VICTIMS OF ABUSE
Elder abuse is the mistreatment of an older adult in which their health or safety is at risk (Hildreth et. al., 2011). More specifically, the World Health Organization (2020, n.p.) defines elder abuse as “a single, or repeated act, or lack of appropriate action, occurring within any relationship where there is an expectation of trust which causes harm or distress to an older person.” Elder abuse can be categorized by the type of abuse, the type of abuser, or the type of setting in which it occurs (Gorbien & Eisenstein, 2005). The type of abuse includes psychological, physical, sexual, financial, and neglect; the type of abuser includes family members, and informal or formal caregivers; and the type of settings can be categorized as in a community or at an institution (Gorbien & Eisenstein, 2005). The main risk factors placing elderly patients at risk for abuse include dementia, being a woman, and being over the age of 74 (Juklestad, 2001; World Health Organization, 2011; Yon et. al., 2019).
People with Intellectual Disabilities
As Thompson and Wright (2001, p.7) wrote, “People with learning disabilities have previously been called mentally handicapped. What makes them special is that they have needed help and support all of their lives. This is different to people who need help just late in life, for example, if they get dementia. People with Down’s Syndrome often get dementia, but they have usually needed extra support all of their lives.” People with intellectual disabilities may experience abuse in a community setting or in an institutional setting. Those with learning disabilities who live in a residential facility for the elderly are at increased risk of abuse: “In addition to the risks associated with having a learning disability, many are with limited safeguards because of poorly trained staff, the infrequent visits of family, friends and social workers, and limited activities outside the home” (Thompson & Wright, 2001, p.18).
In a case study on patient abuse among clients in a residential unit for patients with learning disabilities, a staff nurse was accused by other colleagues of verbal/emotional abuse, physical abuse and sexual abuse (National Library of Medicine, 1999). The staff nurse faced eight charges including teasing residents, using inappropriate methods when feeding residents, inappropriate sexual contact with a resident, using inappropriate materials to clean a resident, and displaying inappropriate behavior at an event for residents (National Library of Medicine, 1999). This case study highlights the importance of nurses taking responsibility and reporting their colleague(s) if they are aware of inappropriate behaviors. Additionally, this study examined events of procedure neglect, as the staff nurse failed to properly feed and clean residents. Caring neglect was also evident through inappropriate behavior and sexual contact, as well as not treating the residents with respect. In settings where individuals suffer from intellectual disabilities, not all residents have the mental capacity or the courage to speak out against a staff member. In these settings, it is important for the organization to emphasize that neglect or abuse in any form will not be tolerated and to support nurses who report their colleagues who may be committing any form of abuse.
Child abuse can be defined as any form of neglect or maltreatment that results in non-accidental harm or injury to a child (Atrium Health, n.d.). While children of all ages can experience child abuse, it is typically more common among children younger than 6 years old and those between the ages of 12 and 14 (Atrium Health, n.d.). In the United States, more than 3 million cases of maltreatment are reported annually, with more than 1 million of these cases confirmed (Atrium Health, n.d.).Medical personnel and other professionals, such as teachers and daycare providers, report more than 50 percent of child abuse allegations (Atrium Health, n.d.).
Feldman and colleagues (2001) reviewed a series of cases from 1982 to 1996 from their hospital archives on accusations of hospital staff abusing pediatric patients. Additionally, the researchers mailed surveys to 108 members of the National Association of Children’s Hospitals and Related Institutions (NACHRI) to obtain information regarding P a g e | 7 their experience with staff abuse allegations from 1990 to 1995, in addition to employment screening and training policies on staff abuse. When examining the hospital case series, it was found that, while sexual abuse complaints mainly involved older children, with an average age of 12.4, physical abuse allegations involved infants to adolescents (Feldman and colleagues, 2001). When looking at the pediatric patients who were the victims in physical and sexual abuse allegations, common risk factors included underlying chronic illnesses, underlying motor or cognitive disability, being in an anesthetized or heavily sedated state, past abuse, and psychiatric illnesses (Feldman and colleagues, 2001). Risk factors were also identified among the families of the victims, including mental illness, substance abuse, personal abuse history, legal issues, and issues with the health care provider (Feldman and colleagues, 2001).
Of the 27 hospitals that responded to the survey, 60 percent of the respondents reported allegations of patient abuse by staff (Feldman and colleagues, 2001). About a third of the allegations were proven as the staff members involved used unacceptable physical or verbal violence, or inappropriately sexually touched the pediatric patients (Feldman and colleagues, 2001). Additionally, while a child protection team was established at most of the institutions, only a third of the institutions required a team evaluation and management of the cases (Feldman and colleagues, 2001). The remaining institutions varied in where the cases were delegated. It was also found that only 19 percent of the institutions had written policies on how accusations should be managed internally, and some hospitals indicated they only reported the accusations to protective services if legally mandated (Feldman and colleagues, 2001).
Measures to prevent child abuse by staff using prescreening measures and training varied among the institutions. Criminal background checks mandated by the state or screening services from police or outside agencies were used for prospective employees in two-thirds of the institutions (Feldman and colleagues, 2001). However, many of the institutions did not provide training for employees on reducing the risk of abuse accusations and incidents (Feldman and colleagues, 2001). With many of the accusations being a result of patient and family misinterpretation of the appropriateness of the medical service being provided, it is important to be proactive in explaining procedures and alerting patients and families of physical contact before a service is provided (Feldman and colleagues, 2001). Proper disclosure of the steps involved in the service will aid in preventing patient abuse accusations and incidents and put the patient and family at ease. Additionally, knowing a patient’s history of victimization and having an extra attendant in the room to reduce patient discomfort will also reduce the risk of patient abuse accusations (Feldman and colleagues, 2001). Averill and colleagues (2001) also noted that providing proper training to staff members will help to reduce accusations and incidents.
Institutions that care for children should have a system in place to efficiently and effectively manage abuse accusations and incidents (Feldman and colleagues, 2001). Having a system in place will not only benefit the institution, but it will also provide the staff member involved an understanding of the process and give the victim and their family a sense of comfort knowing that the accusation is being taken seriously.
Non-elderly adult abuse is an aspect of patient abuse that is not widely addressed. LaRocco (1985) discussed patient abuse in a manner that can apply to all patient populations, regardless of setting or how vulnerable the patient is. Although adult abuse for individuals under the age of 60 is not widely mentioned in the research, it can include those who are mentally ill, have an intellectual disability, or are sedated or under the influence, as well as individuals who are being taken advantage of by staff members or caregivers. While abuse may seem less likely among adults under the age of 60, this is not a safe assumption. Abuse against any patient group, whether in a community or institutional setting, cannot be tolerated, and healthcare professionals need to be aware that abuse can take place in any patient group, regardless of age, setting or mental capacity.