Abuse – physical, emotional, neglect, or material, is (unfortunately) part of the human condition. In spite of what the media may report, the incidence of abuse in our society (as well as other societies) remains relatively steady. The difference today is our sensitivity to the incidents of abuse. That sensitivity is a product of significant factors:
- Information and communication (e.g., media news) about abuse in all its forms
- Values clarification (e.g., societal discussion on the condoning or condemning of abusive power relationships)
- Reporting abuse (in all its many forms across the age continuum)
- Prosecution of the abuser, and the active (positive) response to the victim of abuse
Abuse occurs to the infant, the child, the adolescent, the young and older adult, and the elderly. While society has a major interest in condemning all forms of abuse, it has a preponderant and active role as protector for those who are part of dependent groups –by virtue of age or mental condition - and unable to fully protect themselves from abusive situations. For instance, a child in an abusive situation is unable to call for outside aid, and therefore is in a particularly vulnerable (unprotected) situation. The same could be said for an adult with loss of cognitive capacity - or for an elderly person with cognitive loss. An elderly person with cognitive loss, living alone may be unable to provide for his or herself - and therefore is a victim of self-neglect.
As health care givers, we have an active role in all situations of abuse, but particularly with those who are dependent on others for identifying possible abuse and abusive situations. Society in fact demands that we act in a forthright manner when we suspect the infant, the child, and the adolescent, has been abused, or is in a threatening situation. If the health care professional has reasonable belief that the child (under 18 years of age) has been abused, or neglected, or it is likely to occur, a phone call reporting this fact must be made to the county social or human service agency.
Please note: while it is a mandatory duty to report suspected child abuse, there is no mandatory duty to report abuse if it has occurred to other age groups. In other words, the reporting of abuse that an affects adult (young, older, and elder adults) is encouraged, but is not mandated by law.
TO REPORT OR NOT – Domestic and/or Elder Abuse
This is difficult situation. Let’s illustrate. the health care worker may be working with – let’s say – a female patient that has come to the hospital for non-life threatening surgery. In the course of working with her, the nurse comes to the realization that the patient may be a victim of (physical) abuse. After discussing the situation with the team, there is general belief that this may be true. The nurse then takes the next step in talking to the patient about her ‘safety at home’ and the patient then reveals that her husband has physically beaten her recently and on a number of occasions.
At this juncture, the nurse expresses concern for the patient and encourages her to “do something about the abusive situation”. The patient thinks about it and then turns to the nurse and says: “I had it coming, I guess. I worry about what my husband would do if someone came to the house. He might get very angry and take it out on me. So, I don’t think I want to do anything about it…at this time.”
Actions: One route: If the nurse decides that the patient is at risk, she may go ahead and report the incident to law enforcement. The health care worker, acting out of good faith is not liable. However, the patient’s wishes have not been honored, and the consequences to the patient - in the short run - may have life-threatening implications.
Another route: Recognizing that the patient is at risk, the nurse may obtain phone numbers from the domestic abuse agency in the county where the woman resides. She may even phone the agency and obtain the name of a domestic abuse worker who would be able to talk with the patient during her stay at the hospital, or at a later date. The health care worker then may give that information to the patient, and offer additional meetings with the unit team social worker.
Outcome: In the example above, the second choice preserves the ability of the patient to be in control, and of being above to control the timing of ‘talking’ to the worker from the domestic violence center in her community. Lastly, she will recognize your concern and respect for her as a person.
The above example amplifies the reality that health care workers find themselves when working with potential victims of domestic violence. On one hand, they want people ‘protection’ for the patient, yet may find that the patient is reluctant to take action. Domestic violence does occur to persons throughout the age continuum. As adults, they need to have steps to change the cycle of violence. Providing ‘talking points’ and other resources does change the equation for many persons.
Elder Abuse – Neglect
Another point to reiterate: domestic violence affects adults – young, middle aged, and elderly. For the elderly, the same reality exists for those who may be victims of abuse as the above example illustrates. Yet the question of abuse may broaden to include the issues of neglect
- Neglect would suggest carelessness, laxity, and negligence by a caregiver visited upon a person with lessened ability to make choices.
- Self-Neglect by the person who may have lessened ability to make choices.
While there is no mandate to report, the health care worker needs to use her/his own judgment, of sharing their thoughts and observations with their team, and formulating a plan of action.
Signs of Abuse: The signs of abuse from the gamut from the obvious (physical scars, broken bones, lacerations), to the more subtle (neglect and self-neglect-grossly poor hygiene, malnutrition, confusion, disorientation).
- For a complete description of the signs of abuse across the age continuum, refer to the UWHC Policies and Procedures:
The Process Works: Don’t feel like the Lone Ranger! Remember your clinical intuition is something you can rely on. In providing care to a patient, if you either observe physical signs, behavior suggestive of abuse (or an abusive environment), you are not an isolated health care provider. You have colleagues, and more than that, you have a team of fellow professionals! Rely on them to share your thoughts, you observations.
- Be empowered to use your clinical intuition.
- Be a Team Player: bring your observations back to your team.
- Involve your social worker and other health care colleagues.
Final note: There is a mandatory reporting requirement associated with certain types of injuries (regardless of whether these injuries result from domestic abuse or not). Those injuries are 1) gunshot wounds, 2) wounds occurring as a result of a crime, and 3) certain second and third degree burns. Local law enforcement must be informed.
If you have ANY questions, please call the Social Work Manager.
Question: ‘Which county should be phoned?’
Answer: ‘The county where the above abuse or neglect most likely happened.’ Most county agencies have emergency numbers. In Dane County, the Human Services Child Protection referral is (608) 261-5437 and on weekends or after hours call law enforcement in all Wisconsin counties.