Elder Neglect in Nursing Homes and their Ethical Implications

Elder Neglect in Nursing Homes and the Ethical Implications

Theresa Kokkeler

James Madison University

NSG354 Art and Science

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Introduction

Neglect is the refusal or failure to provide food, clothing, medicine, and medical

services that are essential to the well being of an individual (Gale Encyclopedia of

Medicine, 2008). As unethical as it may be, the unfortunate reality of elder abuse in

nursing homes is a very real concern. It is estimated that two million cases of elder abuse

is reported each year, and one out of ten elderly individuals will encounter some sort of

abuse during their stay in nursing homes (Nursing Home Abuse Statistics, 2017). The

unfortunate truth is that these numbers are only reflective of reported incidents, and the

statistic may actually be much higher. For various reasons, elderly patients are known to

be the population that is least likely to report incidences of abuse, and neglect is the most

common form of abuse these individuals experience (Elderly Abuse Statistics, 2017).

Background

Last semester, a patient in a nursing home had disclosed a situation that had

occurred to her a few weeks prior. She stated that she was assisted to the bathroom by a

Patient Care Technician and was told to either call out to her, or pull the call bell when

she was done and ready to return to her bed. After she was done using the bathroom, the

patient called out to the nurse but no one responded. She then pulled the call bell and

waited for a few minutes. The PCT that had helped her to the bathroom never came back,

and none of the other PCTs or nurses on the floor responded to the call bell. Ultimately,

the patient spent approximately one full hour on the toilet before someone came to help

her. She was understandably distraught and frightened by the event, and when asked if

she had told somebody about what had happened, she stated that she didn’t want to tell
 Elder Neglect in Nursing Homes and their Ethical Implications 3

anybody because she didn’t want to cause the nurses any trouble. She didn’t even want to

tell her son for fear that he would worry about her too much.

Upon hearing the patient’s story, the moral dilemma quickly became clear. Here

was an individual who had undergone an incredibly unfortunate case of neglect that could

have resulted in physical injury. On one hand, the patient could have benefitted from

patient advocacy by having the incidence reported. The charge nurse could have been

notified and the PCT in question- as well as other PCTs on the floor- could have been

educated, or at least informed of the consequences of their actions. Although the solution

seemed obvious, the patient’s desire was to refrain from having the situation reported,

which is a personal decision that should not be taken lightly. It also complicated the

situation further as without reporting the incident, there would be no guarantee that a

similar situation may not occur again to the same patient or a different patient on the

floor. Although there were conflicting feelings, I told my clinical instructor while

maintaining patient confidentiality as I felt her guidance could help me take the

appropriate next steps. As an alternative to informing the clinical instructor, keeping the

situation entirely private and refraining to tell anybody else may have been an option at

the time.

Methods

The 8 Key Questions are especially relevant to JMU Nursing students as they

serve as a guideline for the multiple ways in which to act following the presentation of an

ethical predicament. The eight key values consist of fairness, outcomes, responsibilities,

character, liberty, empathy, authority, and rights (Madison Collaborative, 2017). Keeping

these values in mind, there are many ways in which the story above can be analyzed and
 Elder Neglect in Nursing Homes and their Ethical Implications 4

approached. Fairness pertains to the patient receiving proper and safe care in the facility

that she pays to live and seek treatment in. Outcomes involve ensuring that the patient

will continue to receive quality care throughout the length of her stay. Responsibilities

include the PCT in question being informed of the consequences of her actions, and

owning up to the suffering that the patient experienced. Character should be emphasized

through supporting the patient and family members in dealing with the situation and

helping them process the events that occurred. Liberty is the ability to make personal

decisions regarding the course of action following any situation. Empathy is critical when

caring for the patient and providing comfort and support, regardless of agreeing with the

patient or not. Authority relates to respecting patient and family wishes. Lastly, rights

pertain to respecting the human rights of any individual placed under your care.

Interestingly, one journal discussed the most common actions a nurse would take

in instances of hearing about patient abuse. Rather than practicing patient advocacy,

nurses often exhibit behaviors of avoidance or accommodation (An Educational

Intervention to Increase “Speaking-Up”, 2012). This journal reveals the reality in which

nurses (for various reasons) feel as though they cannot consult available resources and

properly advocate for their patient. The journal proposes that more education is necessary

for nurses to uphold their responsibilities and feel comfortable in speaking out about

patient maltreatment and neglect.

In the American Nurses Association (ANA) Code of Ethics, provision 4.1 states

that, “The nurse has authority, accountability, and responsibility for nursing practice;

makes decisions; and takes action consistent with the obligation to promote health and to

provide optimal care” (Code of Ethics for Nurses, pg. 8). Nurses often delegate tasks to
 Elder Neglect in Nursing Homes and their Ethical Implications 5

individuals such as PCTs, and this provision can be used as a guide to emphasize the fact

that ultimately, it is the nurse who is responsible for the actions of others within the

healthcare team. With this guide in mind, the decision of whether or not to report the

incident can be made much simpler because maintaining quality of care is not only the

responsibility of the PCT- it is a direct reflection of the nurse’s care as well.

Conclusion

Facing ethical issues are never easy, and it is inevitable in the nursing profession.

After researching and reading through various documents regarding ethics, one simple

conclusion is that there is no right or wrong answer. Each case is entirely unique with its

own challenges, and the results are dependent on all of the factors that are involved. In

retrospect, alerting the charge nurse while maintaining patient confidentiality may have

been the better choice. This way, the staff can be alerted to the situation while

simultaneously maintaining patient privacy. Keeping the situation from staff would keep

the facility from practicing safe patient care, and could potentially put other patients in

danger. Lastly, the best way to work through ethical scenarios is to remain educated on

resources to seek when ethical issues arise. Through upholding nursing values, analyzing

dilemmas through the 8 Key Questions and being well-versed in the Nursing Code of

Ethics, one can be equipped with various strategies to detangle the complexities when

facing ethical challenges in the workplace.

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References

Code of Ethics for Nurses With Interpretive Statements (View Only for Members and

Non-Members). (Page 8). (n.d.). Retrieved November 16, 2017, from

http://nursingworld.org/DocumentVault/Ethics-1/Code-of-Ethics-for-Nurses.html

Elderly Abuse Statistics. (2017, Oct 3). Retrieved November 4, 2017 from

http://www.statisticbrain.com/elderly-abuse-statistics/

Gale Encyclopedia of Medicine: elder abuse. (n.d.) Gale Encyclopedia of Medicine.

(2008). Retrieved November 13 2017

from https://medicaldictionary.thefreedictionary.com/elder+abuse

James Madison University. (n.d.). The Madison collaborative: Ethical reasoning in

action. Retrieved from http://www.jmu.edu/mc/8-key-questions.shtml

Nursing Home Abuse Statistics. (n.d.). Retrieved November 04, 2017, from

http://www.nursinghomeabuseguide.org/nursing-home-abuse-statistics/

Sayre, M.M., McNeese-Smith, D., Leach, L.S., & Phillips, L.R. (2012). An educational

intervention to increase “speaking-up” behaviors in nurses and improve patient

safety. Journal of Nursing Care Quality, 27, 154-160. doi:

10.1097/NCQ.0b013e318241d9ff