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Making Safe Choices

  • This module provides critical information/steps needed to ensure that our patients consistently receive safe care. It is your responsibility to notify your supervisor/educator if you have questions about the information in this module, or if you are unable to complete the steps as described.
  • Not following these steps may cause harm to our patients, ourselves or others and is called at-risk behavior. You should expect to be coached if you misstep, or drift, from the described procedures.
  • Should you choose to not follow this procedure (after being coached on the correct procedure) that may be considered reckless behavior and may result in punitive action.

Domestic Violence, Abuse, Neglect & Exploitation

  • What is Domestic Violence?
    • Learned pattern of behaviors used by one person in a relationship to control the other person. Partners may be married, separated, divorced or dating, or in same sex relationships.
    • Violence affects women, children and men, of all ages, in all cultural, ethnic, religious, educational and socio-economic groups.


  • Abuse: Any harm or threatened harm to any person’s health or welfare caused by another person. This includes non-accidental physical injury, sexual abuse or maltreatment.
  • Neglect: Any harm to any person’s health or welfare caused by the conduct of a person responsible for that person’s care. This includes failure to provide food, clothing, shelter or medical care.
  • Endangerment: A life threatening situation caused by the inability of the person whose life is threatened to respond.
  • Exploitation: Improper use/taking advantage of another person for one’s own profit or benefit. Usually involves taking money/belongings.

Healthcare Implications

  • 1 in 5 victims report to an Emergency Center, but only 10% are identified as abuse victims
  • 92% of women who were physically abused didn’t discuss this with their doctor;
    57% didn’t discuss it with anyone
  • 20% of the women who are battered, are assaulted by their partners during pregnancy

Physical Assault

  • Pushing or punching
  • Slapping or kicking
  • Throwing objects
  • Choking
  • Using weapons

Sexual Abuse/Assault

  • Unwanted touching
  • Sexual name calling
  • Forced sex with abuser or others (rape)
  • Hurtful sex
  • False accusations of infidelity

The health care provider must combine elements of

  • History
  • Physical Examination
  • Labs and X-rays
  • Other observations
  • To construct a level of concern regarding the possibility of Abuse or Neglect
  • Document all findings and interventions
  • If indicated preserve evidence

Child Abuse and/or Neglect

  • Committed by person responsible for child’s health or welfare
  • Abuse: Non-accidental harm or threatened harm to child’s health or welfare
  • Neglect: Occurs as result of failure to provide adequate food, clothing, shelter, medical care or placing a child at unreasonable risk of injury

Signs of Child Abuse and/or Neglect

  • Indicators of physical abuse include:
  • Skin injuries (cuts, scrapes, bruises, burns)
  • Fractures or other orthopedic injuries
  • Internal injuries to the chest or abdomen
  • Head Injuries
  • Death

Child Physical Abuse

  • We MUST suspect child abuse in any injury where:
  • The proposed cause of the injury is not realistic for the child’s age or abilities
  • OR
  • There is a discrepancy between the clinical findings and the history
  • AND
  • There is no medical history or condition that could explain the injury

Child Sexual Abuse or Molestation

  • Indicators for sexual abuse/molestation:
    • Genital or anal trauma without a realistic history for an accidental cause
    • Evidence of a sexually transmitted disease that is:
      • Not transmitted before or during birth
      • In a child that is less than 12 years of age
    • Pregnancy in a child less than 12 years of age
    • History by child or caregiver of sexual contact, molestation or exploitation

Other Indicators of Child Abuse:

  • Knowledge or suspicion of alcohol or a controlled substance in the body of a newborn infant which is not the result of medical treatment
  • Suspicion that the symptoms are falsely reported or caused by the caregiver– i.e. Medical Child Abuse
  • Emotional abuse
  • Exploitation

Signs of Vulnerable Adult Abuse/Neglect and/or Exploitation

  • Vulnerable adults are unable to protect themselves due to mental or physical illness, disability or age
  • Must be 18 years old, or older
  • Harm or threatened harm to patient’s health or welfare; placing patient at unreasonable risk of injury by failure to eliminate the risk; taking advantage financially.
  • Complaint of being slapped
  • Burns, bruises, bed sores, improper restraint use
  • Complaint of sexual coercion or assault
  • Complaint of withheld meals, hygiene, therapy, medications, physical aids
  • Complaint of stolen possessions or money taken from bank accounts, controlling elder’s finances
  • Kept isolated, denied news, threatened

Reporting Domestic Violence

  • MCL 750.411: Requires that medical care providers and institutions make police reports under specific circumstances involving people who are suffering from any violently inflicted wound or injury
  • Must Report Immediately to the police in the jurisdiction in which the hospital, pharmacy, physician, or surgeon is located
  • By telephone and in writing, including:
    • Name and residence of the person injured
    • Nature & extent of violently inflicted injury
  •  For patient ’s safety
    • Let the patient know you made the report
  • Failure to report:
    • “Any person, firm, or corporation violating any provision of this section
      shall be guilty of a misdemeanor.”  Failure to report may subject you to a civil liability MCL 750.411
  • Liability:
    • Law provides for immunity when reporting
  • Uncertain if a report should be filed?
    • Contact Social Work
    • Contact Legal Affairs

Reporting Requirements: Child or Elder/Vulnerable Adult

  • Mandatory Reporting for actual or suspected child abuse/neglect, elder or vulnerable adult abuse/neglect and/or financial exploitation
  • Consult the social work staff for guidance
  • Report suspicions to Adult or Children’s Protective Services
  • Refer to Beaumont Policy #320
  • Law provides immunity for reporters

Resources to Help Patients

  • If you are unsure what to do next:
    • Refer to Beaumont Hospitals Abuse Policy #320
    • Ask your Manager, Charge Nurse or Preceptor
    • Call Social Work, Legal or Nursing Manager/Supervisor
    • Refer to the Social Work Website for Domestic Violence and Abuse resources
    • Refer to Domestic Violence Flyer

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