Legislation
Nurses provided mixed responses about the state’s
legislation, including the following: we don’t need a
law, the law should be better enforced, and health
care professionals’ education should be more frequent
and content expanded. A nurse responded about Iowa
legislation that, ‘I don’t really think we even need the
law, because we do it anyway’. And another nurse
provided a different opinion, ‘Oh, I think it definitely
needs to be there, because, you know, without that,
some people when they notice it, well, that’s too bad,
but it’s not me’.
Health care professionals in Iowa are required to
report allegations of elder abuse. A nurse’s perception
about this reporting was, ‘I think that if people feel
like its mandatory, they have to, they are more likely
to do it than if they think, Oh, I don’t really have to
do it. I know it’s wrong, but I don’t really want to
get involved’. Whereas, another said, ‘the nurses that I
know anyway take that seriously and realize that they
have made an oath, so that if they feel that something
is going on with someone that it is their moral and
ethical duty to step up and say, This isn’t right and I’m
not going to let it continue’.
Completion of a dependent adult abuse curriculum
is required for health care professionals, beginning
when they enter a health care profession and every
Perspectives on elder ebuse
5 years thereafter. Additional content to this curricu-
lumwassuggested,as‘moreeducationaboutit[report-
ing abuse], what we can and cannot do. And our legal
liability, are we putting ourselves up for a lawsuit’.
Another complaint about the law was ‘the law doesn’t
lay out the signs and symptoms [of abuse], doesn’t tell
you when you see it. It doesn’t give you that way of
noticing the abuse. It just gives you a way of contacting
thelawenforcement.Itdoesn’tgiveyouawayofrecog-
nizing the abuse or
...
how to recognize the symptoms’.
Ithinkit’sadequate,butlikeIsaidI’dliketohavesome-
thing on elderly abuse and just abuse in general annu-
ally. Because I don’t think every 3 years is enough’.
In response to the law needing to be better enforced,
one nurse stated, ‘we don’t have investigators out
there’. Indicating that the law should provide for
additional investigators for conducting investigations
of alleged abuse. Another final thought on the law was,
‘in the best of all worlds, we wouldn’t have abuse [and
then wouldn’t need the law]’.
Improvement in practice
Various ideas were suggested for improving nursing
practice for elder abuse in critical care. Suggestions
included the following: conduct health history in
private, ask safety questions on admission assessment,
readdress the issue of elder abuse at discharge from the
unit, establish the reporting of elder abuse as a priority
for the unit and offer elder abuse education in addition
to that required by law.
One nurse reports, ‘On admissions, we ask questions
like, Are you in a relationship where you feel unsafe?
Are you in a relationship where you are being harmed
by someone? Do you want to harm yourself’? Those
kinds of things. We ask those questions, and that
gives them an opportunity to say, ‘Yes’. Emphasizing
the need for admission assessment, another nurse
responded, ‘You know, I think probably
...
,youhave
to identify that there is truly a problem, and for
example, a problem there. Epidemiology comes up,
documents transmission of one bacteria from one
patient to another that can be stopped by washing
your hands. And they show that there is a problem.
And if there is problem that it can be changed by doing
this. So, I think that if you could document that there
is some type of abuse going on, then I think there is
more motivation, and maybe that’s how to change’.
Additional education was suggested by providing
information about the seriousness of elder abuse. A
nurse suggested, ‘I think it should almost be like an
annual thing that they cover in the hospital. Because,
I don’t know, I think with the way the economic
situation is out there
...
.I just think things are going
to get worse instead of better and I think we need
to be more aware of that’. Another nurse stated, ‘Just
keeping the education going’.
In conclusion to the interviews, one nurse stated, ‘I
just really think we’re on top of it. Not to toot our own
horn, but I really do, I really think that we’re on top
of it
...
any admission, I mean, we’re really looking at
those things whether you realize it or not’