Patient advocacy is among the primary components of the nursing mandate. In addition to addressing the physical needs of patients, nurses are also expected to be staunch champions of patient wellbeing. In fulfilling this expectation, the nurses need to closely monitor patients and respond to any needs that would otherwise go unmet. Depression among elderly patients who have suffered physical abuse is among the common conditions that nurses are required to help patients deal with. As they respond to this condition, nurses need to make considerations for the ethical and legal implications of their intervention.
As a nursing practitioner, I often face challenges that require me to speak up for patients. One of these challenges occurred recently. It involved a 78 year old woman who had bruises on her face, hands and knees. Upon inquiry, she insisted that the injuries were the result of a fall. Unconvinced, I prodded further and sought to determine the truth. After guaranteeing that her safety would be secured, she shared that she had been abused by her caregiver. The encounter with this patient presented various challenges. For example, I needed to gain her confidence while assuring her that she would be safe. I understand that her case is not isolated. Research shows that physical abuse is rampant among the elderly. Frazao et al. (2015) authored an article in which they detail the findings of their investigation. These researchers determined that a worrying number of elderly patients are subjected to abuse by the very practitioners who are required to attend to their needs. I am not surprised that the patients suffer abuse. Such researchers as Buijck et al. (2014) have observed that elderly patients have complex needs which impose a burden on their caregivers. In response to the burdensome responsibility that they shoulder, the caregivers respond violently.
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When handling the situation described above, I employed various strategies. The main strategy involved establishing trust and channels for open communication. In their article, Haugan, Innstrand and Moksnes (2013) share that the nature of interactions between nurses and patients determine whether the patient makes progress in their recovery from depression and anxiety. While engaging the patient, I understood that I needed to earn her trust and persuade her to share details of her injuries. Having secured trust, I referred her case to my superior who instituted a follow-up plan. The purpose of this plan was to insulate the patient against further abuse. I believe that there are other strategies that I could have used. Involving the authorities is among these strategies. I failed to contact the police and I fear that this failure exposed the patient to the risk of more harm. Despite this failure, I still feel that I advocated for the patient. My advocacy took the form of ensuring that she received the treatment that she needed for her injuries as well as the depression that she had developed.
As I reflected on the case of the elderly patient, I focused on the legal and ethical considerations which surround such cases. I think that protecting patient privacy while advocating for their welfare are the main ethical issues that nurses need to consider. We need to refrain from revealing personal details that could compromise the safety of patients with suspicious injuries or illnesses. Reporting cases to relevant law enforcement agencies is among the legal issues that should guide our actions. I understand that nursing practitioners have an obligation to alert authorities when they learn that a patient is being abused. It is vital for all nurses to be passionate in their advocacy for patient rights and dignity.
References
Buijck, B. I., Zuidema, S. U., Eijk, M. S., Bor, H., Gerritsen, D. L., & Koopmans, T. C. M. R. (2014). Determinants of geriatric patients’ quality of life after stroke rehabilitation. Ageing & Mental Health, 18 (8), 980-5.
Frazao, S. L., Correia, A. M., Norton, P., & Magalhaes, T. (2015). Physical abuse against elderly patients in institutional settings. Journal of Forensic and Legal Medicine, 36, 54-60.
Haugan, G., Innstrand, S. T., & Moksnes, U. K. (2013). The effect of nurse–patient interaction on anxiety and depression in cognitively intact nursing home patients. Journal of Clinical Nursing. DOI: 10.1111/jocn.12072
