Patient abuse can consist of neglect, physical, sexual, financial, and verbal abuse and can take place in any institutional or community setting among any vulnerable group. While patient abuse refers to the intentional harm of a patient, neglect is when a patient’s necessary needs are not being met by a staff member or caregiver. Research, policies and laws on patient abuse and neglect should aim to highlight that abuse takes place in all patient groups and should expand their resources to address all types of abuse in children, the elderly, those with learning disabilities, adults under 60, and other vulnerable groups.
To combat patient abuse by staff and prevent future abuse, institutions are responsible for establishing a patient-centered environment. This involves not only developing policies and procedures to address abuse accusations and create an environment where abuse of any form will not be tolerated, but also training staff to properly care for patients and providing support for staff members and caregivers who feel overwhelmed by the responsibilities of their role. While there is no excuse for patient abuse of any kind, understaffed institutions, faulty systems, undertrained staff, and a lack of management oversight are all institutional factors that place a patient at risk of abuse. Institutions that lack policies on patient abuse are inappropriately placing complete trust in their staff, even though patient abuse can be an issue among some of the most professional staff members (Nations, 1973). Additionally, patient behavior must also be addressed. While staff members and caregivers committing patient abuse because they were provoked by the patient is inexcusable, documenting patient behavior may help staff be more aware of the kind of patient they are dealing with.
The main goals of future research on patient abuse by staff should be to (i) conduct more prevalence studies on patient abuse by staff, (ii) further study patient abuse by staff in other vulnerable populations to include pediatrics, patients with learning disabilities, and adults under the age of 60 who have suffered from abuse in institutional or community settings, (iii) continue to study elder abuse as it is a public health concern, and (iv) conduct more interventions on eliminating patient abuse so that they may be studied and applied in other settings. Conducting more research on patient maltreatment across all patient groups in institutional and community settings will aid in the development of more inclusive policies addressing different types of abuse and settings where abuse can occur. Apart from researchers, patients and their families must be sure to accurately report patient maltreatment events. Ultimately, management and healthcare professionals in community and institutional settings must work together to keep patients safe.
Octavia Goodman graduated with a Master of Public Health degree in 2019 from the Eastern Virginia Medical School & Old Dominion University joint-degree program. She is currently a graduate student at Old Dominion University pursuing a Ph.D. in Health Services Research. Her research interests include sleep health disparities and sleep and health behaviors.
Atrium Health. (n.d.) Abuse and Neglect. https://atriumhealth.org/documents/ACEModules/BlueRidge/BRHC-Abuse-Neglect.pdf
Averill, S. C., Beale, D., Benfer, B., Collins, D. T., Kennedy, L., Myers, J., Pope, D., Rosen, I., & Zoble, E. (1989). Preventing staff-patient sexual relationships. Bulletin of the Menninger Clinic. 53(5): 384–393. Cited by Feldman, K., Mason, C., & Shugerman, R. (2001). Accusations that hospital staff have abused pediatric patients. Child Abuse & Neglect. 25(12): 1555-1569.
Centers for Medicare and Medicaid Services. (2017). State Operations Manual Appendix A – Survey Protocol, Regulations and Interpretive Guidelines for Hospitals. https://cms.gov/Regulations-and-Guidance/Guidance/Manuals/downloads/som107ap_a_hospitals.pdf
Creighton, H. (1976). Law for the nurse supervisor: Abuse of Patients. Supervisor Nurse, 6, 14–15.
Feldman, K., Mason, C., & Shugerman, R. (2001). Accusations that hospital staff have abused pediatric patients. Child Abuse & Neglect, 25(12), 1555-1569.
Francis, R. (2013a). Report of the Mid Staffordshire NHS Foundation Trust Public Inquiry (Report No. HC 898-I). The Stationary Office. Retrieved from https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/279115/0898_i.pdf
Francis, R. (2013b). Report of the Mid Staffordshire NHS Foundation Trust Public Inquiry (Report No. HC 898-III). The Stationary Office. Retrieved from https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/279121/0898_iii.pdf
Gorbien, M. J., & Eisenstein, A. R. (2005). Elder abuse and neglect: an overview. Clinics in geriatric medicine, 21(2), 279–292. https://doi.org/10.1016/j.cger.2004.12.001
Hildreth, C., Burke, A., & Golub, R. (2011). JAMA patient page. Elder abuse. JAMA, 306(5), 568.
Juklestad, O. (2001). Institutional care for older people – the dark side. The Journal of Adult Protection, 3(2), 32-41.
Kendrick, A., & Taylor, J. (2000) Hidden on the Ward: the Abuse of Children in Hospitals. Journal of Advanced Nursing, 31(3), 565–573.
Lachs, M., & Pillemer, K. (1995). Abuse and neglect of elderly persons. The New England Journal of Medicine, 332(7), 437-443.
LaRocco, S. A. (1985). Patient Abuse Should Be Your Concern. JONA: The Journal of Nursing Administration, 15(4), 27-31.
National Library of Medicine. (1999). Case 1: Patient abuse. Clients in a residential unit for people with learning disabilities. British Journal of
Nursing (Mark Allen Publishing), 8(6), 344.
Nations, W. C. (1973). What constitutes abuse of patients? Hospitals, 47, 51–53.
Nova Scotia Department of Health and Wellness. (2020). Protection for Persons in Care – 2019-20 Q1-Q4 Data. Retrieved from https://novascotia.ca/dhw/ppcact/Protection-for-Pesons-in-Care-2019-20-Q1-Q4-Data.pdf
Pillemer, K., Burnes, D., Riffin, C., & Lachs, M. (2016). Elder Abuse: Global Situation, Risk Factors, and Prevention Strategies. The Gerontologist, 56(Suppl2), S194-S205.
Reader, T. W., & Gillespie, A. (2013). Patient neglect in healthcare institutions: a systematic review and conceptual model. BMC health services research, 13, 156. https://doi.org/10.1186/1472-6963-13-156
Reader, T.W., Gillespie, A., & Mannell, J. (2014). Patient neglect in 21st century health-care institutions: A community health psychology perspective. Journal of Health Psychology.19(1): 137-148.
Schoenfisch, A. L, & Pompeii, L. A. (2016). Security Personnel Practices and Policies in U.S. Hospitals. Workplace Health & Safety. 64(11): 531-542.
Spencer, J., & Knudsen, D. (1992). Out-of-home maltreatment: An analysis of risk in various settings for children. Children and Youth Services Review, 14(6), 485-492.
The National Center on Elder Abuse at The American Public Human Services Association, & Westat, Inc. (1998). The National Elder Abuse Incidence Study. Retrieved from https://acl.gov/sites/default/files/programs/2016-09/ABuseReport_Full.pdf
The NHS Information Centre. (2012). Data on Written Complaints in the NHS – 2011-12. Retrieved from https://digital.nhs.uk/data-and-information/publications/statistical/data-on-written-complaints-in-the-nhs/data-on-written-complaints-in-the-nhs-2011-12
Thompson, D., & Wright, S. (2001). Misplaced and Forgotten: People With Learning Disabilities in Residential Services for Older People. London: The Foundation for People with Learning Disabilities. https://www.mentalhealth.org.uk/sites/default/files/misplaced_forgotten.pdf
United Nations. (2015). World population ageing 2015. Retrieved from https://www.un.org/en/development/desa/population/publications/pdf/ageing/WPA2015_Report.pdf
World Health Organization. Regional Office for Europe. (2011). European report on preventing elder maltreatment. Copenhagen: WHO Regional Office for Europe. https://apps.who.int/iris/handle/10665/107293
World Health Organization. (2020). Elder abuse. Retrieved from https://www.who.int/news-room/fact-sheets/detail/elder-abuse
Yon, Y., Mikton, C. R., Gassoumis, Z. D., & Wilber, K. H. (2017). Elder abuse prevalence in community settings: A systematic review and meta-analysis. The Lancet Global Health, 5(2), 147-156. doi:10.1016/s2214-109x(17)30006-2.
Yon, Y., Ramiro-Gonzalez, M., Mikton, C. R., Huber, M., & Sethi, D. (2019). The prevalence of elder abuse in institutional settings: a systematic review and meta-analysis. European journal of public health, 29(1), 58–67. https://doi.org/10.1093/eurpub/cky093