Nurse Engages in Physical Abuse of Cognitively Impaired Resident
Penalty
Summary
A deficiency occurred when a nurse engaged in physical abuse of a resident with moderate cognitive impairment. The incident took place as the nurse was assisting the resident, who had recently returned from the hospital with fractured ribs and was known to be restless and at risk for falls. The resident, who had diagnoses including vascular dementia, psychotic disorder with delusions, and generalized anxiety disorder, attempted to stand from his wheelchair and, during the interaction, grabbed and squeezed the nurse's hand, causing her pain. In response, the nurse struck the resident on the back, pulled the resident's hair, and pinched the resident's arm in an attempt to make the resident release her grip. These actions were witnessed by another nurse and an alert resident. The facility's policy on abuse, neglect, and exploitation, implemented in February 2023, explicitly prohibits physical abuse, including hitting, slapping, and pulling hair. Despite this policy, the nurse admitted to engaging in a physical altercation with the resident, stating that she reacted out of pain and uncertainty about how to de-escalate the situation. The incident was reported through the Health Care Facility Reporting System, and witness statements confirmed the physical actions taken by the nurse, as well as the use of profanity and inappropriate comments in the presence of residents immediately following the event. The investigation found that the resident, who was moderately cognitively impaired, would likely have experienced pain, anger, and emotional distress as a result of being struck and having their hair pulled by a caregiver. The incident was substantiated as physical abuse by the facility's internal investigation, based on direct observations, staff and resident interviews, and review of the facility's abuse prevention policy.