I say this patient is being abused...

Nurses General Nursing

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I assessed a patient last week who was very quiet and timid. Her dh was loud and bossy. I would ask the pt a question and he wouldn't let her answer, he did all the talking. When he spoke loudly I could see that she was cowaring. I almost got the idea when she looked at me that her eyes were asking for help. She did try to answer one question and he told her "NO! I told you that's not how it was be quiet". When she left her appt with her dh she looked at me again with that help me look on her face. I'm not allowed to report anything without talking to my immediate supervisor. He/She was out of town. I will talk to Him/Her tomorrow and hopefully something will be done.

Specializes in Vents, Telemetry, Home Care, Home infusion.
i assessed a patient last week who was very quiet and timid. her dh was loud and bossy. i would ask the pt a question and he wouldn't let her answer, he did all the talking. when he spoke loudly i could see that she was cowaring. i almost got the idea when she looked at me that her eyes were asking for help. she did try to answer one question and he told her "no! i told you that's not how it was be quiet". .

psychological abuse:

the threat of injury, unreasonable confinement, and punishment or verbal intimidation/humiliation, which may result in mental anguish such as anxiety or depression. this may include yelling, screaming, or using demeaning language or ridicule.

doesn't the above scenerio fit the descripton of psychological abuse?

rn's are mandatory reporters

from carie:

the center for advocacy for the rights and interests of the elderly (carie) is a non-profit organization, based in philadelphia, dedicated to improving the quality of life for vulnerable older people.

elder abuse

elder abuse and neglect are prevalent in our society, and yet it is estimated that only one in fourteen cases of elder abuse are reported to authorities. read our elder abuse section for fact sheets, guides and links to resources on elder abuse.

from: national center on elder abuse

state elder abuse helplines and hotlines

if you suspect elder abuse, neglect, or exploitation, report it.

to find the number, click here >>

adult protective services laws

all fifty states, the district of columbia, guam, puerto rico, and the virgin islands have enacted legislation authorizing the provision of adult protective services (aps) in cases of elder abuse. generally, these aps laws establish a system for the reporting and investigation of elder abuse and for the provision of social services to help the victim and ameliorate the abuse. in

most jurisdictions, these laws pertain to abused adults who have a disability, vulnerability, or impairment as defined by state law, not just to older persons.

some states, however, have distinct elder protective services laws or programs and this chart indicates those jurisdictions.these statutes vary widely in: the age at or circumstances under which a victim is eligible to receive protective services; the definition of abuse; types of abuse, neglect and exploitation that are covered; classification of the abuse as criminal or civil; reporting (mandatory or voluntary); investigation responsibility and procedures; and remedies for abuse.

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Specializes in Med/Surg, Geriatrics.

doesn't the above scenerio fit the descripton of psychological abuse?

rn's are mandatory reporters

once again, mandatory reporting laws as they pertain to domestic violence only refer to physical injury. the laws vary from state to state and it is good that this topic has come up because this can give us all incentive to check our own states' laws.

i was interested to learn while looking up georgia's law that there is a lot of controversy over mandatory reporting. some domestic violence groups oppose it on the grounds that it is ineffective, it often hinders victims from seeking help because they are afraid they will be reported, retaliation by abusers and of ethical concerns regarding patient autonomy and privacy.

additionally the american college of emergency physicians, ama, the american college of nurse-midwives and other groups all oppose mandatory reporting on the above grounds.

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Specializes in Vents, Telemetry, Home Care, Home infusion.

my employer recently lost a staff member due to domestic violance which has heightened our awareness, especilaly need to discuss issue along with manadatory reporting for elders.

more info:

emedicine - domestic violence : article by lynn barkley burnett ...

ca reg: mandatory reporting of domestic violence by health care providers

women against abuse have a great: safety plan tips

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elder abuse

elder abuse and neglect are prevalent in our society, and yet it is estimated that only one in fourteen cases of elder abuse are reported to authorities. read our elder abuse section for fact sheets, guides and links to resources on elder abuse.

maybe one in 14 cases of actual elder abuse are reported but not all caregivers who are reported are abusers. the case with my father-in-law is a prime example. the woman came and dug around but she found absolutely no indications of abuse. i'm sure ours is not an isolated case.

again, call an elder law attorney who can tell you the real reasons aps exists.

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Specializes in nursery, L and D.

You never know what might make a person take that step out of an abusive relationship. It might be because she finally gets the courage. It might be because her family helps her. Or it might be because a nurse cared enough about it to report it, and someone goes out to investigate and gives her a card with the name of a shelter on it. Who knows. You will never feel good about this unless you do report it. It might make a difference. If not this minute, maybe in a year. Maybe she doesn't know what kind of help is out there and if someone were to tell her that places do exists for people in her situation she would leave. I would also do as other people have suggested and only allow the patient in for the assessment, and perhaps get some info regarding spousal abuse to hand out at visits.

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Absolutely you can report it......and anonymously.

o......Good Luck

Report what? That she has a "feeling" the woman is being abused. I like the way so many here are assuming that this is an abusive situation without first hand knowledge. Wait for your supervisor's return and discuss it then. If you go out on your own when the policy is using the chain of command you may end up fired. Especially if the patient subsequently sues you for defamation because while her husband is an obnoxious jerk she does not feel abused.

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Specializes in nursery, L and D.
Report what? That she has a "feeling" the woman is being abused. I like the way so many here are assuming that this is an abusive situation without first hand knowledge. Wait for your supervisor's return and discuss it then. If you go out on your own when the policy is using the chain of command you may end up fired. Especially if the patient subsequently sues you for defamation because while her husband is an obnoxious jerk she does not feel abused.

I think a suit for defamation wouldn't go very far. He did yell at her, answered questions for her and wouldn't allow her to answer questions, womans demeanor was timid, etc. Objective data, and the OP would be irresponsible not to do what was in her power to do. Maybe the woman doesn't "feel" abused. Maybe she isn't being abused, and her husband was just having a bad day and being snippy, who knows. But for everyone just to ignore it is the way a lot of woman (and some men) end up seriously injured or dead. If it were my daughter, or sister, or mother, the OP was suspecting of being abused, I'd want her to report it. Even if no abuse was occurring, its better safe than sorry. The couple in the OP can just laugh over the silly nurse that thought abuse was going on and go about their life. If she is being abused maybe she will get some much needed help. We wouldn't ignore it if she were a child, or an elderly person, would we?

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Specializes in ER.

You can ask him to leave for part of the exam, call her at home and ask her about your concerns, continue to document his and her behaviors.

By doing that you have expressed your concern for her, and let her know there is someone outside the family that is available to talk to- someone who knows the resources available.

If she wants help, follow her lead- ask her what she wants, and go over the options to get it done. When she is ready and what she wants-it is her call. If you force your way into the situation you may tip him off, and prevent her next attempt to get help.

APS with a consenting adult seems pretty useless to me. They can't force anyone to do anything anymore than you or I could.

Working in the hospital I just ask for a UA and step into the bathroom to "explain" how to obtain the sample. So far no husband has found an excuse to come too, something about women and bathrooms puts them off.:)

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I would report it. Have the husband step out telling him she needs a UA. Speak to the woman. She may deny the abuse but let her know that you are always there for her at any time if she wants to talk. Keep communication open. Also, by her husband responding to questions meant for the patient that is impeding medical care. The husband cannot possibly know how much pain the patient is in or how nauseated the patient is, color of urine (unless he sits in there with her). My heart goes out to this patient and everyone in her position. She is the one receiving medical care so she needs to answer the questions.

Maybe if he isn't hitting her and he gets reported he might change his ways. Might, but I won't hold my breath.

In response to some others posts, how many women who are abused show up at the hospital or police station proudly announcing that they are abused? None. I was abused for 2 years and was asked about it all the time. Each time I lied. Rarely anyone in an abusive relationship comes out until it's either too late or it get so horrible and they realize what they're really in. I'd hate for Dutchgirl to read about this patient in the newspaper. Just because you don't see bruises doesn't mean it's not abuse.

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Working in the hospital I just ask for a UA and step into the bathroom to "explain" how to obtain the sample. So far no husband has found an excuse to come too, something about women and bathrooms puts them off.:)

CanoeHead-

This is GREAT advice! And likely to work. I will remember this and hope to be able to recall your suggestion when necessary.

WG

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Sounds like the wife is afraid of her husband. However, making this situation better would have to be delicately handled or the womans situation could go from bad to worse. Much as we would like to have all women out of these situations individuals have to make their own decisions. Some of those decisions make little sense taken out of context from all else that is going on in a persons life. Sometime leaving is the most dangerous time of all.

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