Unit 7 - Types of abuse 2

Domestic abuse- what is it?

 

Domestic abuse can be defined as in incident, or number of incidents, when a person is subjected to behaviours that control, scare, threaten or try to persuade them to do something against their will. There is a government definition for domestic abuse. This definition includes the following ideas about what domestic abuse it. It occurs between people who are over 16 and are, or have been, intimate or are, or have been, a family. It can also occur between people who simply live at the same address. Domestic abuse may take the form of physical, sexual, financial or emotional abuse.

Controlling and coercive behaviours are now recognised as abusive within domestic relationships. For example, in a relationship where someone tries to dominate another person by only allowing them to go to certain places or to see certain people. They may also try to manipulate the other person by threatening violence. For example, a servicer user may feel coerced into handling over money because they are threatened with violence although they have never been hit.

You will need to be aware, as a care worker, that some service users may feel too intimidated or disempowered to seek help. There are practical steps that you can take:

• Do not be critical, the service user needs to be supported not judged
• Report your concerns to your line manager
• Make sure your concerns are recorded and sign the documentation appropriate to your workplace
• Never promise the service user that you will keep it a secret.

 

Domestic abuse- The signs.

 

Signs of neglect and acts of omission

As a care worker, you are in a good position to note changes in a service user’s physical appearance.

• Unkempt appearance
• Unexplained weight loss
• Ulcers, especially to the legs
• Pressure ulcers (also called bed sores)

 

 

 

Physical abuse- what is it?

 

Physical abuse includes many aggressive acts such as hitting, punching, pushing or burning. Using medication in a way that is not prescribed in order to subdue the service user is also abuse. Physical abuse also includes force feeding, slapping or breaking bones by inappropriate movement, for example causing a fracture by forcing a service user’s arm into a sleeve awkwardly.

You may see other carers pinching or poking or slapping a patient and saying things like ‘it’s only a joke’ or ‘we’re playing, it’s fine.’ Nothing is fine if it causes harm or distress to a service user who many not feel empowered to complain. You have a responsibility (duty of care) to report your concerns so that they are properly investigated.

Always read a service user’s care plan before you start caring for them, so that you can confidently and professionally manage any atypical behaviour, such as a service user displaying aggression, inappropriate reaction to this type of behaviour could leave you vulnerable to accusations of abuse.

 

 

 

Signs of physical abuse

 

You may think that you have identified signs of physical neglect such as bruises, but are concerned that there may be an innocent explanation and that you can making a fuss. Elderly people tend to bruise very easily. Poor manual handling techniques are a form of neglect. If you see ‘finger mark bruises’ or marks to parts of the body that are not usually touched when supporting a service user in their daily living activities, for example on the face, neck or feet, then this could be a sign of abuse. You should document any bruises that you notice and report this to your manager immediately.

 

 

Psychological abuse- What is it?

Psychological abuse is caused by someone behaving in such a way as to cause a psychological trauma. As a carer, you may notice a change in your service user. For example, they may become very anxious, or depressed, they may be self-harming or deliberately placing themselves in high-risk situations such as running into busy traffic, as an expression of their emotional pain, or they may develop anorexia.

An individual may be subjected to psychological abuse for a long time. Although it can be just as devastating as physical abuse, without any obvious physical signs it may not be noticed for a long period of time.

Psychological abuse is the act of inflicting emotional abuse, verbal abuse or humiliation.

Emotional abuse may include:

• Threatening to withdraw affection if the person does not behave in a certain way
• Acting in an inconsistent way, sometimes being affectionate and sometimes not, in order to manipulate someone and leave them unsure of how to behave to get affection back
• Threat of punishment
• Saying hurtful things in order to exercise control by reducing a person’s self-worth or self-confidence.

Verbal abuse may include:

• Deliberately using language that a service user will find disrespectful
• Shouting or threatening a service user
• Criticising a service user in a way that makes them feel insecure, unsafe or lowers their self-esteem this may be done over a long period of time and gradually reduce the service user’s sense of self-worth.
   
  Humiliation may include:

• Belittling a service user in the presence of family, friends, other care givers or even strangers
• Deliberately undermining a service user
• Deliberately embarrassing a service user by disclosing private information.

Psychological abuse- The signs.

Psychological abuse can change a service user’s behaviour in a way that you might notice. For example, they may become anxious or withdrawn, perhaps they are chatty and then stop abruptly in the presence of their abuser, or they may cry a lot. There is not necessarily one definitive sign that will show you that your service user is being abused, you are looking for a change in behaviour- particularly an unexplained change. It can be difficult to see and some service users will try really hard to cover up what is happening to them.

 

 

Sexual abuse- What is it?

Sexual abuse is forcing a person to take part in sexual behaviour for which they have no desire. It does not have to include touching genitalia (private parts). It can also include non-touching activities. Touching activities can include touching the genitals, penetration of the mouth, vagina or anus, or forcing another to touch genitals against their will. Examples of non-touching activities includes forcing a person to watch pornography, photographing them in sexual positions, forcing them to watch or listen to sexual acts or exposing genitalia to a person when they do want to see them.

Sexual harassment may be passed off as a joke by the perpetrator but may rapidly escalate into behaviour that is not only professional but can also lead to emotional harm.

Care workers often have to deliver personal care when the service user is naked. Do not forget that having no clothes on often makes people feel very vulnerable and they may display a range of reactions to this feeling.

Service users may try to abuse carers by using lewd or suggestive language or by inappropriate touching. It is important that you maintain your professionalism, remind the service user of what is and is not appropriate behaviour and report such incidents to your line manager,

You will need to use empathy to help you to understand why people are reacting in a certain way to their own personal care needs, how you can make them feel more secure and what you need to do in order to support them in their care needs to that they do not get upset and potentially make accusations against you for sexual abuse.

You must be aware of your behaviour at all times. You should not do or say anything which may be misinterpreted.

Sexual activity where the individual cannot give consent.

You need to be aware of the signs of sexual activity without consent for service users with complex needs as they may be unaware themselves that abuse has occurred. A service user cannot consent to sexual activity if they are unconscious or they lack the capacity to give informed consent.

 

Sexual abuse- The signs.

As a carer you must be aware of the signs of sexual abuse such as bruising or bleeding around the anal or genital areas, or the symptoms of sexual transmitted infections or pregnancy. If you observe any of these signs of symptoms, you must report them to your line manager. Preserve any evidence, such as blood-or semen-stained underwear. Remember to be compassionate and respect the dignity of your service user.

 

Financial abuse- what is it?

 

Financial abuse is a type of theft. It is another name for stealing money or valuables from a service user or od defrauding them of their money or property. Often the people who defraud vulnerable service users of their property to inheritance are considered ‘friends’ by the service user. They can be very close to, or get very close to the service user, they may have power of attorney (the legal authority granted to make decisions on behalf of the service user) or they may simply steal a service user’s bank details or property e.g. jewellery.

Financial abuse is a crime and should always be investigated.

As a care worker, you should try to ensure vulnerable people do not fall victim to scams and ‘Get rich quick’ schemes and that someone is not trying to defraud them. Many elderly people or vulnerable people are the victims of cybercrime or literature received in the post that asks for an upfront payment, for example, to retrieve a jackpot prize or requesting bank details.

As a care worker you are also vulnerable to accusations of financial abuse. If a service user asks you to withdraw money from a bank account, ensure you obtain a receipt, or if they ask you to withdraw money from their purse or wallet to ‘buy yourself something nice for being so kind’, you must refuse politely. Remember that you are just doing your job- if they forget that they told you to take the money, or later deny it, you would have no defence.

 

Financial abuse- The signs.

Financial abuse can be perpetrated by anyone that the service user trusts with their financial information. As a carer, you may see that valuable items are missing for the service user’s home or that the service user is short of money. Even a small loss can have a big impact on a service users welfare. They may be left unable to pay for the services that they need or unable to pay their rent or household bills. The service user mat also suffer the range of emotions usually associated with being the victim of a robbery.

 

 

 

Abuse by discrimination- What is it?

It is important, as a care worker, that you are aware of the different types of discrimination and can recognise them when you see them.

People can be discriminated against on many different grounds:

• Age
• Sex/gender
• Race
• Culture
• Religion
• Ability
• Sexual orientation

Sometimes it is hard to know whether someone is being discriminated against, so ask yourself some simple questions such as: Can everyone who wants to take part in the event participate (whatever it is- a meal, sport or a fun activity). If not, why not? The Equality Act (2010), which replaced the Disability Discrimination Act (1995) enshrines the principle of inclusivity.

 

Abuse by discrimination- the signs.

Being discriminated against can lead to a spectrum of feelings ranging from anger and frustration to being withdrawn, anxious or having a low self-esteem. You need to advocate for your service users who are subjected to discriminatory practices.

They may be subjected to:

• Denial of choice about their care, or even what is offered to them
• Denial of privacy and dignity, and maybe personal belongings
• Punishments, such as being denied food and drink, given cold showers
• Refusal of access to services, denial of disabled access of even being excluded from care settings inappropriately.