TYPES OF PATIENT ABUSE
Verbal abuse can be categorized as a form of psychological or emotional abuse. In Canada, for individuals age 16 and older, the Protection for Persons in Care Act (PPCA) defines verbal abuse as mistreatment involving harassment, threatening, intimidation, humiliation, coercion or restriction from social contact causing emotional harm (Nova Scotia Department of Health and Wellness, 2020). Elder abuse is defined similarly, as a form of psychological abuse, often accompanied by physical abuse, carried out with the intention to cause emotional pain or injury (Lachs & Pillemer, 1995). Examples of verbal abuse include threats and insults and statements to humiliate the patient. The threat of abandonment or institutionalization is also a form of psychological abuse (Lachs & Pillemer, 1995).
Physical abuse is the act of intentionally causing physical pain or injury (Lachs & Pillemer, 1995). In elderly patients, the most common acts of physical abuse include hitting, striking the patient with objects, and slapping (Lachs & Pillemer, 1995). These same physical acts can also take place in other vulnerable patient groups where the patient is not able to protect themselves. Any physical act, such as slapping, hitting, burning, tying up or binding, and rough handling, that results in pain, discomfort or injury is a form of physical abuse harm (Nova Scotia Department of Health and Wellness, 2020).
Sexual abuse is any form of nonconsensual sexual contact with a person (The National Center on Elder Abuse at The American Public Human Services Association, & Westat, Inc., 1998). If an individual is incapable of providing consent, then sexual contact with that person is considered sexual abuse (The National Center on Elder Abuse at The American Public Human Services Association, & Westat, Inc., 1998). Sexual abuse includes, but is not limited to, sexual assault or battery, such as rape, coerced nudity, sodomy, and sexually explicit photography (The National Center on Elder Abuse at The American Public Human Services Association, & Westat, Inc., 1998). For patients age 16 and older, the PPCA defines sexual abuse as any form of sexual contact, activity or behavior that occurs between a patient or resident and a health care provider (Nova Scotia Department of Health and Wellness, 2020). Notably, the definition provided by the PPCA does not mention consent and implies that any form of sexual contact or behavior between a health care provider and a patient or resident is a form of abuse. Also, pediatric patients, as minors, cannot legally consent to any form of sexual contact. Those with intellectual disabilities and who are not physically able to speak for themselves due to a medical condition also cannot provide consent for sexual contact.
Financial abuse is the act of material exploitation or the misappropriation of a patient’s money or property (Lachs & Pillemer, 1995; Nova Scotia Department of Health and Wellness, 2020). Financial abuse can include theft of pension or Social Security checks, using threats to force the patients to sign wills or other legal documents, or coercing a patient in any financial matter (Lachs & Pillemer, 1995).
Lachs and Pillemer (1995) define patient neglect in the elderly population as the failure of the needs of the elderly person being met by the designated caregiver. In the PPCA, neglect can fall under section 3(1)(g), a type of abuse where the caregiver fails to provide adequate care, medical attention, nutrition or necessities of life without valid consent (Nova Scotia Department of Health and Wellness, 2020). Although patient neglect is increasing as an issue of public concern, the concept of patient neglect is poorly understood (Reader & Gillespie, 2013). A caregiver neglecting a patient can be intentional if the caregiver is purposefully failing to attend to the patients’ needs in order to cause harm or punish the patient, such as by willfully withholding food or medication (Lachs & Pillemer, 1995). Neglect can also be unintentional, as the caregiver may genuinely be unaware that they are neglecting the patient or may not be able to care for the patient (Lachs & Pillemer, 1995).
Intentional and unintentional patient neglect can be further categorized under two aspects of patient neglect: procedure neglect and caring neglect. Procedure neglect refers to when health care staff fail to achieve the objective standards of care (Reader & Gillespie, 2013). Examples of procedure neglect include failing to feed, hydrate, or P a g e | 5 adjust a bedridden patient as needed (Reader & Gillespie, 2013). Additionally, failing to complete required checks on patients also falls under procedure neglect. Staff may commit procedure neglect as a result of system errors or due to a lack of care for the patient (Reader & Gillespie, 2013). Caring neglect consists of acts that lead the patient or their family to believe that staff members do not care about the patient’s well-being (Reader & Gillespie, 2013). Caring neglect includes acts such as not providing assistance when a patient is eating, dismissing a patient’s concerns, or not treating a patient with respect (Reader & Gillespie, 2013). In cases of neglect, difficult questions arise about the caregiver, their exact responsibilities to the neglected patient, and if the neglect was intentional or unintentional (Reader & Gillespie, 2013).
Patient neglect continues to be an issue despite the technological and organizational advances of the 21st century (Reader & Gillespie, 2014). From patient complaints to scandals, instances of patient neglect are becoming more and more concerning. For example, the United Kingdom’s National Health Service (NHS) receives more than 100,000 complaint letters per year (The NHS Information Centre, 2012), and many of these letters refer to instances of patient neglect ((Reader & Gillespie, 2014). Additionally, in a hospital scandal that took place at the NHS’s Mid-Staffordshire Foundation Trust, approximately 1,200 patients died from 2005 to 2008 because of inadequate care (Francis, 2013a). All of this has led to an increased number of hospital recommendations for improving care in the UK (Francis, 2013b). The recommendations in the report by Francis (2013b) could be beneficial to many healthcare organizations and institutions that are dealing with patient neglect reports and complaints and are overall looking to prevent such instances.