As nurses, our job is to nurture and heal our patients anyway we can. As medical professionals, and caregivers for our patients, abuse is something that’s hard to imagine.
If you are treating a patient who shows signs of having been abused by a parent, family member, domestic partner, or a worker in a long-term care facility, reporting it isn’t just the ethical thing to do: you also have a legal obligation. Abuse can be physical, verbal, or psychological.
Here’s what you need to know about the signs of abuse, and what you need to do to report it.
Abuse Takes Many Forms
When people think of abuse, they often think of physical abuse. However, abuse can take many forms, all of which are psychologically devastating for the victims. Here are some of the most common types of abuse, and the signs that this abuse is happening. While children and the elderly are at increased risk of abuse by those around them, adults can also be victims of domestic abuse.
Physical abuse is defined as the use of physical force in a way that causes pain or injury. Striking, hitting, pushing, shoving, slapping, or shaking someone can qualify as physical abuse. Things like inappropriate use of drugs, force feeding, or even reckless driving can also be forms of physical abuse.
Some of the signs that someone may be a victim of physical abuse include:
- Bruises, black eyes, welts, or lacerations
- Bone or skull fractures
- Sprains and dislocations
- Internal injuries or bleeding
- Broken eyeglasses
- Signs of having been restrained
- Human bites
- Pulled hair or bald spots
- Head trauma
- Cigarette burns
- Laboratory findings of either medication overdose, or underuse of prescribed medications
Along with physical signs of abuse, there are also behavioral indicators:
- Sudden changes in behavior or demeanor, such as withdrawal, aggression, or depression
- Inappropriate or excessive fear of a parent or caretaker
- Antisocial behavior, such as drug abuse, truancy, or running away
- Excessive lies
- Unusual shyness or wariness of physical contact
- Reports of being hit or mistreated
Sexual abuse is any forced or nonconsensual sexual activity of any kind. Physical indicators of sexual abuse, particularly in minors, include:
- Torn, stained, or bloody undergarments
- Unexplained and frequent sore throats, yeast infections, or urinary tract infections
- Somatic complaints, such as irritation of the genitals
- Sexually transmitted diseases
- Bruises or bleeding from genitalia or anal region
As with physical abuse, there are also behavioral indicators, some of which are subtle.
- Regressive behaviors in children, such as bedwetting or thumb sucking
- Inappropriate promiscuity or seductive behaviors
- Disturbed sleep patterns
- Unusual or age-inappropriate interest in sex and sexuality
- Avoidance of undressing
- Decline in school performance
- Difficulty sitting or walking
Emotional abuse can be subtle, and difficult for medical professionals to recognize and identify. It is the infliction of anguish, pain, or distress through verbal assaults, threats, intimidation, and other non-physical means. It can have lasting effects on a person’s self-esteem and mental health.
There are a few physical indicators that can point toward emotional abuse, despite its primarily non-physical nature:
- Eating disorders, including obesity, anorexia, or bulimia
- Speech disorders, like stammering or stuttering
- Developmental delays in speech or motor skills
- Weight or height substantially below normal
- Nervous disorders of a somatic nature, such as hives, tics, or stomach aches
Behavioral indicators include:
- Habit disorders, such as rocking or head-banging
- Cruel behavior, such as pleasure taken in harming people or animals
- Emotional upset or agitation
- Withdrawn demeanor
Neglect is also a form of abuse, especially when children or the elderly are the victims. Unfortunately, neglect of elders is frighteningly common in nursing homes. Some of the physical signs of ongoing neglect in a child or senior include:
- Poor hygiene
- Unsuitable clothing
- An untreated illness or in