NRS 429 What characteristics would lead a provider to suspect domestic violence, child abuse, or elder abuse is taking place within a family?

NRS 429 What characteristics would lead a provider to suspect domestic violence, child abuse, or elder abuse is taking place within a family?

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

Domestic violence, child abuse, and elder abuse are critical and prevalent issues in society today. According to Herrenkohl et al. (2022), millions of Americans are affected each year by these forms of abuse. Many warning signs may lead a provider to suspect that abuse is taking place within a family. For example, if a patient has bruises or injuries inconsistent with their explanation, this may be a sign of abuse. Other warning signs may include changes in behavior, such as becoming withdrawn or agitated, or changes in appearance, such as wearing long-sleeved shirts in summer to cover up bruises. They can all be suspected when there is a pattern of one family member being controlling, aggressive, or violent toward another family member. It can include physical violence, sexual violence, emotional abuse, and financial abuse.

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If a provider suspects that abuse is occurring, it is important to report it immediately to the relevant authorities. In many states, healthcare providers are required by law to register suspected cases of abuse to the appropriate authorities. In other cases, the provider may make a voluntary report. The provider should also contact the police, local child protective services, or adult protective services, if applicable. When making a report, the provider should give as much information as possible, including the patient’s name, address, and other relevant details. The provider should also describe the nature of the suspected abuse, such as the type of injuries observed and any other suspicious circumstances. After a report is made, the authorities will investigate the abuse allegations and take appropriate action (Wißmann et al., 2019). It may include removing the victim from home, filing for a restraining order, or pressing criminal charges. Domestic violence, child abuse, and elder abuse are serious issues that require prompt attention. By being aware of the warning signs and knowing how to report suspected cases of abuse, healthcare providers can play a vital role in protecting the victims and bringing the abusers to justice.

References

Herrenkohl, T. I., Fedina, L., Roberto, K. A., Raquet, K. L., Hu, R. X., Rousson, A. N., & Mason, W. A. (2022). Child maltreatment, youth violence, intimate partner violence, and elder mistreatment: A review and theoretical analysis of research on violence across the life course. Trauma, Violence, & Abuse, 23(1), 314-328.https://doi.org/10.1177/1524838020939119

Wißmann, H., Peters, M., & Müller, S. (2019). Physical or psychological child abuse and neglect: Experiences, reporting behavior and positions toward mandatory reporting of pediatricians in Berlin, Germany. Child Abuse & Neglect, 98, 104165. https://doi.org/10.1016/j.chiabu.2019.104165

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:

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

Signs and symptoms of abuse vary and depend on the type of abuse. Some signs and symptoms of abuse are seen, and some are observed. Still others are expressed during interactions with the victim and family members. Common signs and symptoms of abuse include unexplained bruises, burns, or broken bones; injuries that don’t match the explanation given, sexually inappropriate behavior, social withdrawal, depression, decreased school performance, poor growth and hygiene, hoarding or stealing food, and lack of appropriate medical, dental or psychological care (Mayo Clinic, n.d.). Other common signs and symptoms include frequent headaches, chronic pain, insomnia, gastrointestinal problems, eating disorders, and suicide attempts (Bosch et al., 2015). Behavior of family members also alert health care providers of possible child abuse, intimate partner violence, or elder abuse. These could include blaming the child, elder, or partner for problems, consistently criticizing or calling the victim negative names (e.g., stupid, worthless, or evil), severely limiting contact with others, and demanding attention from the victim (Mayo Clinic, n.d.). Any combination of these signs and symptoms should prompt the nurse or health care provider to investigate the situation further.

I currently work in an assisted living facility. Elder abuse may be physical, sexual, financial abuse or neglect. If any of these are suspected, the staff person would fill out an incident report. This would then trigger notification by nursing staff and administration to the Department of Health and Human Services. They would decide if local authorities needed to be involved. The Wellness Director or director of nursing would cooperate with DHS to conduct an investigation. After that, DHS would then consider the documentation and decide what course of action is needed. Sometimes the police department is involved early to protect the client/victim and assist with the investigation. Not all investigations lead to prosecution but do protect the client/victim involved.

Bosch, J., Weaver, T.L., Arnold, L.D., Clark, E.M. (2015). The impact of intimate partner violence on women’s physical health: Findings from the Missouri behavioral risk factor surveillance system. Journal of Interpersonal Violence, 32(22). https://doi-org.lopes.idm.oclc.org/10.1177/0886260515599162

Mayo Clinic. (n.d.). Child abuse. https://www.mayoclinic.org/diseases-conditions/child-abuse/symptoms-causes/syc-20370864