Week 6: Protection of Vulnerable Persons

Question 1

Define Vulnerable persons

Answer 1

usually dependent on others for ADLs & at risk of being harmed/victimized

Question 2

Define physical abuse

Answer 2

Unwanted physical contact – slapping, pinching, punching, kicking

Question 3

Define Sexual abuse

Answer 3

Unwanted sexual contact – sexual touching, forced sex, forced humiliating acts, Sexual exploitation

Question 4

Define Psychological/Emotional abuse

Answer 4

Being forced by another person to watch or take part in behaviour that is psychologically/emotionally harmful

Question 5

Define Financial Abuse

Answer 5

Use of financial information or other resources to control/cause harm to another person

Question 6

Define Honour based violence abuse

Answer 6

Fear of or actual forced marriage, controlling sexual activity, false imprisonment, forced abortion and death

Question 7

Define Child Abuse as per CFS

Answer 7

means an act or omission by any person where the act or omission results in:
- physical injury to the child,
- emotional disability of a permanent nature in the child or is likely to result in such a disability, or
- sexual exploitation of the child with or without the child’s consent

Question 8

What are the physical indicators of abuse?

Answer 8

• Unexplained burns, bruises, welts, lacerations or abrasions; various stages of healing
• Unexpected fractures or dislocations

Question 9

what are emotional abuse indicators?

Answer 9

oExtreme lack of self-confidence → “cannot win”
oStates no one cares about him/her
oLags in physical, mental, emotional development
oHabit disorders: sucking, biting, rocking
oSuicide threats or attempts

Question 10

Define Child Neglect

Answer 10

the failure of a child’s primary caregiver to provide adequate food, clothing, shelter, supervision, and/or medical care. Child neglect involves an act of omission by a parent or guardian, resulting in (or likely to result in) harm or imminent risk of harm to a child

Question 11

When is a child in need of protection?

Answer 11

a child needs protection, where: “the life, health or emotional well-being of the child is endangered by the act or omission of a person”

Question 12

Who must nurses report suspected child abuse to?

Answer 12

• to CFS if there is suspicion that a child needs protection or immediate harm to police
• will supersede PHIA

Question 13

What is the age of consent for sexual activity?

Answer 13

In Manitoba and across Canada, the age of consent to sexual activity is 16 years

Question 14

What is the sexual activity consent according to the Criminal Code of Canada?

Answer 14

• A 14- or 15-year-old individual can consent to sexual activity with someone who is less than five years older than them (only apply if the older person is NOT in a position of authority or trust)
• A 12- or 13-year-old individual can consent to sexual activity with someone who is less than two years older than them

Question 15

What is the duty to report of Child Abuse?

Answer 15

• Applicable when information is obtained in a nurse-client relationship
• Disclosure without consent – even if the child does not want the report to occur it still needs to happen because it is the obligation of the nurse to do so
• Obligation includes allegations of past abuse
• Report to Child Family Services agency
• Potentially report to parent/guardian – would not report to them if they are the ones causing the abuse
• Failure to report consequences – can be a punishable offence such as legal outcome

Question 16

Who are “adults living with an intellectual disability”?

Answer 16

an adult living with a disability who needs assistance to meet their basic needs with regard to personal care of management of their property.

Question 17

Define intellectual disabilities

Answer 17

significantly impaired intellectual functioning existing concurrently with impaired adaptive behaviour and manifested prior to the age of 18 years, but excludes a mental disability

Question 18

What is the intent behind the Adults Living with an Intellectual Disability Act?

Answer 18

to support people to be as independent as possible and promote and protect the rights of people living with an intellectual disability-free from abuse, neglect and exploitation

Question 19

What are the guiding principles of Adults Living with an Intellectual Disability Act and Autonomy?

Answer 19

1. presumed to have the capacity to make decisions on matters affecting their lives, unless demonstrated otherwise.

2.should be encouraged to make their own decisions.

3.The support network should be encouraged to assist them in making decisions to enhance their independence and self-determination.

4.Assistance with decision making should be provided in a manner which respects the privacy and dignity of the adult living with intellectual disabilities and should be the least restrictive and least intrusive form of assistance that is appropriate in the circumstances.

5. Substitute decision making should be invoked only as a last resort when an adult living with an intellectual disability needs decisions to be made and is unable to make these decisions, either by themselves or with the involvement of members of their support network.

Question 20

What is the duty to report of suspected abuse in adults living with an intellectual disability?

Answer 20

• Duty to report abuse or neglect per sec. 21(1)
  A person who believes on reasonable grounds that an adult living with an intellectual disability is, or is likely to be abused or neglected, shall immediately report the belief and the information on which it is based to the executive director.
• Protect the vulnerable person from abuse and neglect, if there is abuse and neglect present we must report it to CALIDO (Commissioner with adults living with intellectual disability)

Question 21

Define the Protection for Persons in Care Act
- Who does it include?

Answer 21

a law to help protect adults from abuse and neglect while receiving care in Manitoba personal care homes, hospitals or any other designated health facility. – Does not include people living in the community/at home

• Includes a resident/in-patient in a health care facility
• People attending a geriatric day hospital if regulated under the Health Services Insurance Act
• Patients receiving services in an ED or UC department
• People receiving other services provided by a health facility that are specified in the regulations

Question 22

What is the duty to report of suspected abuse in Persons in Care?

Answer 22

• Duty of health facility to protect patients from abuse or neglect (2)
• The operator of a health facility has a duty to protect the patients of the facility from abuse or neglect and to maintain a reasonable level of safety for them.
• Duty to report abuse or neglect 3(1) by both family and health care provider
• Report to protection for persons in care office (PPCO) – can use the online recording system
• Have a legal obligation to report to this office
  Role of PPCO is to conduct an investigation – not the role of the nurse

Question 23

what should be documented with suspected abuse/neglect?

Answer 23

*Description of person, including accurate and objective detail on any signs of abuse noted – remove any feelings
*Specific dates & times of disclosure - in person’s own words
*Concerns about immediate safety – any threats of imminent harm should be reported to the police
*Height & weight – especially for those with suspected neglect

*For children:
– Accurate recording of child’s developmental stage
– Child’s behavior with & without parent or guardian

Question 24

Define restraints

Answer 24

Anything that restricts or reduces voluntary movement or freedom implemented to ensure safety of self, others or the physical environment

Question 25

What is a chemical restraint?

Answer 25

medication is given for inhibiting severe behavioural issues or limit activity (not a typical medication for an underlying issue)

Question 26

What are environmental restraints?

Answer 26

– barrier to a free personal movement
– Removing mobility aid
– Putting them in a particular environment ie. a room

Question 27

What are physical restraints?

Answer 27

– restricts movement in someway
– Mobility-restricting chairs
– Hand mitts
– Bed rails

Question 28

When can restraints be used?

Answer 28

• When it is necessary to protect the patient from harming themselves or others; Last resort
• In an emergency when danger is imminent
• Should be assessed on a case-by-case basis
• For the shortest amount of time necessary

Question 29

When should restraints NEVER be used?

Answer 29

• As punishment
• As a substitute for nursing care
• As a matter of convenience for the healthcare providers

Question 30

When must consent be obtained for with restraints?

Answer 30

*To apply restraints, nurses must generally have consent from the patient or the substitute decision-maker

*There are certain legislative exceptions to the consent requirement:
Emergencies
*Consent should still be obtained as soon as possible following the emergency

Question 31

What are the concerns with restraint use?

Answer 31

1. Restriction of freedom
2. Risk of harm or injury
3. Loss of abilities