Week 8: Protection of Vulnerable People Flashcards
Definition of vulnerable person
Generally, someone dependent on others
At risk of harm due to the choices and actions of others
Includes
- Children (under 18)
- People living with a disability
- People in need of assistance to meet daily needs including older adults
Neglect physical indicators
Underweight, failure to thrive
Constant hunger
Poor hygiene, inappropriate dress
Consistent lack of supervision
Unmet healthcare needs
Neglect behavioural indicators
Inactive babies, no vocalization
Hyper-vigilant facial appearance
Stealing or hoarding food
Extended stays at school
Constant fatigue, listlessness
Assuming adult roles & responsibilities at home
Physical abuse
Unwanted physical contact - slapping, pinching, punching, pushing, kicking, hair-pulling, burning, biting or cutting.
Sexual abuse
Unwanted sexual contact - sexual touching, forced sex, forced humiliating acts, offensive sexual comments, control of birth control, or being forced to watch or take part in sexual acts with a third party
Psychological/ emotional abuse
Being forced by another person, to watch or take part in behaviour that is psychologically/emotionally harmful – threats, humiliation, put-downs, name-calling.
Financial abuse
Use of financial information or other resources (ex: property, possessions) to control and cause harm to another person.
“Honour” based violence
Fear of or actual forced marriage, controlling sexual activity, false imprisonment, forced abortion, and death
Manitoba’s Child & Family Services Act is an important statute for nurses to know and understand. It defines child abuse as an act or omission of a parent guardian or person in whose care a child is in which results in:
(a) physical injury to the child
(b) emotional disability of a permanent nature in the child or is likely to result in such a disability
(c) sexual exploitation of the child with or without the child’s consent
Indicators of physical abuse
Unexplained bruises, welts, lacerations or abrasions; various stages of healing
Unexplained burns
Unexpected fractures or dislocations
Behavioural indicators of physical abuse such as:
- Does not seek comfort when injured
- Indiscriminately seeks affection
- Behavior extremes: aggressive or withdrawn
- Fear of a particular person or place
- Role reversal: tries to care for parent
Sexual abuse physical indicators
Bruises, bleeding, or lacerations in genital area
Torn, stained, bloody underwear
Pain, swelling, itching in genital area
Difficulty walking or sitting
Vaginal or penile discharge
Repeated urinary tract infection
Sexual abuse behavioural indicators
Regressive behavior - e.g., bedwetting
Running away from home
Problematic substance use
Change in school performance
Age-inappropriate sexual play
Provocative drawings of sexual nature
Overtly seductive behavior with adults
What is the age of consent to sexual activity in MB and across Canada?
16 years
A 14- or 15-year-old individual can consent to sexual activity with…
someone who is less than five years older than them (only apply if the older person is NOT in a position of authority or trust)
A 12- or 13-year-old individual can consent to sexual activity with…
someone who is less than two years older than them.
Emotional abuse indicators
Extreme lack of self-confidence -“cannot win”
States that no one cares about him/her
Lags in physical, mental, emotional development
Habit disorders: sucking, biting, rocking
Suicide threats or attempts
MB Child & Family Services Act. When is a child in need of protection?
(a) Is without adequate care, supervision or control;
(b) Is in the care, custody, control or charge of a person:
Who is unable or unwilling to provide adequate care, supervision or control of the child, or
Whose conduct endangers or might endanger the life, health or emotional well-being of the child
Who neglects or refuses to provide or obtain proper medical or other remedial care or treatment necessary for the health or well-being of the child or who refuses to permit such care or treatment to be provided to the child where the care or treatment is recommended by a duly qualified medical practitioner.
(c) Is abused or in danger of being abused, including where the child is likely to suffer harm or injury due to child pornography;
(d) Is beyond the control of a person who has the care, custody, control or charge of the child;
(e) Is likely to suffer harm or injury due to the behavior, condition, domestic environment, or associations of the child or of a person having care, custody, control or charge of the child;
(f) Is subjected to aggression or sexual harassment that endangers the life, health or emotional well-being of the child;
(g) Being under the age of 12 years, if left unattended & without reasonable provision being made for the supervision and safety of the child; or
(h) Is the subject, or is about to become the subject of an unlawful adoption under The Adoption Act or of a sale under section 84.
Legally, anyone suspecting that a child is in need of protection is …
obligated to report the situation to a Child and Family Services agency, or the police if there is imminent danger to the child, based on information that leads to a reasonable belief that the child needs protection.
Failure to report is punishable by prison and fines as well as professional sanctions such as professional censure and suspension. The duty to report applies even if the information is learned through professional activities such as care or assessment, when otherwise Privacy laws might apply. Failure to report means abuse might continue or escalate. The priority is to protect the child from abuse, so it is important to err on the side of reporting any reasonable suspicion.
Disclosure Without Individual’s Consent
Personal Health Information Act (PHIA) allows for the sharing of personal health information without the consent of the person to facilitate a child protection investigation
The Vulnerable Persons Living with a Mental Disability Act
Significantly impaired intellectual functioning and impaired adaptive behaviour, manifested prior to the age of 18 years
Elder abuse
Can be physical, emotional, sexual, financial
Neglect of duties to provide necessities of life
Can happen at home or in PCH settings
Supports available for people experiencing abuse
Financial abuse
- Victims are often older adults, cognitively impaired
- Defined as when someone takes money, property or assets without consent
- Often a relative or friend, via
- Theft
- Taking control
- Coercion or influence
Family violence (domestic violence)
- Physical violence
- Threats
- Control & isolation
- Jealousy, possessiveness
An adult may not feel able to leave an abusive situation, but many supports are available.
Documentation of suspected abuse/neglect
- Description of person, including accurate and objective detail on any signs of abuse noted
- Specific dates & times of disclosure - in person’s own words “What happened?
- Concerns about immediate safety
- Height & weight
- For children:
- Accurate recording of child’s developmental stage
- Child’s behavior with & without parent or guardian
Types of restraints
Environmental restraints
Mechanical or physical restraints
Chemical restraints
Environmental restraints
The control of a person’s mobility by restricting the available geographic area
This may include placing patients in locked observation rooms, and may be called “seclusion”
Mechanical/ physical restraints
The use of any technique, device or mechanism to limit the movement of a person or of a portion of the person’s body
These may include physically laying hands on a person, jackets, straps, beside rails that restrict movement, or handcuffs
Chemical restraints
The use of a psychoactive medication to specifically inhibit a person’s movement or behaviour, that is not required to treat medical symptoms
Chemical restraints generally require an order or written agreement from an authorized health professional (for ex: a physician or a nurse practitioner)
Restraints may be used:
When it is necessary to protect the patient from harming themselves or others
In an emergency when danger is imminent
Should be assessed on case-by-case basis
For the shortest amount of time necessary
Restraints should NEVER be used:
As punishment
As a substitute for nursing care
As a matter of convenience for the healthcare provider
Concerns with restraint use
Restriction of freedom
Risk of harm or injury
Loss abilities
Restraints: restriction of freedom
Restraints can make a person less active and less independent. For example, a chemical restraint may leave the person sedated and inactive. A physical restraint, such as a tray on a geriatric chair, may prevent free movement, which can lead to frustration. The excessive or inappropriate use of some caregiving strategies may result in restraint. These restrictions of freedom can also lead to a loss of confidence and self-esteem.
Restraints: risk of harm or injury
Restraints can cause injuries. For example, if a bed rail is used, the patient may try to climb over it during the night to get to the bathroom. This could result in a fall.
Restraints: loss of abilities
The restrictions created by restraints may result in the loss of cognitive and physical abilities. For example, if the person is sedated for long periods, they may never regain abilities that existed before the sedation.
