Abuse, neglect, trauma, & exploitation

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Abuse, Neglect,
Trauma, and
Exploitation
Spotting the Signs, and how to Report er

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Every patient has the right to be treated with
respect and dignity at all times. Every staff
member is responsible for knowing how to spot
signs of Abuse, Neglect, Trauma, and Exploitation
and how to report suspected, alleged, and
confirmed cases.
Any complaint, observation or suspicion of neglect,
abuse or misappropriation of personal property
must be thoroughly investigated, reported and
reviewed in a consistent, uniform manner.

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Course
Objectives
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NAME AND DEFINE
TYPES OF ABUSE FOUND
AMONG OUR
POPULATION
DESCRIBE PHYSICAL
AND BEHAVIORAL SIGNS
OF ABUSE
EXPLAIN HOW TO
INVESTIGATE AND
DOCUMENT ALLEGED
ABUSE
NAME THE TYPES OF
STRESS PATIENTS MAY
EXPERIENCE

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Definitions
z Dependent Adult Abuse is the abuse,
neglect, trauma, or exploitation of a person
18 and older unable to protect their own
interests or obtain services necessary to
meet essential human needs as a result of a
physical or mental condition.
Elder abuse is the abuse, neglect, trauma, or
exploitation of a person age 60 or older.
Elder abuse laws are specifically aimed at
protecting dependent adults from abuse by
their caretakers.
Child abuse involves a person younger than
18 who has suffered one or more of the
following categories of child abuse as defined
by the state: physical abuse, mental injury,
sexual abuse, denial of critical care, child
prostitution, presence of illegal drugs,
manufacturing or possession of a dangerous
substance.

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Indicators of Possible Child Neglect/Denial of
Critical Care
Indicators of neglect include the failure to adequately provide the following
necessities of life to the point of the child suffering injury, impairment to function or
death:
 Food and nutrition
 Shelter
 Clothing
 Healthcare
 Mental health care
 Emotional needs of the child necessary for normal development
 Proper supervision
 Response to life threatening conditions

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Indicators of
Possible
Elder/Dependent
Abuse, Neglect,
Trauma, or
Exploitation
z No food in the house/rotted food
Lack of proper food storage
Special dietary foods not available or inadequate cooking facilities or equipment
Clothes extremely dirty or uncared for
Not dressed appropriately for the weather
Inadequate or ill-fitting clothing, not dressing/ Wearing all of one’s clothing at once
Structure dilapidated or in poor repair
Utilities cut off or lack of heat in winter
Lack of access to community resources; Lives on the street
Lack of medical care
Lack of personal cleanliness and grooming, excessive body odor
Swollen eyes or ankles, decayed teeth or no teeth
Bites, fleas, sores, lesions, lacerations
Multiple or repeated or untreated injuries; Injuries incompatible with explanation
Helplessness, Hesitation to speak openly, or denial
Bruises, broken bones or burns or signs of confinement
Fear of a particular person or staff member
Obesity, malnourishment or dehydration
Difficulty in communication

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Types of
Abuse
 Verbal Abuse: The use of oral, written or gestured language that willfully
includes disparaging and derogatory terms regardless of a patient’s age,
ability to comprehend, or disability.
 Sexual Abuse: Sexual harassment, sexual coercion or sexual assault.
 Physical Abuse: Hitting, slapping, pinching, kicking and controlling
behavior through corporal punishment.
 Mental Abuse: Humiliation, harassment and threats of punishment or
deprivation.
 Involuntary Seclusion: The separation of a resident from other
residents or from his or her room or confinement to his or her room (with
or without roommates) against the patient’s will, or the will of the patient’s
legal representative.
 Neglect: Failure to provide goods and services that are necessary to
avoid physical harm, mental anguish or mental illnesses.
 Misappropriation of Patient’s Property: The deliberate misplacement,
exploitation or wrongful temporary or permanent use of a resident’s
belongings or money without the patient’s consent.

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Communicating Signs & Symptoms
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If any physical or behavioral signs and
symptoms are present, the Clinical
Director or designee should be notified
immediately. Every staff member is
responsible for reporting any suspicious
physical or behavioral signs. Do not be
satisfied until an investigation is completed
to determine the cause.

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Reporting
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Upon Admission, a member
of the Nursing team will
assess the patient for signs
by looking at both physical
and behavioral signs as well
as ask the patient if they are
or have experienced any
abuse. This will be
documented in the patient
chart and discussed at the
following treatment team
meeting.
The Clinical Director shall
notify the Medical Director
and/or other treatment team
members, so that a team
effort can be implemented
prior to a report being filed.
The Clinical Director,
Medical Director and staff
member who reported the
incident shall inform the
patient that the suspected
child abuse will be reported
to the State.
A Critical incident report
shall be filed within 24 hours
by the Clinical Director, or
designee. The incident
report shall include the
details of the assessment/s,
who was contacted, the
time, date, etc. of the
contact.
The treatment plan and
progress note/s shall
indicate how the treatment
team will be addressing the
abuse.

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State Reporting
Guidelines
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• Alabama
• Arizona: Adults; Arizona: Minors
• California: Adults; California: Minors
• Colorado
• Connecticut
• Delaware
• Florida
• Georgia
• Illinois
• Massachusetts
• Nevada
• North Carolina
• Ohio: Adults; Ohio: Minors
• Tennessee
• Texas
• Utah
• Wyoming
Each State has guidelines on
how to report Abuse, Neglect,
Trauma, and Exploitation.
Please click on the according
link below to see how to report
in your State. If your State is
not listed, please contact your
Compliance Representative.

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Dealing
With
Aggressive
or Stressful
Reactions
of patients
It is important to understand that patients with behavioral
challenges are coping with one or more areas of stress in their
lives. These stressors can be divided into three categories:
 Medical Stressors - can include conditions such as
dehydration, infections, medication side effects and pain.
 Emotional Stressors - are feelings related to a situation,
disease or condition and can include confusion, fear,
agitation, grief, and loss.
 Environmental Stressors - can include extreme heat or
cold, bright lights, and noise. Noise can increase confusion,
distraction and agitation. Staff should continually reduce the
general level of noise in the environment, which is often
produced by paging systems, slamming doors and calling
down the corridors.
When patients are under stress, they often exhibit predictable
patterns of behavior. Knowing how a particular patient responds
to stress can help the staff determine when the patient is feeling
overwhelmed and what to do about it.

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Dealing with Aggressive or Stressful
Reactions of patients
The more typical patterns of stress behavior include: Agitation
 Agitation is a feeling of unrest, uneasiness, or apprehension. It is
an anxious state of emotions that can usually be observed in the
face and gestures. Agitation is often exhibited as facial
grimacing, wringing of hands, restlessness, or closed off body
language.

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Tips and Techniques for Agitated
Behavior
Assess the patient to determine any physical and/or emotional stressors.
 Try an activity, such as music or exercise, until an activity is found that the patient likes.
 Reduce the noise level in the environment by:
 Provide a constructive task that interests the patient, such as distracting techniques –reading a
book, going for a walk, etc.
 Speaking softly and slowly in a calm voice.
 Turning off televisions and radios within hearing distance.
 Walking to a co-worker to talk versus calling down the corridor.
 Divide tasks into simple steps. Give time for the patient to complete one step, before moving to the
next.
What is Aggression:
 Aggression is a physical attack against another patient or staff member. It is usually the result of
anger and intended to harm. If agitation escalates, the patient can become aggressive.
Be calm when approaching the patient.
 Respond to signs of distress; minimize them before they escalate. If the patient becomes
aggressive, stop what you are doing and move other patients to a safe location.
 Use distractions (e.g., food).
 Remove the patient from a tense situation.
 Keep patients who have conflicts away from each other.
 Plan a regular exercise program to work off excess energy.

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Points to Remember
 It is important not to argue with the patient. Arguing can lead to escalation of the
situation and acting out behavior. The best strategy is to walk away (unless the patient
is in danger) and approach the patient at a later time.
 Do not talk about patients within hearing distance. In addition to the legal issues
regarding confidentiality, individuals may misinterpret, or take personally, any
conversation overheard.
 There may be a patient who refuses treatment and is combative no matter what
interventions are used. This may be a source of stress for the staff members and make
them reluctant to want to continue caring for this individual.
 The patient’s behavior is usually the result of his or her own personal stressors:
confusion, fear, loneliness, anger, pain, or hunger.
 Remember not to take the patient’s behavior personally and always treat him or her
with dignity and respect even when he or she is uncooperative.

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Recognizing
our
limitations as
Direct Care
Staff
Members
The qualities that allow people to provide compassionate and
competent care are the same qualities that may cause them to
overlook their own needs. When and why do we feel most
overwhelmed?
Direct Care Staff who find themselves caught between the pressures
of a difficult and emotionally taxing job and the needs of their families
are at the highest risk for burnout.
Many of these feelings are expressed as:
 “My job requires that I learn so many new procedures and still
take care of the patients.”
 “I worry that I am spending less quality time with my children
because I cannot be in three places at once.”
 “I start feeling anxious when I think about all I am supposed to
do.”
 “I feel like I cannot keep up.”
 “I’m losing control of my work, my home life and my ability to keep
up with world events.”
To help maintain emotional and physical well-being consider the
following: Stay Involved and Active
 Be an active part of the interdisciplinary team. Be involved with
the decision- making process; offer suggestions for care.
 Deal with Feelings
 Bottled up emotions are like a pressure cooker. Every now and
then you have to let off “steam.” Do this in a safe environment,
away from patients and families. Speak with a Clinical
professional, friends, or clergy.