Module 5 – Abuse and Neglect

Assignment

General Directions:

A. Work in a small group, as assigned by your instructor.

B. Choose a group member to record the answers for the group.
C. Discuss the following scenarios and record your answers on the assignment sheets
provided.
D. One assignment will be submitted per group— all members will receive the same
mark.
E. Submit your answers to your instructor at the end of the session.
F. Assignment is out of 30 marks.
G. Each group member will receive the same mark, provided all participants contribute
equally.
H. The assignment will count for 40% of your final mark in Module 5.

Name: Rajnandan Malhotra, Pawan, Karanjot Singh, Amardeep Singh

Date: _______________________24-07-2024_______________________

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 CASE
#1

Mrs. Green is your client. She is 78 years old and has progressive degeneration of her
hip joints that makes it very difficult for her to get out. You have been visiting her for
three weeks, helping with the vacuuming, washing, and providing some social contact.

Although Mrs. Green seems to want you to continue coming to see her, you notice that
she is very anxious about your leaving on time. You feel that she is probably worried
about the costs of your visits and wants to make sure that she isn’t charged for extra
time.

You’re aware that Mrs. Green has a daughter and, although she doesn’t say much about
her, you get the feeling that the daughter does visit. You have never met her, though.

At the end of your last visit, Mrs. Green’s washer backs up, spilling water all over the
basement. Mrs. Green becomes very anxious, saying to you that, “It’s alright: the water
won’t hurt the floor. You’d better go, you’ll be late.”

You can’t just leave the water on the floor, and insist on cleaning it up. Somewhat
reluctantly, Mrs. Green decides to let you do this and returns upstairs.

Just as you’re finishing, you hear the door. A younger woman speaks to Mrs. Green. You
notice that her tone is harsh as she says, “You’re out of milk and bread? What did you
do with all of the food I brought last week? Feeding those damn birds again— you don’t
have enough sense to make sure that you keep food for yourself. Now I have to get stuff
because you’ve wasted what you had. Sometimes you act as though you don’t have a
brain in your head.”

Concerned, you put away the last of the cleaning supplies when you hear the younger
woman say, “Whose coat is this?” When Mrs. Green replies that it is yours, the woman
continues, “What’s the matter? You aren’t satisfied with all that I do? You have to invite
some stranger into your house? Where are you getting all the money for this?”

You go to the top of the stairs. The younger woman says to you, “Thanks for your help,
but my mother won’t be needing you anymore. I’ll make sure that you’re well paid for
today.” Mrs. Green looks miserable, but helpless. She looks down at the floor.

1. Describe all the feelings that you (or other PSWs) might have in this situation.
Explain how they might be helpful or unhelpful in resolving the problem. (2 marks)

The feelings are about that Mrs. Green being verbally and maybe financially
abused. One would feel the need to confront the young woman possibly her

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 daughter to be respectful towards Mrs. Green and correcting her on moral
grounds. Also, one might go report the incident with the abuse help authorities.
But one (in case PSW’s) should not be emotional when confronting such situations
rather one should report such incidents to their supervisor or nurse in-charge and
raise voice for the mental health of the patient involved. Seeking the correct
response shall always prove beneficial in response to a possible abuse.

2. List three behaviours of Mrs. Green’s that indicate she may be abused. (3 marks)

a. Her becoming anxious and reluctant as the time exceeds the preset time for
the PSW work shift. This may show signs of being worried about her financial
limits as she tries not to exceed them. The financials maybe supported by her
daughter if not by her pension plan, the daughter’s behavior towards her
spending money could be considered Financial Abuse.
b. When the young woman was speaking to Mrs. Green with a considerable high
tone and condescending words, Mrs. Green response to her was staying silent
and looking down to the floor. This shows that Mrs. Green was experiencing
Verbal abuse by the young woman.
c. Mrs. Green when not sharing information regarding her family specifically
about her daughter may indicate that she does not have many happy memories
about her and might be getting abused.

3. In this situation, describe how power is being exerted over another person. (2
marks)

In this case power is being exerted over Mrs. Green by the young woman possibly
her daughter. This can be seen through Mrs. Green keeping quiet when being
scolded at by the young woman (shows possible verbal abuse), and her being
overly concerned with timely leaving of the PSW worker so as no extra charges
could incur (shows financial concerns). The behavior expressed in the mentioned
scenarios lead the judgement to Mrs. Green being harassed, dominated and
power being exerted over her by the young woman possibly her daughter.

4. What action is appropriate for the PSW to take in this situation? Why? (3 marks)

The appropriate action for the PSW involved that one should keep aside one’s
feelings and emotions but seek advice from the supervisor or the nurse in-charge
and raise concerns for the patients emotional and metal health. And then
whatever suggested should be done even if it involves contacting proper
authorities.

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CASE #2

You have been assigned to assist Sarah, a new mother, care for her infant son. The
mother requires help as she has recently had a sprained ankle and wrist fractures.
Although she can get around, she cannot look after the infant and her 2-year-old
daughter. Home care was ordered by Sarah’s doctor, despite the family’s protests that
they could manage on their own. You have been visiting for two weeks.

Sarah is a quiet, painfully shy person. However, little by little, she has warmed up to
you. She smiles more often now, and seems very grateful for your visits.

Today, as you hand Sarah her son after his bath, you notice a large bruise on Sarah’s
upper arm. It is purplish and about 10 cm. (4 inches) in diameter. Sarah notices that you
have seen the bruise and says, “Oh, that— I hit the freezer door last night.” You must
look doubtful, as Sarah begins to cry. She tells you that her husband grabbed her arm
and twisted it last night. She begs you not to tell anyone, saying that she would be
embarrassed if anyone knew. “He’s a good man,” she says of her husband, “I’d have
nothing if it weren’t for him.”

1. Describe all the feelings that you (or other PSWs) might have in this situation.
Explain how they might be helpful or unhelpful in resolving the problem. (1 mark)

In this situation, a PSW might feel shocked by Sarah's disclosure of domestic abuse,
concerned for her safety and that of her children, and empathetic towards her
emotional turmoil. These emotions can be helpful in guiding the PSW to listen
supportively, reassure Sarah of her worth, and discreetly facilitate access to resources
and safety planning. It's important for the PSW to manage these feelings professionally
to ensure Sarah's confidentiality and safety while providing effective support.

2. Identify three signs that indicate Sarah is abused. (3 marks)

• Visible bruising or injuries: Sarah's explanation of a large, purplish bruise on her
upper arm that she attributes to hitting the freezer door raises concern. The size
and coloration of the bruise suggest it may be inconsistent with a simple accident.
• Emotional distress: Sarah's tears and emotional reaction when confronted
about the bruise, along with her plea for secrecy and conflicted defense of her
husband as a "good man," indicate emotional turmoil and potential fear of
repercussions.

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 • Isolation and dependency: Sarah's shy and quiet demeanor, coupled with her
dependence on her husband despite her injuries and need for assistance with
childcare, may suggest she is isolated and economically dependent, which are
common characteristics in abusive relationships.

3. Describe two ways in which Sarah is demonstrating denial. (2 marks)

• Minimizing the seriousness of the injury: By attributing the large bruise on her arm
to accidentally hitting the freezer door, Sarah is downplaying the severity of her
husband's actions. This minimization is a form of denial that helps her cope with the
trauma and avoid facing the reality of domestic abuse.
• Defending her husband: Despite the physical evidence and her emotional distress,
Sarah defends her husband as a "good man" and insists that she would have nothing
without him. This defense is another form of denial where she rationalizes his abusive
behavior and maintains a positive image of him, despite the harm he has caused.
4. What other emotion is Sarah displaying? (1 mark)
Sarah is displaying fear, as indicated by her tearful reaction and plea for secrecy when
discussing the bruise on her arm caused by her husband.

5. What action is appropriate for the PSW to take in this situation? Why? (3 marks)
The appropriate action for the PSW in this situation is to ensure Sarah's safety and
provide support. It's important to listen empathetically to Sarah, validate her
feelings, and assure her that she is not alone. The PSW should encourage Sarah to
seek help from domestic violence services or a trusted healthcare professional who
can offer resources and safety planning. Maintaining confidentiality and respecting
Sarah's autonomy in deciding the next steps are crucial to building trust and
ensuring her well-being.

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 CASE
#3

You have been assigned to care for the Ross family. The family just had triplets: three
girls. The girls were premature, but they are now home after two months in hospital.
There are two older children in the family, Ray, age two, and Lori, age five. Although
maternal and paternal grandparents are all living, they reside 1600 km away and
cannot visit to help.

The family seems to be loving and close-knit. The parents seem very happy with the
new additions— although they admit that the birth of three was very much a surprise.

You have been with the family for two months and over that time have noticed a
change in Ray. He seems less able to run as steadily as he did before. As well, he
seems to be using more “baby-talk,” not speaking words as clearly as he once did. He
also seems to be more fearful.

Today is your day off. You find yourself in the Ross’ neighbourhood and decide to say
hello. As you go up to the door, you see Mrs. Ross violently shaking her son. She is
visibly upset and is speaking to him in a very angry voice.

1. Describe all the feelings that you (or other PSWs) might have in this situation. Explain
how they might be helpful or unhelpful in resolving the problem. (2 marks)
In such a situation, a PSW might feel shocked and concern upon witnessing a parent violently
shaking a child. These feelings can prompt immediate intervention to ensure the child's safety
and well-being, such as stopping the shaking, comforting the child, and reporting the incident
to authorities if necessary. It's crucial for the PSW to manage these emotions to act
professionally and effectively, focusing on the child's immediate needs while seeking
appropriate support for the family.

2. Identify the possible reasons for the angry outburst in Mrs. Ross. (3 marks)
Possible reasons for Mrs. Ross's angry outburst:
Stress and overwhelm: Mrs. Ross may be experiencing high levels of stress and
overwhelm due to the recent birth of premature triplets, in addition to caring for two
other young children. The sudden increase in responsibilities and demands could lead
to feelings of frustration and being overwhelmed.
Lack of support: With both sets of grandparents living far away and unable to provide
immediate help, Mrs. Ross may feel isolated and unsupported in managing the needs
of her children. This lack of practical assistance can exacerbate feelings of frustration
and stress.
Parenting challenges: Mrs. Ross may be facing difficulties in adjusting to the needs of
her children, particularly with Ray showing signs of developmental regression and

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 increased fearfulness. This could contribute to feelings of inadequacy or frustration,
which may manifest as an angry outburst.

3. Identify two behaviors in Ray that indicate that he may be abused. (2 marks)
Two behaviors in Ray that may indicate he is being abused:
Physical symptoms: Ray's apparent difficulty in running steadily and any visible marks
or bruises on his body could be signs of physical abuse. These physical symptoms may
indicate that he has been subjected to violence or rough handling.
Behavioral changes: Ray's increased use of "baby-talk" and unclear speech, along with
heightened fearfulness, are behavioral changes that could suggest emotional or
psychological abuse. These behaviors may result from experiencing trauma or stress
related to abusive interactions or environments.

4. What action is appropriate for the PSW to take in this situation? Why? (3 marks)

Ensure immediate safety: The PSW should intervene to ensure Ray's immediate safety by
separating him from any further harm, such as stopping Mrs. Ross from shaking him and
comforting Ray to reassure him.
Document and report: It is crucial for the PSW to document the observed incident and any
physical or behavioral signs of abuse. Reporting the incident to the appropriate
authorities, such as child protective services or the designated abuse hotline, is necessary
to initiate an investigation and ensure Ray's ongoing safety.
Provide support and follow-up: The PSW should offer support to Ray and the family,
connecting them with resources such as counseling or parenting support. Follow-up visits
and monitoring of Ray's well-being are essential to ensure that he receives the necessary
care and protection from further harm.

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