Module 5 Nurse Responses to Elder Mistreatment An IAFN Education Course

1. Module 5Nurse Responses to Elder MistreatmentAn IAFN Education Course Ethical Issues in in Elder Mistreatment Cases

2. 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

3. Learning Objectives By the end of this module, participants will be able to: • Discuss key ethical issues in nursing responses to elder mistreatment (EM)— • Patient-centered care • Timeliness of response • Compassionate care • Safety planning • Patient self-determination • Informed consent and confidentiality • Describe how to facilitate safety planning

4. Case: Mrs. Martin • Issues/actions needed in case related to: • Suspected mistreatment and timeliness of response? • Compassionate patient care? • Patient safety? • Patient self-determination, informed consent and confidentiality? • Nursing responses adapted to patient’s needs and circumstances? • Nursing skills to address presenting medical conditions?

5. Case: Mrs. Martin (cont.) • How would changes to scenario impact needed actions? • The patient has no delirium • The patient is younger and less frail • There are indicators that the patient is also being sexually abused • A husband rather than son is involved

6. Focus on Patient • Patients are central participants in EM cases

7. Timeliness • Regardless of practice setting, suspicions of EM must be acted on in timely fashion

8. Compassion • Beingcompassionatewith patients can make a critical difference in outcomes of nursing response in these cases • Help older patients be as comfortable as possible

9. 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

10. Patient Lacks Decision-Making Capacity? • 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. WestrickKillion & K. Dempski, Essentials of nursing law and ethics, 2008

11. Challenges Related to Decision-Making • 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

12. 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

13. Confidentiality • 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

14. Additional Ethical Issues • 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

15. 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

16. Safety Plan: Mrs. Kennedy • Prevention strategies? • Protection strategies? • Notification strategies? • Referrals/services? • Emotional support strategies?

17. 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

18. 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

19. 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

20. Closing Assessment • What have you learned from this module that you can apply to your practice setting?