WHAT CHARACTERISSTICS WOULD LEAD A PROVIDER TO SUSPECT DOMESTIC VIOLENCE, CHILD ABUSE OR ELDER ABUSE IS TAKING PLACE WITHIN A FAMILY? NRS 429

Topic 5 DQ 2

What characteristics would lead a provider to suspect domestic violence, child abuse, or elder abuse is taking place within a family? Discuss your facility’s procedure for reporting these types of abuse.

Although it is generally agreed that there is no specific ‘type’ of person who is more likely to be abused, and the different types of abuse include physical abuse, psychological abuse, sexual abuse, verbal abuse, financial abuse, etc. There are general characteristics which people in an abusive situation tend to have in common and this includes the follow:

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1. Low self esteem
2. Emotional and economic dependency
3. Continued faith and hope abuser will “grow up”
4. Depression
5. Stress disorders and/or psychosomatic complaints
6. Accepts blame and guilt for violence
7. Socially isolated, e.g. avoids social interaction, never seems to be alone
8. Believes social myths about battering
9. Believes in stereotypical sex roles
10. Has poor self image
11. Contemplates or attempts suicide, or self-harms
12. Participation in pecking-order battering
13. Appears nervous or anxious
14. May defend any criticism of abuser
15. May have repeatedly left, or considered leaving the relationship
16. Broken bones, bruises, marks on the body, or bite, burn or scald marks.
17. Frequent injuries that are unexplained or inconsistent with the account of what happened.

Anybody may fall victim to abuse, with all adults (those aged 18 and over) potentially being affected. However, there are some situations that increase an adult’s vulnerability and therefore put them at increased risk. For example, people with particular care and support needs, such as dementia or a learning disability, may struggle to communicate what is happening to them, or their communication may be misinterpreted as a symptom of their condition. Sadly, abusers target these vulnerable adults knowing this. This is why it’s so crucial for you to know the signs. At my facility, It is every nurse’s duty to report any type of abuse whether they are sure it happened or not to the supervisor who then goes to the manager and it finally gets reported to the Texas department of family and protective services.

Reference

Tajinder Singh

replied toOluchi Osueke

Oct 29, 2022, 7:52 PM

Great post Oluchi. I agree with your part that the vulnerable individuals are at higher risk of abuse mainly because abusers mainly target these particular individuals because they may have dementia or other underlying illness that prevents them from speaking up and reporting the issue themselves. We as nurses indeed need to be very mindful of this fact and fully assess our patients for signs and symptoms of abuse as you mentioned in your post.

·  Charity Uroegbulam

replied toOluchi Osueke

Oct 30, 2022, 7:15 PM

Yeah I agree with you that anyone can be a victim of abuse. Statistics have shown that the female folks have a higher rate of domestic violence and sexual abuse although some men have been seem to have experienced domestic violence. Like you stated, those more vulnerable for abuse such as people with dementia and learning disabilities. This sometimes occurs as a result of burn out from thier care givers and significant others. As nurses we should learn ways to deal with this group of people to prevent abuse on them

Michelle Ball

Oct 28, 2022, 6:43 PM(edited)

Domestic violence is not always easily detected. This is because abuse within families is often concealed by the abuser. Registered Nurses are mandated reporters. This means that the nurse must report the suspected abuse to APS (Adult Protective Services) or CPS (Child Protective Services). (Rakovec-Felser, 2014.)

I work in an Emergency Department as a Complex Care Manager. I am often asked to consult with patients who mention domestic violence, child abuse, and/or elder abuse. Some patients or their Caregivers are ready to share this information with the nursing staff. We have a specific ER Triage question which asks the patient if they currently feel safe at home. This question can help a victim of violence to have an opportunity to speak openly with the nurse about the things that they are experiencing.

Domestic violence can be quite complex. Beyond bruises, this type of abuse has physical, emotional, mental, and even spiritual components. A Provider might suspect domestic violence when a patient has had multiple injuries without plausible rationale. Multiple ER visits can also provide a clue. Patients often invent a “cover story” and things do not always seem to add up. Another interesting factor is being new to the area, with a recent and unexpected move, with no connection to or knowledge of, resources. The patient appears to be a refugee, because they truly are one.

Child abuse is suspected when a child has non-accidental trauma, or unexplained marks on the skin. Child abuse can also take many forms. In addition to physical injuries, children can also be chemically restrained by parents who are not interested in engaging in parent training. Again, the presentation of these children can be quite concealed and convoluted, because most abusers have a degree of understanding that they can be prosecuted for child abuse. One of the most disturbing situations is found when children are not fed a nutritious diet and therefore, have failure to thrive. These children are literally starving in this country of wealth and abundance. (Towler, et al, 2020.)

The most common type of elder abuse that I witness is financial exploitation. Adult children live with patients and expect them to pay all of the expenses while they refuse to work or refuse to pay for items that the elderly patient needs to survive, such as food and clothing. Social security checks can be diverted away from patients. Financial exploitation is one of the most difficult forms of abuse to prosecute, even though it is very common. We also see neglect of personal care and nutrition, which causes adult failure to thrive.

It is important for the nurse to be aware of the unspoken and subtle signs of abuse. Does the abuser allow the patient to speak for themselves, or do they try to speak for them? Does the patient appear withdrawn or afraid? Is the patient trying to give you a subtle sign of abuse or pass a note to you? It is so important for nurses to remain fully awake and aware of the unspoken in every patient care environment. This is because lives are truly depending on us for help. Sometimes the nurse is the only one who can help a patient to take back their Voice and speak up. Sometimes the nurse becomes the Advocate and Voice for the patient.

References:

1. Rakovec-Felser Z. (2014). Domestic Violence and Abuse in Intimate Relationship from Public Health Perspective. Health psychology research, 2(3), 1821. https://doi.org/10.4081/hpr.2014.1821
2. Towler, A., Eivers, A., & Frey, R. (2020). Warning Signs of Partner Abuse in Intimate Relationships: Gender Differences in Young Adults’ Perceptions of Seriousness. Journal of Interpersonal Violence, 35(7–8), 1779–1802. https://doi.org/10.1177/0886260517696869