Running Head: VERBAL MISTREATMENT IN NURSING 1

Verbal Mistreatment in Nursing

Brenna M. Halvorsen

James Madison University

VERBAL MISTREATMENT IN NURSING 2

Verbal Mistreatment in Nursing

Introduction

Elder mistreatment is an issue that should be taken very seriously in the United States

health system. As the elderly population increases in size with the aging Baby Boomer

generation, so does the incidence of elderly mistreatment (Wong & Waite, 2017). One form of

elder mistreatment is verbal abuse. Although it may not leave any visible or physical damage, the

effects can be just as harmful. Unfortunately, verbal abuse is often overlooked. Investigators

struggle to define what verbal abuse truly is, because it is highly subjective, the onset of the

abuse can be questionable, and the variability of cultural influence can be difficult to interpret

(Fulmer, Rodgers, & Pelger, 2014). The first National Prevalence Study performed in 2008

discovered that 9% of elder adults experienced some form of verbal mistreatment, which

includes harassment, humiliation, or ignoring (Fulmer, Rodgers, & Pelger, 2014). Research

suggests that verbal mistreatment results in psychological symptoms such as anxiety and

depression, as well as deteriorations in physical health including increases in mortality and

poorer outcomes (Fulmer, Rodgers, & Pelger, 2014). Without a doubt, this poses a serious

concern, especially when considering our increasingly aging population.

Background

Throughout the course of my clinical rotations, I thankfully have not encountered many

instances of elder mistreatment. However, I was unfortunately exposed to an instance of verbal

elder abuse through the testimony of a patient. It took place in the morning, which is a busy time

for both patients and nursing staff alike: with breakfast, morning medications, personal care, and

upcoming therapy sessions to all attend to. It was a Wednesday, which was the linen-change day

at the clinical facility. I had walked into a patient’s room, began changing her roommate’s bed,
VERBAL MISTREATMENT IN NURSING 3

and struck up a conversation with her. She had told me that she really needed to use the restroom

earlier that morning, but since she had limited mobility, she could not get up on her own and felt

unsafe attempting so. She called for an aide, but help did not come soon enough. Taking matters

into her own hands, the patient got herself out of bed with the intent of going to the restroom,

while setting off her bed alarm. An aide came in and proceeded to scold her for getting up on her

own, telling the patient that she should have relieved herself in the bed instead. The patient told

me that this was done in a very humiliating and degenerative fashion and that it had a terrible

impact on her dignity. She had never imagined anyone would ever tell her that.

I listened to her as she told me this, feeling quite shocked. I agreed with her that the

action of the aide was not acceptable, but other than talking to and comforting the patient, I did

not do anything else. Alternatively, I could have told an instructor about this incident, as there

were other patients who could have been receiving similar or worse treatment, a troubling

thought. When considering moral distress and moral dilemmas in this situation, I felt moral

distress. I knew there was a better way to confront this situation, but I lacked the courage to take

action. I suppose I felt that nursing students were already viewed with some degree of annoyance

by nursing staff and I did not want to stir up trouble.

Methods/Findings

James Madison University utilizes a framework of human values which one can use to

base ethical decisions called The Eight Key Questions. The values of this framework are fairness,

outcomes, responsibilities, character, liberty, empathy, authority, and rights (JMU 8 Key

Questions). The Eight Key Questions can be applied to almost any situation and decision, and in

this instance it will be applied to the situation I encountered in my clinical. The first Key

Question is fairness, which entails acting “equitably” and balancing all aspects and interests in a
VERBAL MISTREATMENT IN NURSING 4

certain situation (JMU 8 Key Questions). The next is outcomes, which involves analyzing the

actions taken and how they will affect those who are involved and the situation in general.

Responsibilities is next, and it means to consider the obligations one must fulfill. Next is

character, which means to consider the actions that best reflect who one is as a person. Liberty is

the next Key Question, which means to hold respect for one’s autonomy and personal freedom.

The next Key Question is empathy, which entails understanding someone else’s feelings. Next is

authority, which is considering what authority figures expect of an individual. And lastly, there is

rights, which entails evaluating which rights are involved.

When considering this situation, the actions that the nurse aide took were unfair to the

patient. Her feelings and her dignity as a human being were not taken into consideration, and it is

apparent that the aide did not think of the outcomes of her actions. Similarly, if I had spoken up

to someone, then perhaps another patient would not have had to face similar treatment. As a

nurse aide, she had a duty to see to the needs of her patient and a responsibility to protect her

patient, and I had a responsibility to speak up and be the patient’s advocate. When it comes to

character, the nurse aide did not think about her own character and how the choice she made

reflected that to other people, including her superiors. Additionally, if she had practiced empathy

and put herself in her patient’s shoes, then perhaps she would have taken a different action. If I

had practiced more empathy, I would have been able to tell someone right away about what I had

been told. Lastly, the nurse aide did not respect the patient’s rights to autonomy and liberty by

scolding her for practicing it.

The American Nurses Association Code of Ethics for Nurses helps nurses in ethical

decision making through nine provisions. Provision three states “The nurse promotes, advocates

for, and protects the rights, health, and safety of the patient” (Code of Ethics). I believe that this
VERBAL MISTREATMENT IN NURSING 5

provision is the most relevant to the situation. It is the nurse’s responsibility, or anyone who is

involved in the patient’s care, to see that this provision is put into place. By scolding the patient

for using the restroom, and telling her to go in the bed instead, the nurse aide was not advocating

for the patient nor protecting the patient’s right to autonomy. Instead, she succeeded in

humiliating and dehumanizing the patient. Perhaps if the nurse aide had kept this provision in

mind, she would have considered her actions a little more carefully. This provision applies not

only to the nurse aide, but to me and my actions as well. I am equally accountable as the nurse

aide when it comes to promoting and advocating for the rights of the patient, which I could have

exercised if I had spoken up.

Conclusion. Unfortunately, elder mistreatment is an all too common occurrence.

Reflecting upon this experience, there are some actions I should have taken differently. While I

would not have changed the way I listened to the patient and expressed my apologies for how

she was treated, I could have taken it a step further. I should have brought this issue up to my

instructor to see if she could have talked to the nurse aide or suggested an appropriate action to

take. Considering the nurse aide was treating one patient this way, there was a fair chance that

other patients on the unit were being treated that way as well. As nursing students, we have a

certain gift; we are able to see how units and hospitals operate with new, fresh eyes. Therefore, I

think students have a responsibility to advocate for the patient’s safety and well-being and speak

up when they are being put in jeopardy. By using the Eight Key Questions and the American

Nurses Association Code of Ethics, students can evaluate ethical situations and make informed

decisions that can help in not only improving patient outcomes, but preventing incidences of

elder mistreatment.
VERBAL MISTREATMENT IN NURSING 6

References

Code of Ethics PDF. (n.d.). Retrieved March 21, 2018, from https://www.nursingworld.org/coe-

view-only

Eight Key Questions. (2018, February 07). Retrieved March 17, 2018, from

https://www.jmu.edu/mc/8-key-questions.shtml

Fulmer, T., Rodgers, R. F., & Pelger, A. (2014). Verbal Mistreatment of the Elderly. Journal of

Elder Abuse & Neglect,26(4), 351-364. doi:10.1080/08946566.2013.801817

Wong, J. S., & Waite, L. J. (2016). Elder mistreatment predicts later physical and psychological

health: Results from a national longitudinal study. Journal of Elder Abuse & Neglect,

29(1), 15-42. doi:10.1080/08946566.2016.1235521