How the Travel Nurse Must Recognize the Signs and Symptoms of Physical Abuse to Elder Patients

As I have mentioned in previous articles, travel nurses are not well trained in recognizing elder abuse. Even though most states require courses on child abuse, no such course is required on elder abuse. Nurses also do not contribute bruises, broken bones and other physical injuries as abusive, but attribute them to a higher incidence of elderly people tripping and falling. Thus, the caretaker who commits physical violence, and states that the patient had fallen, is likely to be believed. As well, many abused elders suffer from dementia, Alzheimer and other mental deficiency entities which prevent them from telling how they obtained their injuries. In neglect cases unless the victim is extremely dehydrated or malnourished, the Travel Nurse will not attribute the deteriorating condition of the patient as neglect.

A comprehensive thesis of elder abuse has been compiled by Mary Jo Quinn, RN, MA and Susan Tomita, MSW. They organized maltreatment into three categories: physical abuse, failure to thrive, and self neglect. Their studies will be cited in how to recognized, document and report elder abuse.

Physical abuse must be recorded by utilizing a sketch sheet to demonstrate the anatomical area of the assault. Accompanying photographs must be taken for documentation. These conditions are not in themselves diagnostic of inflicted abuse, but are signs and symptoms that must be explored to rule out abuse.

In an assessment, one must note bruises and hematomas. One must note the lesions distribution over the body. Note if bruises are over bony prominences (elbow, knee, etc.), which are more indicative of a fall, versus inner arm and thighs, which are consistent with abuse. Do the bruises resemble the shape of an object or a thumb/palm/finger print? Note for the presence of old and new bruise. Multiple discolorations in multiple areas are indicative of repeated, systematic abuse. Are the injuries in different stages of resolution? Look for burns; are they unusual in location? Note rope burns to the wrist, ankles or thighs, or mouth gag mark. These are consistent with forcible restraints. Contracture of the musculature may indicate confinement for long periods of time. Assess the ambulatory state, in some incidences; poor ambulation in a capable adult may suggest sexual assault.

Documentation of the physical abuse must record the size, shape and location of the injury. Note the stages of the discoloration, take photographs of the injury. Finally, have an independent source sign the photographs and sketch allegations of abuse to be submitted to state authorities.