1. Module 5 Nurse Responses to Elder Mistreatment An IAFN Education Course Ethical Issues in in Elder Mistreatment Cases

2. Patient-Centered Care Patients play an integral role in clinical decision- making process Customize nursing responses in each case based on patient needs and concerns 2

3. By the end of this module, participants will be able to: Discuss key ethical issues in nursing responses to elder mistreatment (EM)— o Patient-centered care o Timeliness of response o Compassionate care o Safety planning o Patient self-determination o Informed consent and confidentiality Describe how to facilitate safety planning Learning Objectives 3

4. Case: Mrs. Martin Issues/actions needed in case related to: o Suspected mistreatment and timeliness of response? o Compassionate patient care? o Patient safety? o Patient self-determination, informed consent and confidentiality? o Nursing responses adapted to patient’s needs and circumstances? o Nursing skills to address presenting medical conditions? 4

5. Case: Mrs. Martin (cont.) How would changes to scenario impact needed actions? o The patient has no delirium o The patient is younger and less frail o There are indicators that the patient is also being sexually abused o A husband rather than son is involved 5

6. Focus on Patient Patients are central participants in EM cases 6

7. Regardless of practice setting, suspicions of EM must be acted on in timely fashion Timeliness 7

8. Compassion 8 Being compassionate with patients can make a critical difference in outcomes of nursing response in these cases Help older patients be as comfortable as possible

9. Patient Autonomy Respect patient’s right to self- determination related to medical care and reporting, to extent possible Seek informed consent for assessment, treatment, evidence collection and other interventions Follow related practice setting policies and procedures 9

10. Follow practice policy and procedures When patient is temporarily incapacitated, it may be proper to render usual nursing care unless there is evidence that the person would not want it In other situations, there is a legal determination that the person is incompetent and a guardian is appointed Last two bullets: S. Westrick, S. Westrick Killion & K. Dempski, Essentials of nursing law and ethics, 2008 Patient Lacks Decision-Making Capacity? 10

11. Talking with patients in private to hear their account of what happened/assess decision- making capacity Locating guardian/surrogate to act on patient’s behalf Challenges Related to Decision-Making 11

12. Challenges: Decision-Making (cont.) When no prior determination of capacity or legal guardian assigned, legal process takes significant time Concern that guardian is not making decisions in best interest of patient Suspect guardian of mistreating patient 12

13. Maintain confidentiality of medical records by not releasing information about patient unless required to do so (e.g., mandatory reporting) or patient/legal guardian gives permission Confidentiality 13

14.  Ask patient questions and look and listen to understand unique needs and circumstances and then tailor care  Develop geriatrics expertise  Know community resources  Actively participate in multidisciplinary team responses to elder mistreatment Additional Ethical Issues 14

15. Safety Planning A process where helper and victim together create plan to enhance safety National Clearinghouse on Abuse in Later Life, Anticipate: Identifying victim strengths and planning for safety concerns, 2003 15

16. Safety Plan: Mrs. Kennedy Prevention strategies? Protection strategies? Notification strategies? Referrals/services? Emotional support strategies? 16

17. Safety Planning Begins with first encounter with patient through discharge/care transition Prompt safety planning questions at appropriate times Follow agency policy if there is concern about safety while patient is in your facility 17

18. Patient-Driven Planning Patients should develop their own safety plans, to extent possible A process, not a one-time activity Nurses should be willing to help patients with planning and/or connect them with professionals with expertise in safety planning process 18

19. Safety Planning Steps Build rapport and listen to patients Help patients identify fears, obstacles, threats, barriers to safety, and effective past safety strategies Ask what patients want to do to be safer and why Together, think creatively about a variety of options and ideas, keeping in mind that patients need to consider their safety in numerous situations Build a plan that is patient-centered, regardless of circumstances B. Brandl, C. Bitondo Dyer, C. Heisler, J. Marlatt Otto, L. Stiegel & R. Thomas, Elder abuse detection and intervention: A collaborative approach, 2007; National Clearinghouse on Abuse in Later Life, Anticipate, 2003; and National Clearinghouse on Abuse in Later Life, Interactive training exercises on domestic abuse in later life, 2003 19

20. Closing Assessment What have you learned from this module that you can apply to your practice setting? 20