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Purpose
Abuse can affect everyone as some stage of their life. Abuse is not confined to any group of people, although some individuals may be more at risk. Nurses meet a diverse array of people in the course of their work, and therefore need a reasonable working knowledge of the forms, signs and symptoms of abuse.
Abuse is not always obvious and patients may make excuses for various signs and symptoms, such as being bruised, lacking finances or not wanting to socialise. It is important to recognise the signs of abuse and sensitively share your concerns with a person who you think could be experiencing abuse.
This article identifies the recognised forms which abuse takes and the signs and symptoms which nurses need to look out for. See 'Abuse - response' for an overview of how nursing staff should respond to abuse when they encounter it.
Unless otherwise stated, the forms,
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Assessment
The people who are most at-risk of experiencing abuse include:
- children
- older people and those with frailty
- those living with mental health issues
- those living with a learning disability
- those living with dementia
The Social Care Institute for Excellence (2020) recognise 10 types of abuse:
Physical abuse
This is characterised by behaviours such as:
- hitting
- slapping
- over-medicating
The signs and symptoms include:
- unexplained injuries
- bruises, cuts, burns, fractures
- repeated visits to emergency departments which do not make sense
- changed behaviour around a certain individual(s), eg the perpetrator(s)
Domestic violence or abuse
This is characterised by behaviours such as:
- control over the other person
- physical abuse
- another person accompanying the victim to all visits and appointments
- repeated health appointments with no explanation or diagnosis, and describing themselves as 'accident prone' or 'silly'
- economic abuse
In 2021, The Domestic Abuse Act recognised children who see, hear and/or experience
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Risks and complications
Failure to identify and respond to signs and symptoms of abuse can lead to significantly worse consequences for the victim, including death. Nurses who choose to ignore abuse when they see it are at risk of being removed from the Nursing and Midwifery Council register.
Failure to act after identifying abuse means nurses are not fulfilling their statutory duty to promote and protect the welfare of the individuals they are working with (Local Government Association, 2019).
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Next steps
Nurses should educate themselves about the different forms that abuse can take and consider how they will respond when they come across it in practice. Social workers and other professionals working in adult and child protection teams are always available to provide support to staff who are not sure if they are witnessing abuse, and to guide them through the reporting process (NHS, 2021).
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NMC proficiencies
Nursing and Midwifery Council: standards of proficiency for registered nurses
Part 1: Procedures for assessing people’s needs for person-centred care
2. Use evidence-based, best practice approaches to undertake the following procedures:
2.11 recognise and respond to signs of all forms of abuse
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Resources
Ann Craft Trust. What is institutional abuse? Definitions, signs & symptoms. 2019. https://www.anncrafttrust.org/institutional-abuse-definitions-signs-symptoms/ (accessed 7 November 2023)
Antelo E, Saldaña O, Guilera G et al. Psychosocial difficulties in survivors of group psychological abuse: Development and validation of a new measure using classical test theory and item response theory. Psychology of Violence. 2021;11(3):286–295. https://doi.org/10.1037/vio0000307
Ferguson S. What are the signs of domestic violence? 2022. https://psychcentral.com/lib/symptoms-of-domestic-violence (accessed 7 November 2023)
HM Government. Modern slavery awareness booklet. 2017. https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/655504/6.3920_HO_Modern_Slavery_Awareness_Booklet_web.pdf (accessed 7 November 2023)
Home Office. New guidance will ensure all forms of domestic abuse are recognised. 2022. https://www.gov.uk/government/news/new-guidance-will-ensure-all-forms-of-domestic-abuse-are-recognised (accessed 7 November 2023)
Law Society. Financial abuse. 2023. https://www.lawsociety.org.uk/topics/client-care/financial-abuse (accessed 7 November 2023)
Local Government Association. Safeguarding adults: how do you know your council is being effective in keeping people safe? 2019. https://www.local.gov.uk/sites/default/files/documents/1.93%20Safeguarding%20must%20know_03%20WEB.pdf (accessed 7 November 2023)
NHS. Abuse and neglect of vulnerable adults. 2021. https://www.nhs.uk/conditions/social-care-and-support-guide/help-from-social-services-and-charities/abuse-and-neglect-vulnerable-adults/ (accessed 7 November 2023)
Royal College of Nursing. Key indicators for domestic abuse. 2023.
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