particularly important in case of aggressive patients. As there is high incidence of elderly maltreatment in long-term care facilities, the role of nurse in delivering safe care becomes necessary in such situation. The research by Rosen et al, (2016) states that continued illness in elderly people often leads to negative verbal and physical interaction and this becomes the reason for physical or psychological distress in elderly people. In an attempt to minimize maltreatment in long-term care facility, the nurses physical intervene to separate residents, calm the resident and emotionally supporting them to overcome the situation. However, there is still lack of competency in nursing staff regarding the way to recognize, prevent and address elder abuse. Hence, this paper give the implication that nursing students must be better trained in identify signs and symptoms of elder abuse,  finding legal and professional document for reporting about suspected abuse and neglect, improving communication skills related to talking with elder abuse victims and referring people to relevant community support group.

The essay brought into the attention the need to protect the dignity of elderly people by means of legal and professional compulsion given to health care professional to mandatorily report about such case. The process employed by health care staffs to report about abuse gives the indication that different reporting protocols exist in organization and the reporting must comply with them while reporting about abuse. Secondly, safe and efficient reporting is dependent on proper documentation process and assessment of signs related to abuse. As the registered nurse plays a key role in promoting recovery of elder abuse patients, it is critical to increase their knowledge and awareness regarding preventing elder abuse.

References

ANMF Position Statement 2017. Compulsory reporting of abuse in aged care settings for nurses and assistants in nursing. [online] Available at: https://anf.org.au/documents/policies/PS_Compulsory_reporting.pdf [Accessed 22 Sep. 2017].

Barry, L. and Sage-Jacobson, S., 2015. Human Rights, Older People and Decision Making in Australia.

Bond, M.C. and Butler, K.H., 2013. Elder abuse and neglect: definitions, epidemiology, and approaches to emergency department screening. Clinics in geriatric medicine, 29(1), pp.257-273.

Cohen, C., 2016. 4.5 Psychosocial Aspects of Care in Geriatric Psychiatry. Geriatric Psychiatry Review and Exam Preparation Guide: A Case-Based Approach, p.364.

Corbi, G., Grattagliano, I., Ivshina, E., Ferrara, N., Cipriano, A.S. and Campobasso, C.P., 2015. Elderly abuse: risk factors and nursing role. Internal and emergency medicine, 10(3), pp.297-303.

Dong, X., Chen, R., Chang, E.S. and Simon, M., 2013. Elder abuse and psychological well-being: A systematic review and implications for research and policy-A mini review. Gerontology, 59(2), pp.132-142.

Dong, X.Q., 2015. Elder abuse: systematic review and implications for practice. Journal of the American Geriatrics Society, 63(6), pp.1214-1238.

Du Mont, J., Macdonald, S., Kosa, D., Elliot, S., Spencer, C. and Yaffe, M., 2015. Development of a comprehensive hospital-based elder abuse intervention: an initial systematic scoping review. PloS one, 10(5), p.e0125105.

Falk, E. and Hoffman, N., 2014. The role of capacity assessments in elder abuse investigations and guardianships. Clinics in geriatric medicine, 30(4), pp.851-868.

Falk, E. and Hoffman, N., 2014. The role of capacity assessments in elder abuse investigations and guardianships. Clinics in geriatric medicine, 30(4), pp.851-868.

Friedman, B., Santos, E.J., Liebel, D.V., Russ, A.J. and Conwell, Y., 2015. Longitudinal prevalence and correlates of elder mistreatment among older adults receiving home visiting nursing. Journal of elder abuse & neglect, 27(1), pp.34-64.

Hoover, R.M. and Polson, M., 2014. Detecting elder abuse and neglect: assessment and intervention. American family physician, 89(6).

Lachs, M.S. and Pillemer, K.A., 2015. Elder abuse. New England Journal of Medicine, 373(20), pp.1947-1956.

Piel, J., 2015. Expanding Slayer Statutes to Elder Abuse. Journal of the American Academy of Psychiatry and the Law Online, 43(3), pp.369-376.

Queensland Government (2017). A Guide for Elder Abuse Protocols. [online] Available at: https://www.eapu.com.au/uploads/EAPU_general_resources/EA_Protocols_FEB_2012-EAPU.pdf [Accessed 22 Sep. 2017].

Rankine, J. 2017. Protocol For Responding To Abuse Of Older People Living At Home In The Community. [online] Available at: https://www.sa.agedrights.asn.au/files/49_1095_aras_abuseprotocols_final3.pdf [Accessed 22 Sep. 2017].

Reporting abuse | ALRC. 2017 Alrc.gov.au.  [online] Available at: https://www.alrc.gov.au/publications/reporting-abuse [Accessed 22 Sep. 2017].

Rosen, T., Lachs, M.S., Teresi, J., Eimicke, J., Van Haitsma, K. and Pillemer, K., 2016. Staff-reported strategies for prevention and management of resident-to-resident elder mistreatment in long-term care facilities. Journal of elder abuse & neglect, 28(1), pp.1-13.

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