Child and Elder Abuse Reporting
The topic chosen for this Discussion Board is child and elder abuse reporting. Elder abuse refers to intentional acts or omissions that cause or create a risk of harm for adults age 60 or older. It is most common for abuse to be perpetrated by caregivers or people whom the elder trusts. There are numerous types of elder abuse, including: physical, sexual, emotional or psychological, neglect, and financial (Centers for Disease Control and Prevention [CDC], 2022).(Comprehensive Essay Example on Child and Elder Abuse Reporting for Nursing Students) As a result of elder abuse, physical harm is sustained, depression is experienced, hospital referrals increase, hospitalizations occur more frequently, and mortality is more likely (Saghafi et al., 2019). The CDC defines child abuse and neglect as “any act or series of acts of commission or omission by a parent or other caregiver (e.g., clergy, coach, teacher) that results in harm, potential for harm, or threat of harm to a child” (What Is Child Abuse — National Child Abuse Coalition, n.d.). Similar to elder abuse, there are several types of child abuse, such as physical, neglect, sexual, emotional, and abandonment (What Is Child Abuse and Neglect? Recognizing the Signs and Symptoms, 2021).(Comprehensive Essay Example on Child and Elder Abuse Reporting for Nursing Students)
Comprehensive Essay Example on Child and Elder Abuse Reporting for Nursing Students
The article entitled “Examining the ethical challenges in managing elder abuse: a systematic review” aims to identify existing ethical challenges in elder abuse (Saghafi et al., 2019)(Comprehensive Essay Example on Child and Elder Abuse Reporting for Nursing Students). The study results indicated that there is no common definition of elder abuse or legislation regarding the issue, and that the ethical and legal conditions of the local community determine whether health care providers observe ethical principles. In the absence of a common definition and legislation, cultural and religious differences constitute the greatest obstacle to ensuring the rights of the elderly. Insofar as a person is competent, ethical principles should be observed. Health care providers, especially nurses as the primary care providers, function more efficiently when clinical guidelines related to this issue are localized (Saghafi et al., 2019).(Comprehensive Essay Example on Child and Elder Abuse Reporting for Nursing Students)
In accordance with WHO estimates, one out of six elderly people experiences abuse, and only one out of twenty-four abuse incidents are reported. Nursing teams and nurses are responsible for identifying and reporting mistreatments and assisting vulnerable populations such as the elderly, since awareness of abuse is affected by knowledge, expertise, and preparedness of caregivers. The abuse of older persons is an example of a violation of human rights and freedoms contributing greatly to the loss of human dignity, independence, and respect, as well as having significant implications for ethical principles such as autonomy, competence, beneficence, and nonmaleficence (Saghafi et al., 2019).(Comprehensive Essay Example on Child and Elder Abuse Reporting for Nursing Students)
It is often difficult to intervene in cases of abuse due to ambiguity and ethical concerns, since lack of professional principles may lead to issues of personal, legal, and ethical nature(Comprehensive Essay Example on Child and Elder Abuse Reporting for Nursing Students). A nursing professional and other members of the care team may have difficulty intervening effectively with an elderly individual who is willing to remain in an abusive environment. In the case of elder abuse, social, cultural, and religious aspects of life may be in conflict with living with an abusive family member or intimate partner, making it more challenging for the elderly to cope with abusive individuals. Furthermore, it has the potential to lead to job burnout as well as ethical distress among nurses and other members of the care team (Saghafi et al., 2019).(Comprehensive Essay Example on Child and Elder Abuse Reporting for Nursing Students)
Caregivers should take into account the importance of confidentiality and trust as a key ethical principle. As outlined in the APA ethical codes, a person should report suspected cases of elder abuse in accordance with the principles of beneficence, nonmaleficence, and respect for human dignity and rights. It is possible, however, for the care team to disclose an individual’s information without obtaining consent in cases where a serious harm has been caused. The study also reported that even if a therapist is concerned about a patient’s privacy, he or she should report the suspected abuse to authorities, such as the APS. Patients’ private information may be disclosed by psychologists in order to protect them from harm. However, they should attempt to involve the patient in the reporting process and only report relevant data in order to preserve the patient’s privacy to the greatest extent possible. It is essential that psychologists maintain the confidentiality of the information provided by the elderly suffering from cognitive disorders and seek legal assistance if necessary(Comprehensive Essay Example on Child and Elder Abuse Reporting for Nursing Students). However, patients’ information may be disclosed without their consent in suspected abuse cases. The psychologist is also permitted to share patient information with the latter’s family or with other experts in order to ensure that the patient is protected. The most significant obstacle to protecting the rights of elderly people is the lack of legislation in many countries. When dealing with abuse, the care team has access to ethical principles and laws that are outlined by experts to protect their profession (Saghafi et al., 2019).(Comprehensive Essay Example on Child and Elder Abuse Reporting for Nursing Students)
The article “Elder Abuse: Clinical, Ethical, and Legal Considerations in Social Work Practice” reviews clinical, ethical, and legal obligations to inform ethical decisions that arise as a result of the complexity of elder abuse cases (Donovan & Regehr, 2010). Several jurisdictions have instituted mandatory reporting and intervention measures in response to recent legislative changes regarding elder abuse. While this is the case, the concept of treating elderly individuals as if they are children in need of protection raises controversies regarding their right to self-determination(Comprehensive Essay Example on Child and Elder Abuse Reporting for Nursing Students). There is also a strong objection to the concept that elders should be treated as children in need of protection. Many barriers prevent elderly individuals from disclosing abuse. It could be that a person is unable to understand, unaware of the law, or unable to recognize that abuse is taking place for reasons such as diminished capacity to comprehend, ignorance of the law, or cultural differences (Donovan & Regehr, 2010)/(Comprehensive Essay Example on Child and Elder Abuse Reporting for Nursing Students)
There is also the possibility that senior citizens who have been abused are not aware of their legal and human rights. Providers have an important role to play in situations like this. In situations such as these, it is their responsibility and expectation to assist their clients in understanding that they have a right to have their basic human rights met and to make decisions regarding their well-being, health, and finances(Comprehensive Essay Example on Child and Elder Abuse Reporting for Nursing Students). Furthermore, providers involved in the care of abused elders must provide their clients with information regarding the range of choices available to remedy their situation as reflected in their culture, community, and philosophy. As a result, it is imperative that the professional has a thorough understanding of a client’s history, competency, professional code of ethics, as well as legal considerations before responding to cases of elder abuse (Donovan & Regehr, 2010).(Comprehensive Essay Example on Child and Elder Abuse Reporting for Nursing Students)
In the event that their jurisdiction has laws mandating the reporting of abuse, providers have a legal obligation to become knowledgeable about those laws in order to ensure that their clients are protected under the law. There is legislation in all US states authorizing Adults Protective Services (APS) to assist elders who have been abused(Comprehensive Essay Example on Child and Elder Abuse Reporting for Nursing Students). Under these laws, a system is established for reporting abuse and conducting investigations, as well as providing social services to assist victims. In addition, these laws generally stipulate mandatory reporting and condition certain individuals, such as health care professionals, bank tellers, and police officers to report suspected cases of abuse to the appropriate authorities (Donovan & Regehr, 2010).(Comprehensive Essay Example on Child and Elder Abuse Reporting for Nursing Students)
There is a great deal of variation in the statutes regarding abuse types, abuse definitions, reporting requirements, investigation procedures, and remedies for abuse. A majority of state laws cover physical abuse, neglect, and financial abuse, while some exclude psychological abuse, sexual abuse, and abandonment. There are states in which elder abuse is only covered as long as the elderly are living in the community, but there are also states that cover abuse that occurs in institutions. Abuse of this nature may be criminalized in some jurisdictions, whereas it may be considered a civil matter in others. The ethical responsibility to protect elderly clients extends to all health care and law enforcement professionals who interact with them. Thus, it is of utmost importance that healthcare professionals are aware of the laws in their state of employment in regard to abuse reporting, and that they collaborate with clients and prospective parties in order to devise the best plan in order to maintain the safety of the client (Donovan & Regehr, 2010).(Comprehensive Essay Example on Child and Elder Abuse Reporting for Nursing Students)
A study entitled “Challenges of reporting child abuse by healthcare professionals: A narrative review” determined barriers that healthcare professionals face when reporting child abuse (Shahhosseini & Azizi, 2017). A major social issue around the world is the abuse of children. When child abuse goes unreported, it may exacerbate the situation and create a greater likelihood of additional abuse occurring(Comprehensive Essay Example on Child and Elder Abuse Reporting for Nursing Students). The results of this study outlined the challenges into four categories: individual barriers, interpersonal barriers, organizational barriers, and situational barriers (Shahhosseini & Azizi, 2017).(Comprehensive Essay Example on Child and Elder Abuse Reporting for Nursing Students)
Individual barriers include: knowledge of healthcare professionals, their attitudes and beliefs, their inadequate experiences, and uncertainty of the diagnosis. Health care professionals’ knowledge of child abuse is among the strongest predictors of child abuse reports. In other words, healthcare professionals’ knowledge of the rules, procedures, and ways to report child abuse plays an important role when determining whether to file a report. It has been demonstrated that employees who have previously received training in recognizing and reporting child abuse are more likely to do so. Healthcare professionals seem to be influenced by their previous experiences with reporting child abuse when making the decision to report it. Studies have also suggested that other factors, such as threats of violence or retaliation by the child’s family, or fears of their dissatisfaction, may affect their decision-making. A child maltreatment report can be influenced by the inexperience and ineffective interview techniques of healthcare professionals. There is evidence that many health professionals avoid handling sensitive issues, such as child abuse and neglect, due to the difficulty of proving the abuse or neglect of a child or the fear of an inaccurate diagnosis or judgment (Shahhosseini & Azizi, 2017).
Interpersonal barriers, such as fear of disconnecting therapeutic relationships and violation of privacy and secrecy principles, also factor into reporting child abuse. In the experience of service providers, families of exploited children may not seek necessary health care after reporting child abuse. These families stand to lose health services, as well as the opportunity for healthcare professionals to monitor the condition of the child. It is also believed that parents are discouraged from bringing their children to receive medical treatment because of mandatory reporting by healthcare professionals in case there is future abuse. Accordingly, some individuals believe that child protective services should only be used when they are in the best interest of the child and their family. Many healthcare professionals are against the mandatory reporting of child abuse as it undermines the confidentiality of the relationship between the therapist and the patient. According to them, such a practice could cause a rupture in the therapeutic relationship, ultimately leading to a loss of confidence on the part of children and their families (Shahhosseini & Azizi, 2017).(Comprehensive Essay Example on Child and Elder Abuse Reporting for Nursing Students)
Organizational barriers for health care professionals could include poor communication and weak legal processes for reporting. Collaboration between healthcare professionals and social workers is a key element of child protection intervention. There is often a lack of confidence in the child protection system(Comprehensive Essay Example on Child and Elder Abuse Reporting for Nursing Students). There are several reasons for this lack of trust, including the inadequate interaction between child protection systems and health care professionals and the lack of detailed information regarding the progress and follow-up of exploited children in the healthcare system. Situational barriers, such as the victims’ characteristics and available evidence, also prove to be difficult to navigate when determining whether to make a child abuse report. One victim characteristic that influences reporting is their age. Healthcare professionals tend to report abuse more often when the victim is younger than 16 years of age. The likelihood of health professionals reporting mild abuse is also lower (Shahhosseini & Azizi, 2017).(Comprehensive Essay Example on Child and Elder Abuse Reporting for Nursing Students)
The article, “Legal and policy issues from the United States and internationally about mandatory reporting of child abuse” reviews international norms associated with mandatory reporting of child abuse and assesses court cases within the United States that involve mandatory reporting, identifying important issues and underlying problems with the current mandatory reporting system (Liu & Vaughn, 2019)(Comprehensive Essay Example on Child and Elder Abuse Reporting for Nursing Students). The Federal Child Abuse Prevention and Treatment Act (CAPTA) requires each State to have provisions or procedures for requiring certain individuals to report known or suspected instances of child abuse and neglect. Individuals included in this category are health care professionals, including nurses, teachers, and law enforcement officers. Mandatory reporting of child abuse has been questioned with respect to its effectiveness and its ability to identify maltreatment and abuse. Child abuse is defined broadly and leads to a high number of unfounded accusations. To notify Child Protective Services (CPS) of suspected child abuse, a mandatory reporter must only have “reasonable suspicion.” Studies have found, however, that individual interpretations of reasonable suspicion of suspected child abuse vary considerably (Liu & Vaughn, 2019).(Comprehensive Essay Example on Child and Elder Abuse Reporting for Nursing Students)
Individuals’ perception of child protection services, their personal experiences with abuse, and the circumstances of individual cases influence their understanding, interpretation, and application of their responsibility to report suspected child abuse. According to the inconsistency in the thresholds of mandatory reporting for individuals, more training and education should be focused on standardizing how reasonable suspicion is interpreted, so that mandatory reporters possess more uniform guidelines for reporting abuse of children. A lack of clarity in the statutory language regarding the threshold triggering mandatory reporting, such as the use of nebulous, abstract, and obscure terms, such as “reasonable suspicion,” “reasonable grounds for suspicion,” and “reasonable belief.” There is a great deal of confusion surrounding these terms, and they mean different things to different people (Liu & Vaughn, 2019).(Comprehensive Essay Example on Child and Elder Abuse Reporting for Nursing Students)
It has been reported that a significant number of professionals in the U.S. are inadequately trained in regard to policies regarding mandatory reporting and indicators of child abuse. According to another study, despite receiving bi-annual training about mandatory reporting, many professionals remained unclear about these requirements. Reporting failure was attributed to participants’ fear of making inaccurate reports, misinterpreting cultural discipline styles, and compounding adverse consequences. The study also found that more than half of the participants were unaware of the potential consequences of failure to report a crime, such as fines and jail time. In addition, some reporters fail to report child abuse because they lack sufficient evidence, are uncertain about the signs and symptoms of abuse, or are afraid that doing so would result in negative consequences and liability. In general, mandatory reporters have expressed frustration over a lack of knowledge about how Child Protective Services operates, expressed uncertainty regarding current legislation requirements, expressed confusion over the burden of proof required to report suspected child abuse, and expressed demoralization because there was inadequate funding for effective investigations into child abuse. (Liu & Vaughn, 2019).(Comprehensive Essay Example on Child and Elder Abuse Reporting for Nursing Students)
Implications for Practice
Kentucky’s law requires mandatory reporting of child abuse, neglect, and dependency (KRS 620) and the abuse, neglect, or financial exploitation of adults who have a physical or mental disability and are unable to protect themselves; this might include an elderly person (KRS 209) (Mandatory Reporting, 2016). As a PMHNP, it is my responsibility to understand the Kentucky state laws regarding child and elder abuse, how to report abuse appropriately, and consider the ethical implications that may occur in these situations. I will attend trainings that aid in my understanding of the laws regarding abuse, implications of abuse, signs and symptoms of abuse, and how to report abuse formally. As a PMHNP, I must also be able to assess patients who are in abusive situations and develop an appropriate treatment plan to maximize positive outcomes for the patient. When assessing a patient for abuse, I should always keep in mind the patient’s risk level, presenting problems, treatment plan goals with the highest priority, which is always patient safety, and the impact of intervention on the patient (Saghafi et al., 2019). Every abuse situation will present differently, however, as long as I adhere to the laws and my principles, the outcome of reporting abuse should remain the same.(Comprehensive Essay Example on Child and Elder Abuse Reporting for Nursing Students)
References
Centers for Disease Control and Prevention. (2022, April 14). Fast facts: Preventing elder abuse. https://www.cdc.gov/violenceprevention/elderabuse/fastfact.htmlLinks to an external site.(Comprehensive Essay Example on Child and Elder Abuse Reporting for Nursing Students)
Donovan, K., & Regehr, C. (2010). Elder abuse: Clinical, ethical, and legal considerations in social work practice. Clinical Social Work Journal, 38(2), 174–182. https://doi.org/10.1007/s10615-010-0269-2Links to an external site.(Comprehensive Essay Example on Child and Elder Abuse Reporting for Nursing Students)
Liu, B., & Vaughn, M. S. (2019). Legal and policy issues from the united states and internationally about mandatory reporting of child abuse. International Journal of Law and Psychiatry, 64, 219–229. https://doi.org/10.1016/j.ijlp.2019.03.007Links to an external site.(Comprehensive Essay Example on Child and Elder Abuse Reporting for Nursing Students)
Mandatory reporting. (2016). The Kentucky Coalition Against Domestic (Comprehensive Essay Example on Child and Elder Abuse Reporting for Nursing Students)Violence. https://kcadv.org/resources/laws/mandatory-reporting#:~:text=Kentucky%20law%20requires%20mandatory%20reporting,elderly%20person%20(KRS%20209).Links to an external site.
Saghafi, A., Bahramnezhad, F., Poormollamirza, A., Dadgari, A., & Navab, E. (2019). Examining the ethical challenges in managing elder abuse: A systematic review. Journal of medical ethics and history of medicine, 12, 7. https://pubmed.ncbi.nlm.nih.gov/31346400/Links to an external site.(Comprehensive Essay Example on Child and Elder Abuse Reporting for Nursing Students)
Shahhosseini, Z., & Azizi, M. (2017). Challenges of reporting child abuse by healthcare professionals: A narrative review. Journal of Nursing and Midwifery Sciences, 4(3), 110.(Comprehensive Essay Example on Child and Elder Abuse Reporting for Nursing Students)
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