During a home visit, the nurse observes that a cognitively intact older adult client has bruising in various stages of healing, appears frightened when their adult child is present, and winces when the child reaches toward them. What must the nurse do?

ELDER ABUSE IDENTIFICATION AND MANDATORY REPORTING:

Red flags present: Multiple bruises in various stages (suggests repeated injury); fear response to caregiver; flinching (anticipatory fear of being struck).

Types of elder abuse: Physical (most visible); emotional/psychological; sexual; financial; neglect (active or passive); self-neglect.

Mandatory reporting: All 50 states require certain professionals (including nurses) to report suspected elder abuse, neglect, or exploitation to Adult Protective Services (APS) — SUSPICION is sufficient; certainty is not required.

Documentation: Document objective observations (bruise locations, colours, sizes, patient behaviours) without speculative language.

Reporting process: Call APS or law enforcement; provide factual observations.

Assessment in private: If possible, assess the client ALONE without the suspected abuser present — clients rarely disclose abuse in the presence of the abuser.

Legal immunity: Mandatory reporters are immune from liability for good-faith reports.

Failure to report: May be a criminal violation; certainly an ethical failure.