Long-term symptoms include anxiety, fear or post-traumatic stress disorder.
While efforts to treat sex offenders remain unpromising, psychological interventions for survivors, especially group therapy, appears effective. APA Topics, Psych Central, Physical abuse is physical force or violence that results in bodily injury, pain, or impairment. It includes assault, battery, and inappropriate restraint. It often begins with what is excused as trivial contact that escalates into more frequent and serious attacks.
Child abuse and neglect is at a minimum any recent act or failure to act on the part of a parent or caretaker which results in death, serious physical or emotional harm, sexual abuse or exploitation; and an act or failure to act which presents an imminent risk of serious harm.
Physical abuse is the use of physical force that may result in bodily injury, physical pain, or impairment. Physical abuse may include acts of violence like striking, hitting, beating, pushing, shoving, shaking, slapping, kicking, pinching, and burning. This abuse may not have been intended to hurt the child; but an injury may have resulted from over-discipline or physical punishment.
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Child abuse or neglect is defined by the child welfare branch of the U. Any recent act or failure to act on the part of a parent or caretaker which results in death, serious physical or emotional harm, sexual abuse or exploitation; or. To access the statutes for a specific State or territory, click here to visit the State Statutes Search.
Any suspicion of abuse involving minors requires consideration of cultural values and standards of care as well as recognition that the failure to provide the necessities of life may be related to poverty. Elder abuse can take many forms. It too may include physical, emotional, psychological, sexual abuse, neglect, abandonment, or financial and material exploitation.
With the frail elderly, neglect is a major problem. Neglect is the refusal or failure to fulfill any part of a person's obligations or duties to an elderly person. Most laws concerning elder abuse are state laws, and can be found in a variety of state legal codes such as criminal, probate, welfare, business, and professional codes.
Please be aware of your own states regulations and guidelines. Many victims of abuse are seen in healthcare settings. Healthcare professionals often fail to identify victims, because there is a lack of training on what to look for and how to ask about abuse. Opportunities for intervention are missed and victims continue to suffer the adverse health consequences of physical and emotional abuse. For example, physically battered victims seek assistance in healthcare settings, often repeatedly.
Screening for abuse must be done. The healthcare professional should document abuse in the medical record; safeguard evidence; provide medical advice, referrals, and safety planning; and show empathy with compassion. Each facility must maintain a list of private and public community agencies that provide help for abuse victims. Staff should make appropriate referrals for victims. Screening questions should always be asked in a private room, away from the suspected batterer, and preceded by assurances of all the confidentiality allowed by law.
Healthcare professionals should find ways to separate the patient from the possible abuser should the latter demand to accompany the potential abuse victim into the examining room. Sometimes patients need to be kept safe from their own actions. While we always encourage individuals to exercise internal control, at times there may be need for external measures of restraint. The decision to use physical or chemical restraints is a medical decision. Restraints must never be used for the purpose of discipline or convenience. Review the equipment, policies, and documentation tools for each facility where you practice, as there may be some variation in both practice and definition of restraints.
Different standards are used for behavioral management, such as in a psychiatric setting. The use of restraints for behavioral reasons in a non-behavioral healthcare setting is differentiated by the reason the restraints are being used.
Different standards are used for long term care. Behavioral use of restraints are the last option, and used only when a patient is imminently at risk of harming themselves or others with their behaviors. Less intrusive methods of regaining safety must be attempted before restraint is applied.
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Medication to control behavior should be used only as part of a therapeutic plan, after appropriate assessment by professionals. An example is the use of a sedating psychotropic drug to manage or control behavior. It is the intended use of a device or method that classifies the device or method as a restraint.
For instance IV armboards, postural support devices, orthopedic appliances, protective devices like helmets, are not restraints when used to promote healing or protect an easily injured tissue or surgical site. However, a bed enclosure e. If for example a bed rail is used to facilitate mobility in and out of bed, it is not a restraint. Restraints or seclusion are to be used as a last resort after alternatives have proven to be unsuccessful. Restraints should not cause harm or be used as a form of punishment. Examples of alternatives to restraints include, but are not limited to:.
Staff or patient initiated time out in a quiet room with door unlocked. It should be presented as a way for patient to regain control, not as a threat. Removal of stimuli from the patient or vice versa. If lesser interventions are not successful and you need to apply a physical restraint as a last resort, use the least-restrictive device possible. For example, a lap buddy is a soft vinyl device that attaches to the wheelchair rather than the patient.
Another alternative is a geriatric chair set in a reclining position or with a lapboard. This is less restrictive than a safety belt or roll belt. And a roll belt, in turn, is less restrictive than a vest restraint. Mitts are generally more suitable than wrist restraints because they are less restrictive and allow the patient to move their arms freely. Another option is elbow restraints that keep the arm straight but allow free arm movement. A licensed, independent practitioner must order the restraint or seclusion; however, the facility may authorize qualified staff members, usually registered nurses, to initiate the use of restraints when needed before an order is obtained.
The independent practitioner must evaluate the need for restraint or seclusion and assess the patient within 1 hour. The authorized staff member can discontinue restraints or seclusion as soon as assessment reveals that restraints or seclusion is no longer necessary. The use of restraints for acute medical or surgical purposes must be reviewed and renewed if needed by the licensed, independent practitioner at least every 24 hours.
The use of restraints for behavioral healthcare purposes in long term care must be reviewed and renewed if needed by the licensed, independent practitioner at least every 30 days. Procedures for checking and documenting while a patient is in restraints are rigorous. Each facility will have a restraint or seclusion documentation tool that must be completed which must include the following. Assess, turn, reposition, range of motion exercises, offer nourishment and fluids, and toilet the patient at least every 2 hours.
The written order in the chart must include the justification for restraint or seclusion, type of restraint used, and the time limit for use. The documentation of restraints and seclusion needs to include; the circumstances that led to seclusion or restraint, consideration or failure of non-physical interventions, rational for intervention used, notification of family if appropriate, criteria for discontinuation as well as informing the patient of the behavior criteria, each evaluation, any assistance provided to the patient, continuous monitoring, debriefing of patient with staff and any injuries that are sustained and treatment received.
Physical restraints should always be fastened for easy release in an emergent situation. The restraint should be attached on a fixed part of the furniture, like the bed frame. Fixing it to a movable part, like a side rail, could inadvertently tighten the restraint causing patient injury, or loosen the restraint causing it to be ineffective.
A Joint Commission surveyor comes to the ward where a patient is in behavioral restraint due to assaultive behavior, and secluded in a corner room due to loud cursing and continuous verbal threats upsetting other patients. The observing staff refuses, stating this patient must have continuous direct attendance at all times. This is a WIN! No person in seclusion AND restraint can be left alone at any time, for any reason. The possibilities of things going wrong while in restraints and isolated are mind boggling, here are a few:. Medical emergencies due to heightened adrenal functions and agitation, e.
Another patient or person entering the room where the first is tied down and unattended and causing injury. NOTE: Surveyors do not utilize trick questions, they are however willing to observe if staff are familiar with their own institutional procedures and policy. A high falls risk is not a reason to use restraints. The following are suggestions to reduce falls risk:. Use low beds or put the mattress on the floor for patients who will not call for assistance to get up. CDC reports identify the risk of violence to healthcare workers being much higher than for all other private sector industries.
The circumstances of hospital violence differs from workplace violence in other settings such as banks, convenience stores or taxicabs where violence most often relates to robbery. Violence in hospitals is usually an outpouring of emotion rather than an attempt at material gain. With the violence toward others resulting from patients or their family members who feel frustrated, vulnerable, and out of control. Common risk factors for hospital violence include the following. CDC Violence, Working directly with volatile people, especially if they are under the influence of drugs or alcohol or have a history of violence or certain psychotic diagnoses.
Lack of staff training and policies for preventing and managing crises with potentially volatile patients. Violence may occur anywhere in a hospital, but it is most frequent in psychiatric wards, emergency rooms, waiting rooms, and geriatric units. Studies indicate that violence often takes place during times of high activity, and during interaction with patients. Assaults may occur when service is denied, when a patient is involuntarily admitted, or when a healthcare worker attempts to set limits on eating, drinking, tobacco or alcohol use. Patients with a condition that causes confusion and impaired judgment are more likely to become violent than a patient with normal mentation.
Confusion and impaired judgment may be caused by neurologic conditions, seizures, hypoglycemia, or dementia. Watch for signals that may be associated with impending violence:. Also, it is important to note how your co-workers behave. For example, slamming equipment around is red-flag behavior. Learn from history. Notify the supervisor if you suspect a patient is going to be violent.