Case study - Dependent adult abuse and neglect: Nursing

Nurse Madison works night shift in a long-term care facility, and is caring for Edward, a 71-year-old patient with a history of dementia. Nurse Madison goes through the steps of the Clinical Judgment Measurement Model to make clinical decisions about Edward’s care by recognizing and analyzing cues, prioritizing hypotheses, generating solutions, taking action, and evaluating outcomes.  

First, Nurse Madison recognizes important cues. As she approaches Edward’s room, she notices a chair has been placed in front of the door, preventing it from opening all the way. When Nurse Madison asks the unlicensed assistive personnel, or UAP, about it, the UAP admits they placed the chair there to prevent Edward from wandering off the unit.  

Then, upon entering the room, Nurse Madison notes Edward's hair is unkempt, and his shirt is stained with dried food. She also sees that Edward’s bed sheets are soaked with urine and he’s visibly upset. 

Next, Nurse Madison analyzes these cues. She recalls that the electronic health record, or EHR, documents that Edward is at high risk for elopement, and that he’s attempted to leave the unit several times before being stopped by security. She also notes that Edward is normally continent of urine. Nurse Madison recognizes that preventing Edward from leaving his room by forcing him into physical confinement is considered restraints abuse. It also appears that Edward has been neglected, meaning that his basic needs, such as hygiene, haven’t been met.  

Now, using the information she’s gathered, Nurse Madison chooses a priority hypothesis of powerlessness.  

Then, she generates solutions to address Edward’s powerlessness, and she establishes the expected outcome that after intervening, Edward will have his basic needs met while remaining safe in his environment.  

Nurse Madison then takes action to implement these solutions. She makes sure Edward is safe by ensuring he's free from injuries and confirming his room is safe and clear of anything he could trip or slip on, like blankets or urine on the floor.  

Then, she helps him to clean up and change clothes, and she replaces his linens.  

Since Edward is currently alert and responsive, Nurse Madison attempts to explain the situation to Edward.