Fluent Essays

Use the power point attached to have the Idea of how to respond to the question on word file. Please chat me if any clarification is needed Scenario #1: Abuse • Mr. CO is a 75, year old male. He was admitted to your unit with Pulmonary Fibrosis. As you are walking towards his room to administer medications you hear his son say to him in a nasty tone of voice: “Stop being so stubborn. I need you to give me access to your bank accounts. You’re going to die alone unless you start cooperating”. As you enter he room, the son leaves quickly and you notice the patient has tears in his eyes. You ask “Is everything okay?” Mr. CO shakes his head yes, but remains nonverbal and does not make eye contact. You administer his medications and leave the room. Directions: Part 1: •The original post must be at least 200 – 300 words in length •What types of elder abuse did you notice in the scenario? (give examples and explain) •What signs, (in the scenario) if any suggest that the nurse should ask some follow up questions? •As a nurse in this scenario what is your next action? •How can older adults protect themselves from ever becoming victims of abuse or mistreatment? Scenario #2 You are viewing social media at home when you notice one of your coworker’s post on Facebook. The post is complaining about an elderly patient on your unit at work. The post reveals that the patient has Alzheimer’s disease and is “crazy” and your coworker states “I can’t wait until she is transferred out of here and back to Comfort Care Homes. After this shift, you will find me at the bar, line them up, I will need it.” Additionally, the coworker’s full name, occupation and employer are listed on their “about me” page. Respond with atleast 100 words not more than 150 words 1. What would you do regarding this posting? Explain clearly what you would do and why. Gerontologic nursing Chapter 3: Legal and Ethical Issues Professional Standards Health care providers have a general obligation to live up to accepted or customary standards of care Federal and state statutes require nursing facilities to have written health care and safety policies Sources of Law Statutes are laws created by legislation and are enacted at the federal and state level Health Insurance Portability and Accountability Act of 1996 (HIPAA) In some states failure by clinicians to report suspected incidents of mistreatment is a misdemeanor punishable by fine or penalty Sources of Law HIPAA Health Insurance Portability and Accountability Act 1996 Increase a person’s ability to get health care coverage when the person begins a new job Help maintain continuous health coverage when a change of job occurs Limits the use of preexisting conditions Sources of Law Every state in America has mechanisms for reporting elder mistreatment Adult Protective Services (APS) programs exist in each state Standards of care for nursing homes are based on policy stipulated in the Nursing Home Reform Act of 1987 (Omnibus Budget Reconciliation Act, 1987) Many states currently have mandatory reporting laws for elder mistreatment in which nurses & health care practitioners are required by law to report suspected cases Elder Abuse Categories of Elder Mistreatment 3 basic categories of elder mistreatment Domestic treatment - older persons home – by child, spouse, In-law) Institutional mistreatment – contractual arrangement & suffer abuse - LTC facilities, assisted living, rehabilitation or hospital Self neglect or self abuse – are mentally competent enough to understand the consequences of their own decisions – that threaten their own safety Institutional Mistreatment The types of mistreatment that occur in nursing homes likely mirror those in domestic settings Physical abuse Sexual abuse Neglect Financial abuse Psychological abuse Researchers have also speculated that shortages of staff, inadequate training of staff & staff burnout may be precipitating factors in mistreatment of nursing home residents Institutional Mistreatment Delay in reporting incidents Residents afraid of retribution Family members may fear having to find a new nursing home Staff may fear losing their jobs Facing recrimination by other staff members Want to avoid adverse publicity Assessment Ideally the older adult and any suspected abuser should be interviewed separately Maintaining a nonjudgmental approach will enable the nurse to obtain more accurate data The physical symptoms of elder mistreatment are often difficult for clinicians to discern because older adults may suffer from chronic and acute illness that mask or mimic the presence of mistreatment Assessment Their self reporting may be questioned for accuracy or they may be unable to express the mistreatment situation due to Amnesia Aphasia – total or partial loss of ability to speak or understand language Agnosia – inability to recognize common people and things Apraxia – inability to perform simple task It is often difficult to determine whether the older adult’s worsening physical condition is a result of the natural progression of illness or mistreatment Because some frail older individuals are prone to underlying conditions that give rise to trauma, such as instability of poor gait and poor vision resulting in falls, it may be difficult to differentiate accidental from willful injuries Types of Elder Mistreatment Physical abuse Psychological / emotional abuse Sexual abuse Financial exploitation Caregiver neglect Self neglect Abandonment Institutional mistreatment Physical Abuse Intentional infliction of physical injury or pain Hitting Shaking Pushing Improper use of physical restraints Signs & symptoms Bruises Black eye Bone fractures Injuries in various stages of healing Reports of being hit or mistreated Psychological / Emotional Abuse Infliction of anguish, pain or distress Yelling / verbal attacks Swearing Name calling Belittling Signs & symptoms Emotional upset Agitation Extreme with drawl Sexual Abuse Any form of nonconsensual sexual intimacy Rape Molestation Sexual harassment Signs & symptoms Genital bruising Unexplained sexually transmitted disease Financial Exploitation Taking advantage of an older person for monetary or personal benefit Unexplained monetary expenditures Lack of money for personal necessities Theft Fraud Signs & symptoms Unexplained inability to pay bills Inability to purchase necessity items such as food Caregiver Neglect Intentional (active) or unintentional (passive) failure to meet needs necessary for elder’s physical & mental well being Failure to provide adequate food, clothing, shelter, medical care, hygiene or social stimulation Signs & symptoms Dehydration Malnutrition Unattended or untreated health problems Listlessness Decubitus ulcers Urine burns History of being left alone Self Neglect Personal disregard or inability to perform self care Poor hygiene Unkempt home environment Signs & symptoms Malnutrition Fungal skin & nail infection Insect & rodent infestation in the home Abandonment Desertion or willful forsaking of an elder Dropping off an elder adult in the emergency department Desertion Signs & symptoms An older adult left inappropriately alone Institutional Mistreatment When older adult has a contractual arrangement & suffers abuse or neglect May be any combination of the afore mentioned Signs & symptoms Can be any of the signs & symptoms of the other examples of abuse Characteristics of Older Adults at Risk Difficult to obtain Several characteristics are more common among victims Sex Age Race Low socioeconomic status Low educational levels Impaired functional or cognitive status History of domestic violence Stressful events Depression Interventions Health care workers must be aware of local elder mistreatment reporting laws in their state Many states have mandatory reporting laws & health care professionals must report suspected cases In cases were abuse is suspected an older adult may benefit from a hospital admission to allow the healthcare team to carefully assess & formulate a plan of care Documentation Excellent documentation is extremely important in elder mistreatment cases Objective documentation Unbiased manner Physical indicators that are clearly documented will assist in discussing & planning goals Photo documentation is especially warranted in cases where there is evidence of physical or sexual abuse Residents Bill of Rights Most facilities have developed a contract for new residents to sign at the time of admission Called admission agreement This agreement sets forth the rights, obligations and expectations of each party It is a way to inform residents of a facility’s rules, regulations and philosophy of care See Box 3 – 1 on page 37 “Residents Bill of Rights” Unnecessary Drug Use & Chemical & Physical Restraints The OBRA requires that nursing facility residents be free of unnecessary drugs of all types, chemical restraints and physical restraints Chemical restraints Drugs that are used to limit or inhibit specific behaviors or movements Physical restraints Are appliances that inhibit free physical movement Limb, vest, waist Wheelchairs, geriatric chairs & side rails may also be restraints Unnecessary Drug Use & Chemical & Physical Restraints The nurse must carefully document the behavior or condition that led to the order for a restraint Residents receiving antipsychotic drugs must have an indication for the use of the drug Reasons must be documented in the physician’s order and chart / care plan Advanced Medical Directives Documents that permit people to set forth in writing their wishes and preferences regarding health care Used to indicate their decisions if the time should come when they are unable to speak for themselves An advance directive is not operative until the patient is no longer capable of decision making Living Wills Are intended to provide written expressions of a patient’s wishes regarding the use of medical treatments in the event of a terminal illness or condition The patient’s wishes regarding the withholding or with drawl of life support Living Will Not effective until: The attending physician has the document and the patient has been determined to be incompetent The physician has determined the patient has a terminal condition or a condition such that any therapy provided would only prolong dying The physician has written the appropriate orders in the medical record Durable or General Power of Attorney May designate someone else to make health care decisions at a time in the future when they may be rendered incompetent The role of the designated surrogate in this situation is to make the decisions that most closely align with the patient’s wishes, desires and values Conflicts Families may disagree with the directives of a family member Often family members express the desire to have more care than is requested by a patient The law upholds the expressed desires of a patient over those of the family But families may try to exert influence to bring about a decision that is sometimes contrary to the patient’s expressed wishes POLST Physician Orders for Life Sustaining Treatment Process of communicating health care wishes during a medical crisis or decline in health Include: Cardiopulmonary resuscitation (CPR) Medical interventions Artificially administered nutrition See Table 3.1 on page 42 See Figure 3.2 on page 42 PSDA Patient Self-Determination Act Came into effect 12/1/1991 To ensure that patients are given information about the extent to which their rights are protected under state law Requires hospitals, nursing facilities and other health care providers who receive federal funds such as Medicare or Medicaid to give patients written information explaining their legal options for refusing or accepting treatment should they become incapacitated