Addressing Elder Abuse in a Home Health Setting: A Case Study Analysis

QUESTION

You are initiating home health for an 84-year-old male with chronic obstructive pulmonary disease and mild cognitive impairment who
lives with his son, daughter-in-law, and grandchildren. You find him in his room smoking cigarettes with oxygen running. You ask him to extinguish the cigarette and proceed with your assessment. In your patient teaching, you explain he cannot smoke with oxygen and assess how well he can apply and remove his nasal cannula and turn his oxygen on/off. He says, “Oh you know how forgetful us old codgers are; I won’t do it again.” You speak with his family and reinforce no smoking with oxygen running. On your next three visits, he is not smoking but you notice multiple cigarette butts in an ashtray. On the fifth visit, you again find him smoking with oxygen running but also some bruises on his arms which he says he received when he fell down.

Review the case study above. Then, create a 1-2 page paper that addresses the following:

1. Discuss the risk factors and/or indicators of elder abuse are observed in this case study.
2. Discuss the nurse’s approach to further investigation of this situation and any additional details would be important to assess.
3. Examine how the mandatory laws in your state may apply to this situation.
4. Describe steps you would take to ensure the client’s safety.

ANSWER

 Addressing Elder Abuse in a Home Health Setting: A Case Study Analysis

Introduction

Elder abuse is a significant public health concern that can manifest in various forms, including physical, psychological, financial, and neglect. In the case study presented, an 84-year-old male with chronic obstructive pulmonary disease and mild cognitive impairment is found smoking cigarettes while oxygen is running, despite being advised against it. Furthermore, the presence of bruises on his arms raises concerns about potential physical abuse. This paper will discuss the risk factors and indicators of elder abuse observed in the case study, explore the nurse’s approach to further investigation, examine the relevant mandatory laws in the state, and outline steps to ensure the client’s safety.

Risk Factors and Indicators of Elder Abuse

In this case, several risk factors and indicators of elder abuse can be identified. The patient’s cognitive impairment and dependence on others for care make him more vulnerable to mistreatment. The presence of mild cognitive impairment suggests a potential cognitive vulnerability, while his chronic obstructive pulmonary disease may contribute to his increased reliance on family members for assistance.

The indicators of elder abuse in this case include the patient’s noncompliance with the nurse’s instructions not to smoke with oxygen running. This behavior may suggest neglect, as the patient’s safety is compromised by the potential for oxygen-related accidents. Additionally, the presence of bruises on his arms raises concerns about physical abuse. Bruises can be indicative of physical harm or mistreatment, particularly if the patient provides explanations that are inconsistent or implausible.

Nurse’s Approach to Investigation and Important Assessment Details

When faced with suspicions of elder abuse, the nurse must adopt a careful and systematic approach to further investigation. It is important to document the observations and conversations with the patient and his family accurately. In this case, the nurse should inquire about the origin of the bruises, seeking explanations that are consistent and reasonable. If the patient’s explanations are evasive or contradictory, it may be necessary to involve other healthcare professionals, such as a social worker or the patient’s primary care physician, to conduct a more comprehensive assessment.

Assessing the client’s mental capacity is crucial to determine his ability to make informed decisions and to understand the potential implications of his actions. The nurse should evaluate the patient’s cognitive function and decision-making capacity in relation to his smoking behavior and ability to adhere to safety instructions. This assessment should involve an exploration of the patient’s understanding of the consequences of smoking while on oxygen therapy.

Mandatory Laws and Their Application

Understanding the mandatory laws related to elder abuse in the specific state is essential in addressing this situation. In this case, the nurse should research the state’s laws regarding mandatory reporting of suspected elder abuse. Familiarity with these laws will guide the nurse’s obligations and responsibilities in terms of reporting the observed abuse. It is crucial to follow the legal requirements to ensure the patient’s safety and well-being.

Ensuring Client’s Safety

To ensure the client’s safety, several steps should be taken. First, immediate intervention is required to address the smoking behavior and mitigate the risk of an oxygen-related accident. The nurse should provide comprehensive patient education, focusing on the dangers of smoking while on oxygen therapy and the potential consequences. Reinforcement of the no-smoking policy should be done in collaboration with the patient’s family members to emphasize the importance of adhering to safety instructions.

Given the presence of bruises on the patient’s arms, concerns about physical abuse should be addressed. The nurse should document the bruises, engage in a non-judgmental conversation with the patient to elicit information about the cause, and carefully assess his safety in the home environment. If necessary, the nurse should consult with the appropriate authorities or social services to ensure a thorough investigation and appropriate actions are taken to protect the patient from further harm.

Conclusion

The case study highlights the importance of recognizing risk factors and indicators of elder abuse in the home health setting. Nurses play a critical role in identifying and responding to elder abuse cases. By adopting a systematic approach to investigation, understanding the relevant mandatory laws, and taking appropriate steps to ensure the client’s safety, nurses can contribute to safeguarding vulnerable older adults from mistreatment and promoting their well-being.

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