Martin Chitwood:

As nurses, our job is to nurture and heal our patients anyway we can. As medical professionals, and caregivers for our patients, abuse is something that’s hard to imagine.

If you are treating a patient who shows signs of having been abused by a parent, family member, domestic partner, or a worker in a long-term care facility, reporting it isn’t just the ethical thing to do: you also have a legal obligation. Abuse can be physical, verbal, or psychological.

Here’s what you need to know about the signs of abuse, and what you need to do to report it.

Abuse Takes Many Forms

When people think of abuse, they often think of physical abuse. However, abuse can take many forms, all of which are psychologically devastating for the victims. Here are some of the most common types of abuse, and the signs that this abuse is happening. While children and the elderly are at increased risk of abuse by those around them, adults can also be victims of domestic abuse.

Physical Abuse

Physical abuse is defined as the use of physical force in a way that causes pain or injury. Striking, hitting, pushing, shoving, slapping, or shaking someone can qualify as physical abuse. Things like inappropriate use of drugs, force feeding, or even reckless driving can also be forms of physical abuse.

Some of the signs that someone may be a victim of physical abuse include:

• Bruises, black eyes, welts, or lacerations
• Bone or skull fractures
• Sprains and dislocations
• Internal injuries or bleeding
• Broken eyeglasses
• Signs of having been restrained
• Human bites
• Pulled hair or bald spots
• Head trauma
• Cigarette burns
• Laboratory findings of either medication overdose, or underuse of prescribed medications

Along with physical signs of abuse, there are also behavioral indicators:

• Sudden changes in behavior or demeanor, such as withdrawal, aggression, or depression
• Inappropriate or excessive fear of a parent or caretaker
• Antisocial behavior, such as drug abuse, truancy, or running away
• Excessive lies
• Unusual shyness or wariness of physical contact
• Reports of being hit or mistreated

Sexual Abuse

Sexual abuse is any forced or nonconsensual sexual activity of any kind. Physical indicators of sexual abuse, particularly in minors, include:

• Torn, stained, or bloody undergarments
• Unexplained and frequent sore throats, yeast infections, or urinary tract infections
• Somatic complaints, such as irritation of the genitals
• Sexually transmitted diseases
• Bruises or bleeding from genitalia or anal region
• Pregnancy

As with physical abuse, there are also behavioral indicators, some of which are subtle.

• Regressive behaviors in children, such as bedwetting or thumb sucking
• Inappropriate promiscuity or seductive behaviors
• Disturbed sleep patterns
• Unusual or age-inappropriate interest in sex and sexuality
• Avoidance of undressing
• Decline in school performance
• Difficulty sitting or walking

Emotional Abuse

Emotional abuse can be subtle, and difficult for medical professionals to recognize and identify. It is the infliction of anguish, pain, or distress through verbal assaults, threats, intimidation, and other non-physical means. It can have lasting effects on a person’s self-esteem and mental health.

There are a few physical indicators that can point toward emotional abuse, despite its primarily non-physical nature:

• Eating disorders, including obesity, anorexia, or bulimia
• Speech disorders, like stammering or stuttering
• Developmental delays in speech or motor skills
• Weight or height substantially below normal
• Nervous disorders of a somatic nature, such as hives, tics, or stomach aches

Behavioral indicators include:

• Habit disorders, such as rocking or head-banging
• Cruel behavior, such as pleasure taken in harming people or animals
• Emotional upset or agitation
• Withdrawn demeanor

Neglect

Neglect is also a form of abuse, especially when children or the elderly are the victims. Unfortunately, neglect of elders is frighteningly common in nursing homes. Some of the physical signs of ongoing neglect in a child or senior include:

• Poor hygiene
• Squinting
• Unsuitable clothing
• An untreated illness or injury
• Lack of immunizations or necessary medications
• Indicators of prolonged exposure to the elements, such as sunburn or insect bites
• Malnutrition
• Dehydration
• Hazardous or unsafe living conditions, such as not having running water or heating
• Unsanitary living conditions

Some of the behavioral indicators that neglect is taking place include:

• Age-inappropriate behaviors in children, such as bedwetting or self-soiling
• Withdrawn demeanor

Financial Abuse

Financial abuse is a form of abuse that’s often carried out against geriatric patients. It’s probably the least well-known form of abuse, but it’s frighteningly common, and it’s something that you, as a nurse, can report to the proper authorities.

Signs of probable financial abuse include:

• Sudden changes in a person’s bank account or banking practice, such as an unexplained withdrawal of a large sum
• Inclusion of additional names on a bank card
• Unauthorized withdrawal of funds using the person’s ATM card
• Abrupt changes in a will, advance directive, or other documents
• Substandard care or unpaid bills, despite the availability of adequate finances
• An unexplained sudden transfer of assets to someone
• The person reporting financial exploitation

Your Legal Obligations

If you have evidence that a patient is the victim of abuse, you must report it. While state laws vary, you most likely have a legal obligation to do so.

If a child is being abused, you should contact your local Child Protection Services. If a person between 18 and 22 is mentally disabled, they are still considered a child, and so contacting CPS is still appropriate.

If you suspect elderly abuse, you may be subject to specific laws in your state. In New Hampshire, for example, elderly abuse is covered under the Adult Protection Law. If you have reason to believe that a geriatric patient is being subject to abuse or neglect, you must contact the Bureau of Elderly & Adult Services.

If you’re not sure where to report elderly abuse, look for specific regulations and agencies in your state of residence. Similar state-level regulations also govern reporting abuse of a disabled person.

If you suspect domestic violence, serious injuries like burns or gunshot wounds should be reported to the police. A safety plan should be discussed with the patient and documented.

Helping Patients Who May Be Abuse Victims

While specific laws and regulations vary from state to state, almost all US states require nurses, physicians, and other healthcare professionals to report suspected abuse. Not only is it the ethical thing to do, but it may also be a legal requirement. Never hesitate to say something to the appropriate authorities if you suspect that one of your patients has been the victim of abuse.

You can connect with Martin Chitwood by visiting his official website for more information, or via social on Linkedin, Facebook or Twitter page.