Recognizing and reporting abuse

The nurse's legal duty is to report suspicion, not to prove abuse.

TypePossible signs
Physical abuseBruises in various stages or on protected areas (ears, neck, buttocks), patterned injuries, immersion burns, injuries that do not match the story
NeglectPoor hygiene, malnutrition, missed medical care, unsafe living conditions
Sexual abuse (child)Sexually transmitted infection, genital injury, age-inappropriate sexual knowledge
Elder abuseUnexplained injuries, fearfulness, financial changes, untreated pressure injuries
Intimate partner violenceRepeated injuries, partner who answers for the client, missed appointments

Document objectively, using the client's own words in quotation marks, and photograph or diagram injuries per policy.

SafetySeparate ifneededAssessPrivately;injuriesDocumentObjectivefactsReportPer state lawSupportResources,safety plan
Response to suspected abuse. Do not confront the suspected abuser; follow the facility protocol and involve social work.

Crisis intervention

A crisis is a time-limited state in which usual coping fails.

StepsSafetyAssess risk of harm to self or othersEngageCalm presence, listen, establish trustFocusThe immediate problem, not the whole life storyCopeIdentify strengths, supports, optionsFollow upReferrals and a concrete plan
Crisis intervention. Crises typically resolve within weeks; the goal is a return to the previous level of functioning.

Grief and loss

Support the person without forcing a timeline.

  • Common responses include shock, denial, anger, bargaining, sadness, and acceptance; they do not happen in a fixed order.
  • Therapeutic responses acknowledge feelings: "This must be very hard for you." Avoid clichés such as "They are in a better place."
  • Anticipatory grief can begin before a death.
  • Grief that is prolonged and severely impairs daily life may be prolonged grief disorder and needs referral.
  • Respect cultural and religious practices around death and mourning.

Palliative, hospice, and the last days of life

Comfort-focused care is active nursing care.

Palliative careAny stage of serious illnessAlongside curative treatmentSymptom relief and supportHospital, clinic, or homeHospice carePrognosis about 6 months or lessComfort-focused, not curativeInterdisciplinary team, family supportOften at homevs
Palliative vs hospice. All hospice care is palliative, but not all palliative care is hospice.
Sign of approaching deathComfort measure
Mottled, cool extremitiesLight blankets; reassure family it is expected
Changes in breathing (pauses, irregular patterns)Elevate head; medications for dyspnea as ordered
Noisy respirations from secretionsReposition; anticholinergics as ordered; suction gently only if helpful
Decreased intake and urine outputMouth care; do not force food or fluids
Decreased responsivenessContinue to speak to the client; hearing may persist

After death, provide postmortem care per policy and allow the family time; requests for organ and tissue donation follow the organ procurement organization process.

NGN-style case

Recognizing a reportable situation.

functions Clinical judgment case — the explanation does not fit

A 7-month-old is brought in with a spiral fracture of the femur. The parent says the infant "rolled off the couch." The infant has bruises on both ears and the abdomen at different stages of healing. What should the nurse do?

  1. Recognize cues: fracture pattern and bruises inconsistent with the history and the infant's development; bruises on protected areas in different stages.
  2. Analyze: suspected physical abuse.
  3. Ensure the infant's safety and provide care; document objectively.
  4. Report to child protective services per state law and facility protocol; involve social work. Do not confront the parent.

Answer. Report suspected abuse as required by law, ensure the child's safety, and document objectively.