Running head: THE FIGHT AGAINST ELDER ABUSE: ANALYZING ELDER 1

ABUSE FROM AN ETHICAL STANDPOINT

The Fight Against Elder Abuse: Analyzing Elder Abuse from an Ethical Standpoint

Mikalah J. Jones

James Madison University

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THE FIGHT AGAINST ELDER ABUSE: ANALYZING ELDER ABUSE FROM AN
ETHICAL STANDPOINT
The Fight Against Elder Abuse: Analyzing Elder Abuse from an Ethical Standpoint

Introduction

Abuse in older adults, whether it be neglect, physical, financial, or psychological abuse,

is a prevalent problem in the United States. According to the Centers for Disease Control, about

one in ten older adults ages sixty and older have experienced a form of abuse, which is defined

as the “intentional act or failure to act by a caregiver or another person in a relationship

involving an expectation of trust that causes or creates a serious risk of harm to an older adult

“ (Hall, Karch, & Crosby, 2016). Older adults are more vulnerable to abuse as a result of

varying factors including: social isolation, physical disabilities, and mental disabilities. Older

adults who have experienced abuse have a 300% higher risk for mortality than those that have

not experienced abuse (Dong et al, 2009). It is estimated that this issue affects about 700,000 to

1.2 million older adults per year with an estimated cost to be approximately tens of billions of

dollars annually (Bond & Butler, 2013). The importance of educating through discussing

instances where elderly abuse occurred is essential when finding solutions to prevent it from

happening.

Background

I work part time as a patient sitter where I sit with patients who are a fall risk or who are

a danger to themselves and others. One night, I was working third shift in the Emergency

Department watching an older man presenting with confusion and slight delusions. He was listed

as a fall risk due to a diagnosis partial blindness. He began to get rowdy and yell for someone to

help him, so I assured him that I was sitting beside him and that he was safe. He asked for my

hand, so I placed my hand in his and he smiled. As time went by, he became rowdy again yelling

and trying to get out of bed. I was not able to calm him down, so I poked my head out of the door
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THE FIGHT AGAINST ELDER ABUSE: ANALYZING ELDER ABUSE FROM AN
ETHICAL STANDPOINT
to get his nurse’s attention. She came in to try to calm him down and keep him in bed, but she

too had to call for help. A male nurse came in very stern and yelled to the patient to sit back and

shut up. The patient became more agitated and began trying to get out of bed again. The male

nurse, forcefully pushed the patient back on the bed preventing the patient from sitting up. The

patient began to yell at the nurse saying, “You cannot treat me like this.” The male nurse replied,

“I would not have to if you would calm down, lay back, and shut up.” The patient continued to

get out of bed and every time the male nurse would push him back to the bed. The last time the

patient tried to reach the side rail to help himself up, he grabbed the female nurse’s arm instead.

The male nurse then (more aggressively than the past times) pushed the patient back and yelled,

“Do not touch her!” in the patient’s face. The female nurse told me to go ahead and take my

lunch break, and she shut the curtain behind me.

I was shocked about what I had witnessed and did not know what to do, therefore I stayed

quiet and figured that someone who had walked by or heard the commotion would report it. I

was afraid to say anything because it was my first job, and as a patient sitter I was the lowest on

the totem pole. As a patient sitter, it was one of my responsibilities to keep the patient safe, so I

should have spoken up and reported it to my supervisor. This situation was a moral dilemma for

me because I knew it was my responsibility to report the situation, but I did not want to

jeopardize my job or get the nurses in trouble.

Methods/Findings

I will be using the JMU Eight Key Questions to analyze this situation. The Eight Key

Questions consists of outcomes, fairness, authority, liberty, rights, responsibilities, empathy, and

character. These Eight Key Questions were created by Madison Collaborative: Ethical Reasoning
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THE FIGHT AGAINST ELDER ABUSE: ANALYZING ELDER ABUSE FROM AN
ETHICAL STANDPOINT
in Action. Their mission is to encourage people to use the eight key questions to apply ethical

reasoning in their personal, professional, and civic lives (The Madison Collaborative, 2013).

When considering outcomes, we ask ourselves, “What achieves the best short- and long-

term outcomes for me and others within the situation?” The best short-term outcome for this

situation would have been for the patient to have calmed down and the male nurse to have

handled the situation more professionally. The best long-term outcome was for the patient to

receive the help and care he needed to be discharged home safely. Fairness consist of finding a

balance between the interest of everyone. A fair solution to this situation would have been to

help the patient calm down without using unnecessary force. For example, talking to a physician

about giving him a medication that would relieve his anxiety or simple talking to him and trying

to understand what is wrong with him. Authority asks, “What do legitimate authorities expect of

me?” In this situation according to hospital policy, I was expected to report this incident to my

supervisor and fill out an incident report because what I witnessed was considered elderly abuse.

Liberty consists of the principles of freedom and personal autonomy that applies to the

situation. Patients have the freedom to decline care and make their own decisions about their

care. In this case, the patient was confused and did not have the appropriate skills to make his

own decision about his care. Although he was not capable of making rational decisions, he did

have the right to be treated respectfully and safely. Responsibility takes in account when

reflecting on what me and the nurses’ duties and obligations were to the patient. It was all of our

responsibility to provide the best care to the patient, keep him safe, and gain his trust. I

empathized with the patient because I would have felt scared also if I was in an unfamiliar place

and could not help myself due to my disability of not being able to see. The actions that would

have reflected more effectively on my character would have been to have spoken up for the
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THE FIGHT AGAINST ELDER ABUSE: ANALYZING ELDER ABUSE FROM AN
ETHICAL STANDPOINT
patient and express to the male nurse that the patient was just scared and that there was a better

way to handle the situation. Also, I should not have just walked away and said nothing but

instead have reported it to the charge nurse and my supervisor.

Provision 1 that states, “a nurse should practice with compassion and respect for the

inherent dignity, worth, and uniqueness of every individual, unrestricted by considerations of

social or economic status, personal attributes, or the nature of health problems” is the provision

that stands out most when analyzing this situation (Hegge et. al, 2015). This provision guides the

actions of respecting the human rights of the patient, establishing a healthy professional

relationship with the patient, respecting the worth of the patient no matter their functional status,

respecting the patient’s right to self-determination, and resolving conflict effectively while

utilizing other resources. If these actions were employed during this situation, there would have

been better outcomes for the patient and nurses involved.

Conclusion

Looking back and facing this situation with moral courage, I would change a few of my

responses. First, I would have spoken up appropriately and told the male nurse to stop being

physical to the patient and instead find another way to calm the patient down and keep him in

bed. Second, I would have gone to the charge nurse and informed her about what had occurred,

then I would have also emailed my supervisor to let her know. This situation taught me that

speaking up for what is right is important, and in this case, it could have protected a patient from

being abused by someone whose responsibility is to provide care to him. The Eight Key

Questions provide a bases for making sound ethical decisions, and the ANA provisions set a

foundation for being a proficient nurse. These sources should be incorporated into hospitals and

other care facilities to remind nurses that they have an obligation to provide healthcare ethically.
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THE FIGHT AGAINST ELDER ABUSE: ANALYZING ELDER ABUSE FROM AN
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References

Hegge, M., Fowler, M., Bjarnason, D., Godrey, T., Lee, C., Lioce, L., Ngai, M., ... Zanni, R.

(2015). Code of ethics for nurses with interpretive statements. American Nurses

Association.

Bond, M., & Butler, K. (2013). Elder abuse and neglect: definitions, epidemiology, and

approaches to emergency department screening. Clinics in Geriatric Medicine, 29(1),

257-273. doi:10.1016/j.cger.2012.09.004

Dong, X., Simon, M., de Leon, C. M., Fulmer, T., Beck, T., Hebert, L., … Evans, D. (2009).

Elder Self-neglect and Abuse and Mortality Risk in a Community-Dwelling Population.

JAMA: The Journal of the American Medical Association, 302(5), 517–526.

http://doi.org/10.1001/jama.2009.1109

Hall J., Karch D. L., Crosby A. (2016). Elder Abuse Surveillance: Uniform definitions and

recommended core data elements. Atlanta: Centers for Disease Control, National Center

for Injury Prevention and Control, Division of Violence Prevention.

Madison Collaborative. (2018). The Eight Key Questions (8KQ). Retrieved March 15, 2018,

from https://www.jmu.edu/mc/8-key-questions.shtml