Unit 3: Knowledge Centred Nursing Service and Support Flashcards
Narrative Competence
The ability to acknowledge, absorb, interpret, and act on the stories we hear
Objectivity in Parentheses in relation to narrative competence
everyone has differing interpretations of reality
Narrative Horizon:
Patient’s subjective experience, showing up with authentic curiosity and seeing a hope for the future
Narrative Construction:
Actively listening to story, understanding of sociocultural context, respecting diversity
Medical Relationship
empathy, patient-centred care, facilitating and empowering
Medical Care
responsive, timed, reflected
4 components of narrative competency
- narrative horizon
- narrative construction
- medical relationship
- medical care
Reduction of suffering can be accomplished through the use of three main techniques:
deconstruction, externalization and re-authoring
Deconstruction
whole story, listen to what they’re not saying
Externalization
put it into context, depersonalize it from defining them, someone experiencing a problem, they are not the problem
re-authoring
rewrite story to create hope
5 Disciplines of Servant Leadership
- Values people
- Develops people
- Builds community
- Provides leadership
- Displays authenticity
Roles of Nurse in Family Centred Rounds
- coach, orient and prepare patient
- advocate and address patient concerns
- speak early to provide critical information
- Speak often to share thoughts or concerns, suggestions, and nursing therapeutics
- Ask questions to create a shared mental model and create opportunities for change (CFIM)
How is caregiving a universal experience?
There are only four kinds of people in this world:
ü those who have been caregivers;
ü those who currently are caregivers;
ü those who will be caregivers and
ü those who will need caregivers.
Define informal caregiver
Someone who cares for and gives unpaid support to a family member, friend, or neighbour who is frail, ill, or disabled and who lives at home or in a care facility.
What is the outpatient medical care setting in family caregiving?
Home
When do the caregiving responsibilities usually intensify
At end of life
Define caregiver strain
difficulty with duties and responsibilities associated with the caregiver role. Juggling with the number of technical tasks.
Define caregiver burden
alterations in caregiver’s emotional and physical health that can occur when care demands outweigh available resources
Can caregiver strain exist without burden
Yes
Caregiver wellbeing is felt when we balance our
demands and resources
Caregiver stress occurs when
demands are not balanced with resources
_____________to resources/supports that are in place can occur with prolonged caregiver status.
Desensitization
_________ Canadians aged 15 and over, are caregivers for someone with a chronic health problem
3 in 10
What gender is most likely to be a caregiver
Women
_____ of caregivers state they are not receiving as much support as they need
42%
39% of family caregivers are caring for their
mother or father
______ canadians are a caregiver ______ will become one
1 in 4
1 in 2
What is the CCCE
Canadian Centre for Caregiving Excellence
Supports caregivers across Canada
Saskatchewan is one of only provinces without caregiver support network
4 Most Prevalent Problems for Caregivers in Canada
- Current supports not meeting needs
- Services for care givers and recipients are insufficient and fragmented
- Leaves of absence and other protections are inadequate
- Financial supports are insufficient and ineffectively designed
Objective Measures of Caregiver Burden
- number of hours providing care
- type of tasks
Subjective Measures of Caregiver Burden
- emotional distress
- depressive symptoms
RAISE caregivers
R - recognize
A - assist
I - include
S- support
E - engage
3 Evidence Based Caregiver Interventions Recommended for Practice
- Cognitive Behavioural Interventions
- Psychoeducation Interventions
- Supportive Interventions
Cognitive Behavioral Interventions for Caregivers
draw on the principles of CBT
The interventions are aimed at helping the caregiver identify negative thoughts, beliefs, and behaviors so that they can be altered in a positive way
Psychoeducational Interventions for Caregivers
a focus on providing education in combination with other activities, such as counseling or support, that are delivered in a variety of methods to the caregiver or the patient–caregiver dyad, as well as individually or in a group setting
Examples of Psychoeducational Interventions for Caregivers
Education
Counselling
Anticipatory Guidance
Supportive Care Interventions for Caregivers
that provide emotional support to caregivers, with the goal to build rapport with them and/or provide a safe space to discuss feelings and learn problem-solving techniques.
Examples of Supportive Care Interventions for Caregivers
structured/unstructured support, counselling, active listening, presence
6 Necessities for Canada Meeting the Needs of Family Caregivers
- safeguard caregiver health and wellbeing
- increased respite
- increased caregiver assessment to sustain their contributions
- financial support
- access to info and training
- job protection and income support
Caregiver Resilience
Ability to adapt or to improve one’s own conditions following experiences of adversity
Define watershed moment
an important event that changes the direction of history.
Crossroads of past and future
Advanced Care Planning
The goal of an advance care planning discussion is to ensure that clinical care is consistent with the person’s expressed preferences and wishes.
Bereavement
the experience of losing someone important to us. It is characterised by grief, which is the process and the range of emotions we go through as we gradually adjust to the loss.
Hospice Palliative Care
Hospice is comfort care without curative intent
Instructional Directive
a document you use to tell your physician and family about the kinds of situations you would want or not want to have life-sustaining treatment in the event you are unable to make your own healthcare decisions.
Proxy/Substitute Decision Maker
a designated person authorized to make decisions on behalf of a patient who is unable to make important decisions about their own personal care
How does the palliative approach refer to the family
As the unit of care
Those closest to the patient in knowledge, care, and affection
What does palliative care seek to do?
improve a person’s quality of life once a chronic, life-limiting condition is diagnosed.
When does palliative care continue into?
until death and into family bereavement and care of the body.
Where is palliative care provided?
in all primary care settings, including homes, ambulatory clinics and other community settings, and in all tertiary care settings, including hospitals, hospices and long-term care facilities.
5 Palliative Care Principles
- dignity
- hope
- comfort
- quality of life
- relief of suffering
Define palliative approach
The use of palliative care principles with people facing life limiting conditions at ALL stages - not just end of life
What does a palliative approach reinforce?
- personal autonomy
- right for persons to be actively involved in care
- greater sense of control for individuals and family
The palliative approach does not link the provision of care with
Prognosis
Specialized Palliative Care
involves a specialist palliative care team or health professional to augment palliative care
In what 2 ways does specialized palliative care augment palliative care?
- assessing and treating complex symptoms
- providing information and advice to staff about complex issues
Palliative care provides relief from:
pain and other distressing symptoms
Palliative care affirms _____ and regards dying as a _______
affirms life and regards dying as a normal process;
Palliative care provides a ________ to help the family cope during the patient’s illness and in their own _________
support system
bereavement
Palliative care is applicable _____ in the course of illness, in conjunction with other _________________, such as chemotherapy or radiation therapy, and includes those investigations needed to better ________________
Early
therapies that are intended to prolong life
understand and manage distressing clinical complications
Describe the Canadian Hospice Palliative Care Association model from the time of diagnosis to patient’s death
Presentation: as many therapies as possible
Illness progress: curative therapies decreases and therapies to relieve suffering/increase quality of life increase
Focus of care movement in Canadian Hospice Palliative Care Association model
Focus of care moves toward family for anticipation of death
A lack of what can lead to complex grief?
Anticipation
True or False: palliative care includes physician assisted death
False
What is a good death
Variations in which individuals perceive as good
Trends toward death midwifery, death cafes, dignity and comfort with death
6 Components of Palliative Performance Scale
- Ambulation
- Activity level/evidence of disease
- Self-care
- Intake
- Level of Consciousness
- Estimated median survival in days
6 Guiding Principles for Conducting Palliative Family Meetings
- goals of care
- sharing of information
- based on need
- be resource effective/triage of priorities
- preventative approach to avoid crisis and conflict
- are offered routinely on admission and prn
What 4 things do families want out of family meetings?
- process attributes
- information content
- hope and control
- information divergency
What process attributes do families want from palliative family meetings?
o Process matters more than content
o Well-paced
o Active Listening
What information content do families want from palliative family meetings?
o Specifics about what lies ahead (estimated time)
What hope and control do families want from palliative family meetings?
o Sense that family can contribute in some way ex) hold his hand
o Maintain professional honesty
o Reasonable and respectful family involvement
What information divergency do families want from palliative family meetings?
o Cannot just have family meeting and let it go
o Increased updates to family as new information comes forth
o Meeting needs of each family member
Current Palliative Trends in Society
- Death-phobic
- Families under a lot of stress
- Demand for euthanasia and new legislation
- Dying not well-understood or accepted
- Variable responses across cultures
- CHPCA and CNA position statement: A “palliative approach” in any setting/situation
Bereavement Definition
Used to describe having lost someone important or significant through death
The objective loss
Grief Definition
Intense emotion or distress following bereavement
Emotional/Physical manifestations attached to grief
What is the most appropriate conceptual framework associated with grief?
The Dual Process Model - people oscillate between loss oriented and life oriented living as they experience everyday life
Factors that can affect the grieving of the survivor (6)
- angry/ambivalent/dependent relationship with the deceased
- other losses/stressors
- history of mental illness
- perceived lack of social support
- family conflict
- loss of tradition, beliefs, network
Who is at risk for complicated grief?
- Stressful factors associated with type of death
- personal encounter with death
- lack of support
- angry/ambivalent/guilty relationship with deceased
- other mental illness
6 difficult caregiving experience
What makes grief difficult for caregivers?
- dual caregiving responsibilities
- stressful relationships
- financial/employment concerns
- missing the death
- health problems
- difficulty making decisions
- lack of information
- the healthcare system
Why are indigenous peoples at risk for complicated grief?
Intergenerational trauma and they face concurrent stressors & hardships (adverse childhood events, poverty, unemployment, and witnessing traumatic events such as violence and homicide
Deficit discourse
to discourse that represents people or groups in terms of deficiency – absence, lack or failure.
* Limitation focussed
* Most LGBT health research is skewed towards deficits – substance use, mental health disorders, etc.
What population are LGBT youth overrepresented in?
homeless youth population across Canada
Sexual minority young people have demonstrated higher rates of ______________ and _______ in comparison to heterosexual peers
emotional distress and suicidality
What is the University of Toronto School of Dalli Llama’s research focus?
- understand emotional health of LGBT people
- To describe how experiences such as homophobia, biphobia, transphobia, racism, sexism and ableism impact the health of LGBTQ2S+ people.
- To identify elements that help LGBTQ2S+ people to access health services, as well as those that prevent them from doing so.
What 3 reasons do disparities exist in the LGBT community?
- a long history of stigma and discrimination for LGBTQ2S people
- sexual and gender minority status
- accessibility to health services…barriers exist
3 Levels of Barriers to Healthcare for LGBT People
- individual
- provider
- systemic
Individual barriers to healthcare for LGBT
- Fear of discrimination
- Negative past experiences with HCPs
Provider barriers to healthcare for LGBT
- Negative past experiences with HCPs (individual/provider)
- Insensitivity of HCPs. (provider)
- Lacking knowledge and competence in care provision. (provider)
Systemic/Institutional Barriers to healthcare for LGBT
- Lack of standardized data collection in HC system (system)
- Responsive service gaps. (system)
- Lack of adequate research to guide practice. (system)
What is one of the top barriers to culturally sensitive care for the LGBT population
Lack of Knowledge
What is minority stress?
the stress experienced by individuals from stigmatized social categories as a result of inferior social status
In the research, minority stress has been linked to LGBTQ health disparities such as
o Substance abuse
o Tobacco use
o Mental health challenges
What does do ask/do tell refer to?
Collection of and utilization of data related to SOGI (sexual orientation and gender identity) r/t pronoun sharing
What does the fenway institutes do ask/do tell movement recommend?
SOGI demographic data collection becomes standardized and routine
Sexuality RN Self-Assessment
- Level of comfort (desensitization)
- What are your attitudes, values and beliefs?
- Knowledge:
o What is “normal”?
o What are the considerations for the clinical area in which a RN works?
Gender based violence
the abuse of power and control over another person based on their gender, gender expression or perceived gender.
Violence defintion
Violence is an action that causes harm of any kind.
“Pain does not have to be visible to be real, and violence does not have to be physical to be serious.” - Alok Vaid-Menon
4 Aspects of Gender/Sexual Identity
Gender Expression
Sex
Gender
Attraction
Intersectionality
basically a lens, a prism, for seeing the way in which various forms of inequality often operate together and exacerbate each other
Pronouns
Specific words used to refer to a person when you aren’t using their name.
Some people use one set while others use other sets interchangeably.
Why do pronouns matter?
Using a person’s current pronouns show respect, safety, and acceptance. It shows you are.
Using the wrong pronouns feels invalidating, dehumanizing and violent for the person being misgendered and put them in harms way.
Deadname
Using a person’s incorrect name/birth name/legal name, instead of using their correct name
What should you do when you mess up a person’s name/pronouns?
- catch it
- correct it
- carry on with care
Microaggressions
subtle, everyday comments or actions that intentionally, or unintentionally, communicate bias and prejudice towards a marginalized group.
3 Pillars of LGBT Affirming Care Approach
- Intersectional Care
- Person Centred Care
- Meaningful Human Connection
Advocate
is a person who actively works to end
intolerance, educate others, and
support social equity for a group
Ally
a straight person who supports queer
and trans* people.
Androgyny
1) a gender expression that has elements of both masculinity and femininity
2) occasionally used in place of “intersex” to describe a person with both female and male anatomy
Asexual
A person who generally does not experience sexual attraction (or very little)
Bigender
A person who fluctatuates between traditionally woman and man gender based behaviour and identities identifying with both genders
Binary Gender
A traditional and outdated view of gender, limiting possibilities to man and woman
Binary Sex
A traditional and outdated view limiting possibilities to only female or male
Biological Sex
the physical anatomy in which one is born typically male, female, or intersex
Biphobia
an aversion toward bisexuality and
bisexual people as a social group or as
individuals. People of any sexual
orientation can experience such feel-
ings of aversion. Biphobia is a source
of discrimination against bisexuals,
and may be based on negative
bisexual stereotypes or irrational fear
Bisexual
a person who has emotional, romantic, or sexual attraction for a person of more than one gender
Cisgender/cissexual
a person whose gender identity
matches society’s expectations of
someone with their physical sex
characteristics
Cissexism
harmful beliefs that being
non-trans is the only acceptable and
“natural” form of gender expression
Cross-dressing
is wearing clothing that conflicts with
the traditional gender expression of
your sex and gender identity (e.g., a
man wearing a dress) for any one of
many reasons, including relaxation,
fun, and sexual gratification; often
conflated with transsexuality
Gender/Gender Identity
how we perceive our identity as male,
female, both, neither, regardless of our
physical bodies.
Gender Expression
is the external display of gender,
through a combination of dress,
demeanor, social behavior, and other
factors, generally measured on a scale
of masculinity and femininity
Genderqueer/Gender nonconforming
an umbrella term used proudly by
some people to defy gender restrictions
and/or to deconstruct gender norms.
Gender neutral pronouns include: Ze,
Hir, Hirs, They, and Them
Gender Identity Dysphoria
a formal psychiatric diagnosis used
by the medical profession to describe
trans people
Heterosexism
a behaviour that grants preferential
treatment to heterosexual people,
reinforces the idea that heterosexuality
is somehow better or more “right” than
queerness, or ignores/doesn’t address
queerness as existing.
Pansexual
is a person who experiences sexual,
romantic, physical, and/or spiritual
attraction for members of all gender
identities/expressions
Queer
an umbrella term used proudly by
some people to defy gender or sexual
restrictions. Not used by all. Can be
considered offensive
Questioning
process of exploring one’s own
sexual orientation, investigating
influences that may come from their
family, religious upbringing, and
internal motivations.
Real Life Experience
the period in which
a trans person is currently obligated
to prove they can adapt to societal
gender roles before being approved by
publicly funded medical institutions
for hormones or surgeries.
Same Gender Loving
a phrase coined by the
African American/Black queer
communities used as an alternative
for “gay” and “lesbian” by people who
may see those as terms of the White
queer community.
Stealth
is means to live as their self-identified
gender without other people knowing
that they are trans.
Third Gender
(1) a person who does not identify with
the traditional genders of “man” or
“woman,” but identifies with another
gender; (2) the gender category
available in societies that recognize
three or more genders
Transvestite
is often used to refer to trans women in
an insulting manner, despite having a
true definition:
a person who dresses as
the binary opposite gender expression
(“cross-dresses”) for sexual gratifica-
tion
often confused with “transsexual”
6 Forms abuse takes
- emotional/psychological
- economic/financial
- ritual
- physical
- sexual
- religious
Coercive control is _____ abuse
emotional/psychological
Define interpersonal violence
Any behaviour by one person against another person in an intimate relationship which may endanger that person’s survival, security or well-being
Interpersonal violence involves an ___________ and ____________
abuse of power
violation of a position of trust
The rate of violence against women in Saskatchewan is almost _________ the national average.
double
Saskatchewan leads all provinces and territories in rates of:
- intimate partner violence and sexual offences
- in rates of violence against girls and female teenagers.
(7) Saskatchewan is #1 in:
- In police-reported violent crime rates in Canada since 2021 (X2 the National Rate)
- provincial family violence rate
- Provincial intimate partner violence rate
- Dating violence
- Provincial child and youth violent victimization rate
- Family-related violence against seniors
- 2nd highest violent crime severity index and homicide rate
Most often, victims of IPV were in a __________________ with the accused, with about half of victims (49%) being currently or previously married to the accused.
spousal relationship
___ % of IPV are reported to the police
11
Incidence of violence during pregnancy ranges from _% to _%, however domestic violence during pregnancy is
4-17
underreported
Women who are abused during pregnancy are ____ times as likely to experience
4
serious physical violence
Why does IPV occur against pregnant women?
assert power over the prenatal woman and want to be centre of control in mother’s life compared to fetus
______ family members were identified as the accused in a sizable majority of _____________ sexual (96%) and physical assaults (71%) against _________
Male
Family related
children and youth
Infants (<1yr) experience higher rates of family-related _________, than older children
Homicide
______________ are disproportionally represented among those accused for IPV against children/youth (60%)
Young parents
Apparent motives for elderly homicide when family was perp
frustration, anger or despair
Apparent motives for elderly homicide when non family was perp
financial gain
4 Most Prevalent Types of Abuse of Elderly
o Financial 52%
o Psychological/Emotional 30%
o Physical/Sexual Abuse. 10%
o Neglect (unintentional, self) 8%
Why are adults who experience abuse are more likely to become smokers, obese, alcoholics, drug addicts, suicidal because…
If someone is being constantly controlled by someone else tend to elicit control over these areas of their lives
To deaden pain
3 Phases of the Cycle of Violence
- Tension Building
- Violent Incident
- Remorse/Romance Phase
Duration of Tension Building Phase
days, weeks, months, years
What occurs at the beginning of the tension building phase?
Initial infatuation of the relationship fades
In the tension building phase, the abuser starts…
exhibiting aggressive/abusive tendencies
In the tension building phase, the victim attempts….
to stop aggression by pleasing, placating, or staying out of the way, thinking those actions can control the abusive behavior
What does the victim do when their attempts to stop aggression do not stop the abuse, and how does the abuser respond?
Victim withdraws
Abuser feels rejected and tried harder to control victim’s activities
Traits of Abuser in Tension Building Phase (5)
o Jealousy
o Actions that isolate the victim
o Rule changing
o Name calling
o Dominating
Traits of Victim in Tension Building Phase (8)
o Use of calming techniques
o Minimizing abusers’ behaviours
o Anger suppression
o Fatigue
o Confusion
o Self-doubt
o Withdrawal
o Fear
What is the effect of the violent incident on the abuser and the victim?
The violent incident relieves the stress/tension of the abuser
While the perpetrator feels instant relief, the victim experiences shock/denial
Who else is usually involved in the violent incident phase?
Police are usually involved at this stage, victim may seek safe shelter
4 traits of abuser in violent incident phase
o Anger
o Assault on the victim
o Uncontrolled tension
o Exhaustion
4 Traits of victim in violent incident phase
o Fear
o Anger
o May call the police
o May seek safety
What does the abuser do in the remorse/romance phase?
o Abuser becomes tender, apologetic, gift giving, proclaims love, one-time event etc.
o Abuser may take actions and demonstrate willingness/desire to change (i.e. rehab, stop drinking etc.)
What do a high number of victims do in the remorse/romance phase?
High number of women return to the abuser during this phase, believing the abuser and their actions to be sincere
4 Traits of Abuser in Romance/Remorse Phase
o Apologies and promises
o Shows insecurities
o Loving
o Demonstrates dependency on the victim
5 Traits of Victim in Romance/Remorse Phase
o Guilt
o Hope
o Loneliness
o Low-self esteem
o Dependency
3 Goals of nursing interventions in relation to IPV
o to empower the client to take control
o to provide support
o to maximize safety
Universal Screening for Abuse
refers to the characteristics of the group to be screened and occurs when nurses ask every woman over a specified age (12) about her experience of abuse.
Routine Screening for Abuse
refers to the frequency with which screening is carried out. Routine screening is performed on a regular basis regardless of whether or not signs of abuse are present
Indicator Based Screening for Abuse
refers to screening whereby nurses observe one or more indicators that suggest a woman may have been abused and subsequently question her about the indicator(s).
Most comprehensive approach to screening for abuse
Universal and Routine
Barriers to screening from Provider’s Perspective (9)
o Fear of opening “Pandora’s Box”
o Fear of offending the patient
o Heterosexism, classism, racism
o Time constraints
o Don’t know what to do if the abuse is confirmed
o Believe that attempts to help are futile
o “Not in my practice setting” mentality
o Believe the victim caused the abuse
o Lack of awareness of woman abuse including:
Not recognizing some acts of violence as abuse
Lack of organizational support.
Barriers to Disclosure from Client’s Perspective (9)
o The children
o Cultural or religious values
o Fear of violence/retaliation if the abuser finds out about disclosure
o Isolation
o Fear about immigration status
o Concern partner will be arrested
o Stigmatization if only certain women are asked
o Hope that the partner will change
o Lack of knowledge of available resources.
How to respond when the women says yes to the question of abuse?
- Believe the woman
- Name the abuse (identify what she is experiencing is abuse)
- Assess immediate health needs; if a recent sexual assault has occurred, refer for sexual assault care
- Assess immediate safety and complete a safety check
- Explore her immediate concerns/needs and determine a plan of action
- With the woman’s consent, refer to appropriate resources, including multi-disciplinary health team, community specialists, counsellors, support groups, shelters, and justice/advocacy services
- Have a contact list of violence against women services available
Responding when she says “NO” and you suspect “YES” to the question of abuse
- Discuss what you have observed and explain why you continue to be concerned about her health and safety
- Offer educational information about the health effects and prevalence of abuse;
- Highlight referral services
- Document her responses
Responding when she says no to abuse question
- Share general information/provide education about woman abuse
- Document the woman’s response
Guiding Principles for Screening for Abuse
Attitude and approachability of the health care provider
Belief in the women’s account of her experience
Confidentiality is essential for disclosure
Documentation that is consistent and legible
Education about the serious effects of violence & abuse
Recognition that dealing with violence & abuse has to be at her pace, directed by her decisions
5 Key Points about Documentation of Abuse
- facts not opinions
- importance of accuracy and specifics
- as soon as possible
- tools like body maps
- photograph with clients permission
What types of nursing actions might jeopardize your relationships with patients experiencing abuse?
o Telling people what to do
o Blaming the victim
o Violating confidentiality
o Confronting the abuser about the abuse
Challenges of a rural setting related to family violence include:
o Lack of access to public transportation/phone service
o Decreased anonymity and confidentiality
o Lack of services / ineffective services
o Increased number of weapons in the home (i.e. hunting)
o Fewer resources (i.e. employment, childcare etc.)
What needs to be considered when a disclosure of abuse against a woman is made
no mandatory obligation to report woman abuse to the police.
It is the woman’s right to choose if she wishes to have police involvement and she must consent to this involvement prior to the nurse initiating such action.
Nurses must respect the woman’s decision and advocate for her right to choose
Age of consent for sexual activity is ___ in Canada
16 years
best practice guideline recommends screening for woman abuse for women ages ________ , disclosure of abuse by a teen woman may necessitate the involvement of the ____________
12 and over
Children’s Aid Society
According to the Criminal Code of Canada (Department of Justice, 2003) young women over the age of 12 are able to consent to sexual activity in the following 2 circumstances:
When she is between the ages of 12-14 and the age difference between the two persons is not more than 2 years
When the young person is age 14 or older and the other person is not in a position of trust or authority
While teen sexuality may pose a challenge for the individual nurse, it is not necessarily a reportable event as illustrated in the above circumstances. The 2 factors that define a report to CAS are:
When the young woman is under 16 years of age and the alleged abuser is a person in a care-giving role;
When the young woman is under 16 years of age and the alleged abuser is in a role of authority or trust
The Interpersonal Violence Disclosure Protocol (Clare’s Law) Act
Authorizes a police service to disclose certain risk-related information to a current or former intimate partner in cases where such information can assist them in making informed decisions about their safety and relationship.
When must you report child abuse/neglect
Anyone who suspects that a child is being abused or neglected has a legal duty to report it
True or False reporting abuse against older adults is mandatory
False - unlike suspected child abuse
