Abstract
Reporting patient abuse remains the prerogative of the abused patient or caregivers who witness the abuse within a healthcare facility. Usually, caregivers watch each other’s back, and hence the probability that they would report to their superiors on each other is almost nonexistent. Patients on the other hand fail to report the abuse since some feel responsible for the abuse, while others lack the capacity or the means to express the same. Others on the other hand are afraid of what will happen when they speak out and hence choose to remain silent. This research paper seeks to find out why amidst increased allegations of patient abuse, there is no increased reporting of the same or disciplinary action taken against the perpetrators of the same. The research paper is based on a review of the existing literature. The study has an introduction, a literature review, research findings, conclusions, and implications.
Introduction
Patient abuse can happen through neglect, physical harm or deprivation of food, medical treatment, rehabilitative therapy, proper clothing, supervision, or even appropriate accommodation. Patients who are denied the services necessary for their mental and physical well-being are also abused, as do those who are exploited or misused because of their vulnerability.
Literature Review
According to Bradley (1996, p. 548) patients are abused for a variety of reasons such as social isolation, the power imbalance between the abuser and the abused, bad family relations, and the caregiver lacking enough training, moral support, and resources to handle the patient well. Most health facilities lack clear policies on how patients should be handled, while others lack the means to make the care providers accountable for their behaviors towards patients. Moreover, behaviors such as disturbed sleeping patterns, fecal incontinence, and difficult behavior may put a lot of strain on the caregiver hence setting a scene where abuse is possible. Without proper means to channel their frustrations, worries, and despair, caregivers might turn on the patient as a way of venting the pressure building inside them. But why does the abuse go unreported?
In cases where the caregiver fails to acknowledge the abuse and therefore rarely thinks his/her behavior needs changing or improvement. When a patient is unable to express his reservation for different reasons, the cycle of abuse may continue.
Emotional abuse is perceived as the common form of patient abuse and the most unreported. This is usually the case because it is hard to recognize and even harder to substantiate. Emotional abuse on patients includes name-calling, yelling and guilt trips. Belittling the patient and sarcasm are also forms of patient abuse, which can either be through non-verbal or verbal actions. Patients who feel intimidated or those who think that reporting the abuse would only cause them deeper trouble often do not report abuse. In other cases, a patient may feel that reporting the abuse will not change anything and they, therefore, choose to remain silent hoping for a quick recovery and return to normalcy. Still, some categories of patients (due to the nature of their illness) may lack the capacity to express their concerns, therefore, lacking the means to report abuse.
Exploitative abuse is less common and even hard to pinpoint and report by the patients because they feel guilty. Abuse through exploitation can take the form of material, emotional, sexual or financial. The exploitative tendencies involve the caregiver taking advantage of the patient’s vulnerable state. Caregivers charged with the administering of drugs to patients may exploit the patient by failing to administer the entire dose prescribed by a doctor and instead engage in medication theft, where they can later sell and benefit from the proceeds.
Granholm (2000) observes that most forms of patient abuse occur in long-term healthcare facilities. This complicates the reporting of abuse in two ways. First, most patients in such facilities are rarely aware of the abuse. This means they are not quite sure that they are abused either physically or emotionally especially where no physical pain is being experienced. Secondly, the patients may have little means to express their objections even when they think they are being abused. In addition, they are intimidated by the probability of worse conditions if they should report the abuse without anything to stop the perpetrator (Granholm, 2000).
The fact that no one is on the lookout for signs of patient abuse, means that the reporting of the same remains the prerogative of the abused patient or other caregivers within the facility. Usually, caregivers watch each other’s back, and hence the probability that they would report to their superiors on each other is almost limited. Relatives of the patient as well as the management of the healthcare facility should learn to be on the lookout for the patient abuse tell-tale signs.
Unfortunately, patient abuse statistics indicate that some patients may continue suffering due to abuse because some of them suffer some physical and /or mental incapacity. They also have difficulties communicating caused by their illnesses or language barrier and have very few or no visitors.
Findings and Discussion
The intensity of the patient abuse cases that go unreported is documented by Garner and Evans (2005), who in a telephone interview established that 36 percent of the 577 health caregivers interviewed, had witnessed patients being abused physically, with 10 percent of this caregivers admitting to having committed the offense. 81 percent said they had witnessed psychological abuse and 40 percent said they had committed the offense.
In cases where a patient had violent tendencies, he or she is more likely to provoke abusive treatment from the care provider. Usually, such is seen as self-defense, but Garner and Evans (2005) note that care providers lack the proper training needed to handle such patients and often react to the patients through physical abuse. Notably, abuse to such people may be perpetuated even in instances where they have done nothing to warrant punishment or restrain. Abusive patients rarely report abuse, especially because sedatives are used to calm them down.
Garner and Evans (2005) note that patients who are in an institution where they are cut off from outside interaction are likely to suffer abuse more than those who are within conventional health facilities. In institutions, the managers restrict privacy, individual responsibility, possessions and even mobility of the patients. This means that the patients have to settle into a “batch living” kind of lifestyle where everything is coordinated by the management. In such cases, the aims and objectives of the host institution are regarded as more important than the aims of the individual patient. This lays a perfect abuse ground for patients, since there are no outside authorities to report the abuse to.
Garner and Evans (2005) further state that patient abuse is not something that only nurses and basic caregivers engage in. Doctors have also been found to abuse patients through prejudice, collusion and unthinking practices. Doctors also engage in ageist assumptions, which lead to unintentional abuse of the patient through the denial of proper medical care. Coming from a doctor, most patients would not even know why they are being abused, since they perceive the doctor as an authority figure in healthcare provision.
Bostwick (2008) documents a case where the money allocated to elderly patients by Medicaid was diverted to the accounts of the caregiving staff in a specific elderly group home. To justify the huge spending, the records of the home indicated that the “mentally disabled vulnerable adults” had been provided with expensive branded sporting items as well as personal computers. Fraud investigators later stated that there was no way the “developmentally disabled patients” could have used the alleged bought items.
Children are more prone to receiving abuses such as emotional blackmail or physical beating, especially where the care provider thinks the child is misbehaving (Bostwick, 2008). Common forms of abuse to children include where a care provider yell, ridicules, harasses, intimidates, or uses threats on the child. Nicknaming the child is also a form of child abuse, especially where the nickname distresses the child or exposes him to ridicule. Examples of sexual abuse include any physical or verbal advances perpetrated by a caregiving staff to the patient. It also includes instances where the staff member fails to discourage sexual advances made to them by the patient. Having established that patient abuse is either intentional or unintentional, the first step towards ensuring the same does not occur in different facilities, would include entailing what constitutes abuse and putting it in a mission statement for all healthcare providers in different institutions to read and understand. Ensuring that the patients know and understand their rights may also be a strategy that individual healthcare institutions can use to ensure that patients always know when their rights are being infringed upon.
Healthcare facilities have a huge role to play if patient abuse is to be stopped. First, such facilities need to develop a culture of taking patient complaints seriously. As mentioned elsewhere in this research, some patients report abuse but are ignored, brushed off or told that they are exaggerating things. If so, the same patient is faced with an even serious case of abuse in the future, he or she will have no confidence to report based on the previous treatment he/she got. This clearly shows that healthcare facilities should not tolerate any kind of abuse or disregard any complaint unless there is sufficient ground to do so. It is also the prerogative of healthcare professionals to ensure that their staff members are well motivated, well-rested and well trained to any reduce chances of abuse. According to Garner and Evans (2005), care providers who suffer fatigue and frustrations at work, and those who lack proper training usually take out their frustrations on the patients. Some even use sedatives to deal with problematic patients where no support from other caregivers is available.
Conclusion
This research has concluded that the problem of patient abuse remains an open secret among medical personnel as well as the patients. How soon this culture will end largely depends on the healthcare institution’s willingness to put measures in place that will not only discourage patient abuse by the health care professionals but will also encourage the patients to speak out against abuse. As established in the literature review, patients keep mum about abuse because they think they are partially responsible or think that nothing will be done to stop the abuse. A little encouragement from the authorities in a healthcare institution would no doubt end this.
References
Bostwick, J. (2008). The patient abuse and neglect of our vulnerable adults: America’s shame. Washington DC: iUniverse.
Bradley, M. (1996). Caring for older people: Elder abuse. British Medical Journal, 313(1), 548-550.
Garner, J & Evans, S. (2005). Institutional abuse of older adults. Council Report CR84. Web.
Granholm, J. M. (2000). Preventing resident abuse and neglect in healthcare facilities. Michigan: Office of the Attorney General. Web.