Module 5

Nurse Responses to Elder MistreatmentAn IAFN Education Course

Ethical Issues in in Elder

Mistreatment Cases

Patient-Centered Care

Patients play an integral role in clinical decision-making process

Customize nursing responses in each case based on patient needs and concerns

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By the end of this module, participants will be able to:

Discuss key ethical issues in nursing responses to elder mistreatment (EM)—

o Patient-centered careo Timeliness of responseo Compassionate care o Safety planningo Patient self-determination o Informed consent and confidentiality

Describe how to facilitate safety planning

Learning Objectives

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Case: Mrs. Martin

Issues/actions needed in case related to: o Suspected mistreatment and timeliness of response?

o Compassionate patient care?

o Patient safety?

o Patient self-determination, informed consent and confidentiality?

o Nursing responses adapted to patient’s needs and circumstances?

o Nursing skills to address presenting medical conditions?

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Case: Mrs. Martin (cont.)

How would changes to scenario impact needed actions? o The patient has no delirium

o The patient is younger and less frail

o There are indicators that the patient is also being sexually abused

o A husband rather than son is involved

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Focus on Patient

Patients are central participants in EM cases

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Regardless of practice setting, suspicions of EM must be acted on in timely fashion

Timeliness

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Compassion

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Being compassionate with patients can make a critical difference in outcomes of nursing response in these cases

Help older patients be as comfortable as possible

Patient Autonomy

Respect patient’s right to self-determination related to medical care and reporting, to extent possible

Seek informed consent for assessment, treatment, evidence collection and other interventions

Follow related practice setting policies and procedures

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Follow practice policy and procedures

When patient is temporarily incapacitated, it may be proper to render usual nursing care unless there is evidence that the person would not want it

In other situations, there is a legal determination that the person is incompetent and a guardian is appointed

Last two bullets: S. Westrick, S. Westrick Killion & K. Dempski, Essentials of nursing law and ethics, 2008

Patient Lacks Decision-Making Capacity?

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Talking with patients in private to hear their account of what happened/assess decision-making capacity

Locating guardian/surrogate to act on patient’s behalf

Challenges Related to Decision-Making

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Challenges: Decision-Making (cont.)

When no prior determination of capacity or legal guardian assigned, legal process takes significant time

Concern that guardian is not making decisions in best interest of patient

Suspect guardian of mistreating patient

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Maintain confidentiality of medical records by not releasing information about patient unless required to do so (e.g., mandatory reporting) or patient/legal guardian gives permission

Confidentiality

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Ask patient questions and look and listen to understand unique needs and circumstances and then tailor care

Develop geriatrics expertise

Know community resources

Actively participate in multidisciplinary team responses to elder mistreatment

Additional Ethical Issues

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Safety Planning

A process where helper and victim together create plan to enhance safety

National Clearinghouse on Abuse in Later Life, Anticipate: Identifying victim strengths and planning for safety concerns , 2003

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Safety Plan: Mrs. Kennedy

Prevention strategies? Protection strategies? Notification strategies? Referrals/services? Emotional support strategies?

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Safety Planning

Begins with first encounter with patient through discharge/care transition

Prompt safety planning questions at appropriate times

Follow agency policy if there is concern about safety while patient is in your facility

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Patient-Driven Planning

Patients should develop their own safety plans, to extent possible

A process, not a one-time activity

Nurses should be willing to help patients with planning and/or connect them with professionals with expertise in safety planning process

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Safety Planning Steps

Build rapport and listen to patients Help patients identify fears, obstacles, threats,

barriers to safety, and effective past safety strategies Ask what patients want to do to be safer and why Together, think creatively about a variety of options

and ideas, keeping in mind that patients need to consider their safety in numerous situations

Build a plan that is patient-centered, regardless of circumstances B. Brandl, C. Bitondo Dyer, C. Heisler, J. Marlatt Otto, L. Stiegel & R. Thomas, Elder abuse detection and intervention: A

collaborative approach, 2007; National Clearinghouse on Abuse in Later Life, Anticipate, 2003; and National Clearinghouse on Abuse in Later Life, Interactive training exercises on domestic abuse in later life, 2003

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Closing Assessment

What have you learned from this module that you can apply to your practice setting?

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