Week 8: Protection of Vulnerable People

Question 1

Definition of vulnerable person

Answer 1

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

Question 2

Neglect physical indicators

Answer 2

Underweight, failure to thrive
Constant hunger
Poor hygiene, inappropriate dress
Consistent lack of supervision
Unmet healthcare needs

Question 3

Neglect behavioural indicators

Answer 3

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

Question 4

Physical abuse

Answer 4

Unwanted physical contact - slapping, pinching, punching, pushing, kicking, hair-pulling, burning, biting or cutting.

Question 5

Sexual abuse

Answer 5

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

Question 6

Psychological/ emotional abuse

Answer 6

Being forced by another person, to watch or take part in behaviour that is psychologically/emotionally harmful – threats, humiliation, put-downs, name-calling.

Question 7

Financial abuse

Answer 7

Use of financial information or other resources (ex: property, possessions) to control and cause harm to another person.

Question 8

“Honour” based violence

Answer 8

Fear of or actual forced marriage, controlling sexual activity, false imprisonment, forced abortion, and death

Question 9

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:

Answer 9

(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

Question 10

Indicators of physical abuse

Answer 10

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

Question 11

Sexual abuse physical indicators

Answer 11

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

Question 12

Sexual abuse behavioural indicators

Answer 12

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

Question 13

What is the age of consent to sexual activity in MB and across Canada?

Answer 13

16 years

Question 14

A 14- or 15-year-old individual can consent to sexual activity with…

Answer 14

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)

Question 15

A 12- or 13-year-old individual can consent to sexual activity with…

Answer 15

someone who is less than two years older than them.

Question 16

Emotional abuse indicators

Answer 16

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

Question 17

MB Child & Family Services Act. When is a child in need of protection?

Answer 17

(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.

Question 18

Legally, anyone suspecting that a child is in need of protection is …

Answer 18

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.

Question 19

Disclosure Without Individual’s Consent

Answer 19

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

Question 20

The Vulnerable Persons Living with a Mental Disability Act

Answer 20

Significantly impaired intellectual functioning and impaired adaptive behaviour, manifested prior to the age of 18 years

Question 21

Elder abuse

Answer 21

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

Question 22

Financial abuse

Answer 22

• 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

Question 23

Family violence (domestic violence)

Answer 23

• Physical violence
• Threats
• Control & isolation
• Jealousy, possessiveness

An adult may not feel able to leave an abusive situation, but many supports are available.

Question 24

Documentation of suspected abuse/neglect

Answer 24

• 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

Question 25

Types of restraints

Answer 25

Environmental restraints
Mechanical or physical restraints
Chemical restraints

Question 26

Environmental restraints

Answer 26

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”

Question 27

Mechanical/ physical restraints

Answer 27

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

Question 28

Chemical restraints

Answer 28

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)

Question 29

Restraints may be used:

Answer 29

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

Question 30

Restraints should NEVER be used:

Answer 30

As punishment
As a substitute for nursing care
As a matter of convenience for the healthcare provider

Question 31

Concerns with restraint use

Answer 31

Restriction of freedom
Risk of harm or injury
Loss abilities

Question 32

Restraints: restriction of freedom

Answer 32

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.

Question 33

Restraints: risk of harm or injury

Answer 33

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.

Question 34

Restraints: loss of abilities

Answer 34

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.