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Criminal NursingAbuse by Nurses
Professional Duties of a NurseAdvocates for and protects patient’s safety
and health (ANA, 2015)Vigilance to report improper practice (ANA,
2015)Care of the patients assigned to them
Do no harm (Huston, 2014) Client protection and safety are priorities
Ugly Truth of NursingCommon perceptions
Benefactor, caretaker, incapable of harmReality
Abuse does occur by nurses Neglect Verbal abuse Psychological abuse Physical abuse/murder
Victims of AbuseAnyone patient can be abused, although;
Patients with diminished capabilities are primary targets (Lubaszka, Shon, & Hinch, 2014) Babies Elderly Terminal patients Mentally ill Comatose patients
PerpetratorsNot limited by age or
raceNurses are primary
abusers in healthcare (Lubaszka, Shon, & Hinch, 2014)
Perfect career choice to hide ill-willSnake in the grass
No one suspects a nurse
Can be anyone
Actions of PerpetratorsCultivates trust with victim/victim’s familyUtilize medical knowledge to conceal abuse
Vienna, Austria Elderly clients smothered with wet washcloths
(Lubaszka, Shon, & Hinch, 2014) Moisture in lungs raised no alarms
Small injuries can be explained away Nurses possess inherent trust (Gallup, 2014)
Actions of Perpetrators, contHumor
Brings levity to tragic situationsViewed as coping mechanism in healthcare
Allows abuser to nonchalantly relive experienceLainz Angels of Death (49 murders)
Suspicion aroused by their humor (Lubaszka, Shon, & Hinch, 2014)
Actions of Perpetrators, cont•Prolong the suffering (Lubaszka, Shon, & Hinch, 2014)
Colleen Thompson Invited widowers of
victims to her wedding
Kristen Gilbert Called victim’s family to
remind them death
Motivation of PerpetratorsPsychology
Power is most prevalent reason (Field & Pearson, 2010) Vulnerability of patients
Crave respect and control “Come to the rescue”
Makes patient ill, then “saves” them (Lubaszka, Shon, & Hinch, 2014)
Factors that Increase AbuseStress imposed by a facility
Time constraints due to: High workload Poor support from management Conflicts with patients
Leads to categorizing patients Treatment was altered to reward “good” patients
punish “bad” ones (Reader & Gillespie, 2013)
Factors that Increase Abuse, contWorkplace quality
Poor leadership and job environment cultivates: Disengagement De-motivation Low job satisfaction Worker burnout
Factors that Increase Abuse, contWorkplace quality
Work dissatisfaction Highly correlated with poor
job performance (Reader & Gillespie, 2013)
Poor job performance can lead to neglect and abuse
Worker burnout (Mayo, 2015)Questioning the value of one’s work Coupled with emotional and/or physical exhaustion.
Closely tied with physical and mental abuseHas been found to reduce empathy (Natan,
Lowenstein, & Eisikovits, 2010 )
Caused by Symptoms
Dysfunctional workplace dynamics
Disillusionment
Unclear job expectations Irritability
Feeling of lack of control Impatience
Lack of social support Low job satisfactions
Factors that Increase Abuse, cont
Factors that Increase Abuse, contSocial norms within a facility
Some nurses accept maltreatment as norm (Natan, Lowenstein, & Eisikovits, 2010) Slapping, cursing, embarrassing patients
Stress when vacillating to report or notPoor avenues for whistleblowing (Reader &
Gillespie, 2013)
Factors that Increase Abuse, contFacility size
High correlation between Facility size and maltreatment High staff turnover and maltreatment/abuse
Length of time employedAbuse vs. time employed are inversely related
Possible CountermeasuresAssessing personal characteristics in nursing
schoolGauge emotional intelligence and sensitivityTest aptitude for verbal and non-verbal cuesTeaching students to report illegal behavior
(Wolf, 2012) Implement rigorous screening processes for
applicantsQuestionnaire fed through algorithm to
determine suitability
Possible Countermeasures, contMandatory survey provided to patientsScrutinize facilities with low job
satisfactionComprehensive teaching of the subject in
facilities
ConclusionsAbuse can occur by the hands of a nurseRemain vigilant to report suspected cases of
abuseAcknowledgement and teaching of nurse
abuse is the solution
“Nursing and nurses need to acknowledge the possibility that any nurse in virtually any clinical setting could murder a patient or patients. Clearly it is exceptional. It is not impossible. Only when this is acknowledged will it become more difficult for these murderous nurses to operate […]”
- James Field, 2010
ReferencesAmerican Nurses Association. (2015). Code of Ethics for Nursing with Interpretive
Statements. Silver Spring, MD: NurseBooks.orgField, J., & Pearson, A. (2010). Caring to death: The murder of patients by nurses.
International Journal of Nursing Practice, 16, 301-309. Honesty/Ethics in Professions. (2014). Retrieved October 22, 2015, from
http://www.gallup.com/poll/1654/honesty-ethics-professions.aspxHuston, C. (2014). Professional issues in nursing: Challenges & opportunities (3rd
ed.). Philadelphia: Lippincott Williams & Wilkins.Lubaszka, C. K., Shon, P. C., & Hinch, R. (2014). Healthcare Serial Killers as
Confidence Men. Journal Of Investigative Psychology & Offender Profiling, 11(1), 1-28.
Mayo Clinic Staff. (2015). Job burnout: How to spot it and take action. Retrieved October 24, 2015, from http://www.mayoclinic.org/healthy-lifestyle/adult-health/in-depth/burnout/art-20046642
Reader, T., & Gillespie, A. (2013). Patient neglect in healthcare institutions: A systematic review and conceptual model. BMC Health Services. Retrieved September 26, 2015, from http://www.biomedcentral.com/1472-6963/13/156
Wolf, Z. (2012). Nursing Practice Breakdowns: Good and Bad Nursing. MEDSURG Nursing, 21(1), 16-22, 36.