Abuse and Neglect

Many clients endure abuse and/or neglect in silence, yet some seek help in various healthcare settings. As the largest group of healthcare professionals, nurses, in collaboration with team members, can assist victims and suspected victims of abuse or neglect.

In this learning experience, learners will gain knowledge about nursing considerations for clients who are, or are suspected to be, victims of abuse or neglect, as well as planning and evaluating interventions for these individuals.

2.1 Assessment of Clients for Abuse or Neglect

Nurses are required to assess all clients for abuse and/or neglect. To effectively carry out this responsibility, they must understand the various types of abuse and neglect, along with their associated risk factors and signs and symptoms (Burke, 2023). Additionally, they need to be well-versed in their state's laws regarding the reporting of suspected or confirmed abuse (Kaplan Nursing, 2023a) and be familiar with the policies and procedures of their respective healthcare facilities.

Types of Abuse or Neglect

Abuse and neglect can be physical, psychological, or financial encompassing types such as physical, psychological, sexual abuse, and financial abuse or neglect (Burke, 2023; Kaplan Nursing, 2023a). Elder abuse is the term used when the victim is elderly. These forms of abuse and neglect can also occur in children (Burke, 2023). Nurses are obligated to report any suspected child abuse to the appropriate authorities and document it in the client's electronic health or medical record Kaplan Nursing, 2023a). According to Burke (2023):

• In physical abuse or neglect, abuse might involve actions like punching, limb twisting, or burning. Neglect is characterized by the failure to meet the physical needs of the client by the person responsible for their care.
• Psychological abuse or neglect includes threatening harm, bullying, or confining the abused to a room. Neglect in this context may involve isolating the client at home away from their family.
• In cases of sexual abuse, sexual acts are performed without one of the clients' consent.
• Financial abuse or neglect occurs when a client's funds are withheld or misused, such as when a power of attorney does not use the funds for the client's needs. Neglect can also be manifest when the party responsible fails to use the client's money to meet their needs.

Clients who have experienced abuse often become perpetrators themselves; they are most likely to abuse and/or neglect others (Burke, 2023). These individuals are also prone to engage in spousal abuse or batter, perpetuating a "cycle of violence" or "cycle of battering". The four stages of the cycle of violence are this cycle include:

• The Honeymoon Phase: Where there is a period of peace between the couple.
• The Tension-Building Stage: During which tension escalates within the relationship.
• The Violence Stage: When the perpetuator is triggered, leading to abusive actions.
• The Reconciliation Phase: When the couple reconciles. However, they often find themselves repeating the cycle of violence.

General Risk Factors for Abuse or Neglect

According to Burke (2023), the clients groups identified as being at high risk for abuse and/or neglect include:

• Infants.
• Children.
• The elderly.
• Females.
• Pregnant women.
• Additionally, clients with the following conditions are also at increased risk:  
• Cognitive impairment.
• Developmental challenge.
• Disabilities, whether mental or physical.

Furthermore, specific risk factors unique to child, elder, and spousal/domestic abuse are detailed in Table 1.

Table 1

Some Risk Factors for Child, Elder, and Spousal/Domestic Abuse

Adapted from Kaplan Nursing. (2023a). Next Generation NCLEX-RN Prep 2023-2024: Practice Test + Proven Strategies (9th ed.). Kaplan Test Prep.

Signs and Symptoms of Abuse or Neglect

The signs and symptoms of abuse/neglect, as outlined in Table 2, are identified and observed during the nursing assessment (Kaplan Nursing, 2023b). Nurses are advised to conduct interviews and physical examinations, whenever feasible, to minimize the perpetuator's influence on the victim's responses (Kaplan Nursing, 2023b). Beyond inquiring about signs and symptoms, it is crucial for nurses to question victims and those suspected of being victims about the presence of weapons in their homes and any substance abuse issues (Kaplan Nursing, 2023b). This information is essential as it may indicate whether it is safe for them to return to their environment.

Table 2

Assessment Findings of Signs or Symptoms of Child and Spousal or Domestic Abuse

Adapted from Kaplan Nursing. (2023b). NCLEX-RN Content Review Guide: Preparation for the NCLEX-RN Examination (9th ed.). Kaplan Test Prep.

2.2 Planning Interventions for Victims/Suspected Victims

Nurses' ought to devise interventions for victims and those suspected of being victims of abuse and/or neglect, guided by their assessment findings and as directed by the healthcare provider (Burke, 2023). Additionally, these cases should be reported to the relevant agency or agencies, as mandated by law (Burke, 2023; Kaplan Nursing, 2023b) and in accordance with healthcare policies and procedures.

• Physical interventions can include specific nursing care for physical injuries, such as:
• Treating burns in a child or adult.
• Providing fluid and nutrition to an elderly client who is dehydrated and has a poor nutritional status.
• Managing a fractured femur in a client who has been abused by a spouse.
• Psychosocial needs of abuse or neglect victims can be addressed through the following measures:
• Ensuring a safe environment, which may involve:
• Law enforcement relocating a child to a safer setting.
• Removing an elderly client from an unsafe environment to protect them.
• Making plans for their safety.
• Identifying and utilizing community resources.
• Referring abused spouses and intimate partners to safe houses.
• Directing individuals to support groups.
• Additionally, nurses and healthcare team members should embody the qualities of being:
• Supportive.
• Trustworthy.
• Nonjudgmental.

As nurses work to assist these clients affected by abuse and/or neglect, it's crucial to also provide them with coping strategies and skills to manage the trauma associated with these experiences (Burke, 2023). Additionally, the designated or appropriate healthcare team member should emphasize that the cycle of violence can be broken if the victim chooses to leave the abuser (Burke, 2023). Importantly, abusers also need coping strategies; they can be encouraged to participate in anger management and/or parenting classes, as relevant (Burke, 2023). For emotional support for children, play therapy can be an effective method to help them in express their feelings (Kaplan Nursing, 2023b).

2.3 Evaluate Interventions for Victims/Suspected Victims

Nurses are responsible for assessing the effectiveness of the interventions implemented for victims or suspected victims of abuse and neglect (Burke, 2023; Kaplan Nursing 2023b). This evaluation should consider aspects such as:

• The safety of clients.
• Healing progress of physical injuries.
• Stabilization of any imbalances.
• Development and implementation of safety plans.
• Positive reactions to psychological support and interventions.
• Clients' perceptions of support and assistance through psychological interventions.

Upon conclusion of this learning experience, the learner will have gained knowledge in assessing clients for abuse and/or neglect and implementing and evaluating nursing care plans. The primary objectives include facilitating success on the NCLEX exam and enhancing professional competency in the workplace.

After reviewing the provided resources, identify the specific areas for improvement and concentrate on them.

• Burke, A. (2023, October 9). Abuse and Neglect: NCLEX-RN. https://www.registerednursing.org/nclex/abuse-neglect/
• Kaplan Nursing. (2023a). Next Generation NCLEX-RN Prep 2023-2024: Practice Test + Proven Strategies (9th ed.). Kaplan Test Prep.
• Kaplan Nursing. (2023b). NCLEX-RN Content Review Guide: Preparation for the NCLEX-RN Examination (9th ed.). Kaplan Test Prep

Readings

• Robinson, L., Saison, J., & Segal, J. (2024, February 5). Elder Abuse and Neglect. https://www.helpguide.org/articles/abuse/elder-abuse-and-neglect.htm

Videos

• Centers for Disease Control and Prevention. (2018, August 1). What are Child Abuse and Neglect? [Video]. YouTube. https://youtu.be/6kcKX2In0B0