As a nurse, you play a pivotal role in identifying and reporting abuse, which can save lives. It’s your duty to protect the safety and well-being of vulnerable patients, whether the victim is a child or an adult.
Nurses are considered mandated reporters, a term defined by the National Association of Mandated Reporters as “people required by law to report suspected or known instances of abuse,” including “known or suspected abuse or neglect relating to children, elders, or dependent adults.”
Types of abuse
Before delving into how nurses can report abuse, let’s review the different forms of abuse you might encounter, which include:
- Physical abuse: This includes any form of physical harm, such as hitting, slapping, or inappropriate restraint. Visible signs can include bruises, burns, broken bones, and other unexplained injuries.
- Emotional or psychological abuse: Often harder to detect, this form of abuse involves behaviors that harm the victim's mental well-being, such as verbal threats, intimidation, humiliation, or isolation.
- Sexual abuse: This includes any non-consensual sexual activity or behavior, including inappropriate touching or exploitation.
- Neglect: Failing to provide necessary care, including food, water, shelter, and medical treatment, is a form of abuse, particularly in dependent individuals like children, the elderly, or disabled persons.
- Financial abuse: This type involves the illegal or unauthorized use of a person's funds, property, or resources, often seen in elderly or cognitively impaired individuals.
Recognizing the signs of abuse
Being vigilant in recognizing the signs of abuse is the first step in the reporting process. One study shows that 88% of human trafficking victims have had contact with the healthcare system while being trafficked, but less than 1% of nurses report full confidence in being able to identify the red flags and signs of human trafficking.
Some common indicators of patient abuse include:
- Physical indicators: Unexplained injuries, prolonged infections, black eyes, frequent hospital visits, signs of malnutrition, or poor personal hygiene. Also look for delays in seeking care and repeat visits for chronic injuries.
- Behavioral changes: Withdrawal, depression, anxiety, fearfulness around certain individuals, or sudden changes in personality. Is the person who is accompanying the patient speaking for the patient or attempting to control the visit?
- Environmental clues: The patient's living conditions may be unsafe, unsanitary, or inadequate, and there may be signs of neglect or financial exploitation.
It’s important for nurses to note that signs of abuse can vary depending on the individual and the situation. A single sign may not confirm abuse, but patterns or combinations of signs should raise concern.
Legal and ethical obligations for nurses
As legally mandated reporters, nurses are required by law to report any suspected abuse. This obligation is designed to protect vulnerable patients under your care.
- Legal requirements: Laws vary by jurisdiction, but generally, nurses must report any suspected abuse to the appropriate authorities, such as child protective services, adult protective services, or law enforcement. Failure to do so can result in legal consequences, including fines and loss of licensure.
- Ethical considerations: The American Nurses Association (ANA) Code of Ethics emphasizes the nurse's duty to advocate for the health and well-being of patients.
Steps to reporting abuse
If you suspect a patient is being abused, taking prompt and appropriate action is important. Here’s a step-by-step guide:
- Document your observations: Keep detailed records of any signs, symptoms, or behaviors that led to your suspicion. Include dates, times, and specific details, as this documentation may be vital in an investigation.
- Follow your facility’s protocol: Most healthcare facilities have specific procedures for reporting abuse. Familiarize yourself with these protocols, which typically involve notifying a supervisor, social worker, or the facility’s abuse coordinator.
- Report to the appropriate authorities: Depending on the type of abuse and your jurisdiction, you may need to contact child protective services, adult protective services, or local law enforcement. Some regions have hotlines specifically for reporting abuse.
- Protect the patient’s safety: If you believe the patient is in immediate danger, take steps to protect them, which may include making sure they aren’t left alone with the suspected abuser.
- Provide support: Survivors of abuse often need emotional and psychological support. This might involve coordinating with social workers, psychologists, or support groups to see they receive the support they need.
- Maintain confidentiality: While it’s important to report suspected abuse, you must also maintain the confidentiality of the patient’s information, sharing details only with those directly involved in the investigation or care process.
Overcoming barriers to reporting
Nurses can face various challenges when it comes to reporting abuse, including:
- Uncertainty about the signs: Doubts about whether a situation truly constitutes abuse can cause hesitation. In such cases, it’s better to err on the side of caution and report suspicions rather than risk further harm to the patient.
- Emotional toll: Reporting abuse can be emotionally challenging, especially if the nurse has built a rapport with the patient or the abuser. Seek support from colleagues, supervisors, or a mental health counselor that can help you process your feelings.
- Reporting colleagues: It can be especially challenging for nurses if the abuser that needs to be reported is a colleague. A 2020 World Health Organization (WHO) study found 66% of nursing home staff members admitted to abusing residents. Nursing home abuse can entail neglect, physical or sexual, emotional, or financial abuse. If you suspect that a colleague is abusing an elderly patient, you can call Adult Protective Services or your state’s branch of the Long-Term Care Ombudsman Program.
The toll on nurses
As a nurse, reporting abuse can be a stressful and emotionally draining experience. It’s important to take care of your own mental health during and after the process.
- Seek support: Talk to colleagues who have gone through similar experiences and can provide comfort and practical advice.
- Utilize Employee Assistance Programs (EAPs): Many healthcare facilities offer EAPs, which provide confidential counseling and support services for staff dealing with stress, trauma, or other emotional challenges.
- Engage in self-care practices: Regular exercise, sufficient sleep, healthy eating, and mindfulness practices can help you to manage stress and maintain emotional resilience.
