Preventing Patient Abuse: Why Abuse Happens and How to Stop It

INTRODUCTION

A substantial amount of literature and policies regarding patient abuse focuses on the elderly; however, patient abuse is not limited to this population. Patient abuse can occur in other vulnerable populations including children and people with intellectual disabilities and can even occur among adults under the age of 60. With elderly abuse being such a large focus of patient maltreatment, many patient abuse and neglect definitions and laws largely address only maltreatment within the older population. Additionally, within those definitions of elderly abuse laws, a number of states address physical abuse or sexual abuse but give less attention to other forms of abuse including emotional/verbal abuse, financial abuse, and neglect. Understanding patient abuse among vulnerable groups and adults under the age of 60 is vital in order to identify recommendations to combat and prevent abuse among all groups. The abuse of patients, such as health care staff striking patients, is not as uncommon as nurses and other health care staff members might think (Creighton, 1976). A director of nursing services reported having to deal with a number of incidents in which frustrated nurses lashed out at patients. In one incident, an R.N. slapped a mother in labor who was screaming despite being given pain medication and assurance that her labor was going as expected (Creighton, 1976). In another incident, an LPN grabbed and shook a child, leaving bruise marks, for throwing his toys around the playroom and hitting other children because his mother left the room (Creighton, 1976). While the abusive acts in the cases presented above are legally prohibited, not all acts of undesirable conduct are addressed by law, so they must be prohibited in policy to establish and uphold standards of behavior (Centers for Medicare and Medicaid Services, 2017). “Abuse of patients can and does occur on pediatric wards, when children cry and act in certain ways because they are frightened and lonely; on obstetrical wards, when women are frightened or cry out in pain; and on geriatric wards, when senility has reduced patients to a state considered repugnant by many” (Nations, 1973, p.51). Regardless of the state of the patient, all patients in health care facilities have a right to be treated with respect, care, and dignity and deserve a safe setting for the best possible care (Atrium Health, n.d.; Nations, 1973).

PREVALENCE OF PATIENT ABUSE

Despite a large portion of patient abuse occurring with the elderly population, there is a gap in the literature on the prevalence of abuse in nursing homes and residential facilities for the seniors (Yon et. al., 2019). To help close this gap, researchers estimate the prevalence of patient abuse among the elderly using meta-analytical methods based on available publications. In community settings, it is estimated that one in six adults over the age of 60 was the victim of patient abuse during the past year (Yon et. al, 2017). In institutional settings, the rates of abuse are much higher, with two-thirds of staff admitting to having committed elder abuse in the past year (Yon et. al., 2019). With

the expectation that the global population of people aged 60 and older will more than double from 900 million in 2015 to approximately 2 billion by 2050 (United Nations, 2015), it is predicted that elder abuse will also increase in many countries (World Health Organization, 2020).

Estimating the prevalence of patient abuse, as a whole, and among specific groups is difficult because of limited research and data on abuse among groups outside of the elderly population. For future studies, researchers have called for more research quantifying the frequency of abuse allegations at institutions nationwide (Feldman et. al., 2001). While Feldman and colleagues (2001) focused on child abuse and neglect, the future directions they identified can be applied to all patient populations. These include: nationally and institutionally quantifying the frequency of abuse allegations, developing and evaluating staff training materials to prevent allegations, and sharing experiences to minimize risk to patients and staff (Feldman et. al., 2001).