İstismar ve Etik

Yazarlar

Özet

Bu bölüm, istismar olgusunu etik bir çerçevede ele alarak tanımlarını, türlerini ve farklı yaş/gruplarda görülen örüntülerini multidisipliner bir bakışla tartışır. Çocuk, yaşlı, engelli ve psikiyatrik hastalığı olan bireylerde istismar riskini artıran bireysel, ailevi ve toplumsal etmenler; bildirim engelleri ve görünmeyen istismar biçimleri (ihmal, kurumsal istismar, modern kölelik/insan ticareti) literatür örnekleriyle açıklanır. Hemşirelikte çalışan istismarı ve mobbing, Türkiye’deki yasal düzenlemeler ve başvuru yolları bağlamında değerlendirilir. Bölüm ayrıca araştırma etiğinin tarihsel gelişimini (Helsinki Bildirgesi, UNESCO Biyoetik Bildirgesi) insan onuru ve rıza ilkeleri üzerinden özetler. Hemşirelerin etik duyarlılık, travma-bilgili bakım, iletişim, mahremiyet ve adalet ilkeleri doğrultusunda istismarı tanılama, önleme ve yönetme sorumlulukları vurgulanır. Son bölümde, adli olguların yönetiminde hemşirenin değerlendirme, delil korunumu, aydınlatılmış onam, öykü alma, muayene ve belgeleme basamaklarındaki rolü, etik ve hukuki yükümlülüklerle bütünleştirilerek sunulur.

Referanslar

Cambridge University Press & Assessment. Abuse [İngilizce-Türkçe çeviri]. Cambridge Dictionary. 2025. Available from: https://dictionary.cambridge.org/dictionary/english-turkish/abuse [Accessed 29th Oct 2025].

Türk Dil Kurumu. Güncel Türkçe sözlük. 2025. Available from: https://sozluk.gov.tr [Accessed 29th Oct 2025].

World Health Organization (WHO). Child maltreatment [Fact sheet]. 5 November 2024. Available from: https://www.who.int/news-room/fact-sheets/detail/child-maltreatment [Accessed 29th Oct 2025].

Gonzalez, N., Gevers, A., & Dartnall, E. (2022). An overview of child sexual abuse research conducted in low and middle income countries between 2011-2021. Available from: https://svri.org/sites/default/files/attachments/2022-06-07/CSA%20Scoping%20Review%20FINAL_3%20June%202022.pdf [Accessed 29th Oct 2025].

Starke M, Larsson A, Punzi E. People with intellectual disability and their risk of exposure to violence: identification and prevention – a literature review. Journal of Intellectual Disabilities. 2024;29(3):760–783. doi:10.1177/17446295241252472

Social Care Institute for Excellence. Types and indicators of abuse: safeguarding adults. January 2015. (Last reviewed December 2020). Available from: https://www.scie.org.uk/safeguarding/adults/introduction/types-and-indicators-of-abuse/ [Accessed 29th Oct 2025].

Härkänen M, Koskiniemi S, Syyrilä T, et al. Abuse of social care clients committed by nurses and other social service employees—analysis of employees' reports. Journal of Advanced Nursing. 2023;79(9):3812–3826. doi:10.1111/jan.15713

Morris G. How nurses can recognize and report human trafficking. NurseJournal. 3 March 2023. Available from: https://nursejournal.org/resources/how-nurses-can-recognize-and-report-human-trafficking/ [Accessed 29th Oct 2025].

Shamsi-Gooshki E, Parsapoor A, Moosavi S. Ethical challenges in conducting research in low and middle income setting during public health emergencies: a qualitative evidence of a COVID-19 pandemic: the experience of Iran. BMC Med Ethics. 2025;26:38. doi:10.1186/s12910-025-01193-6.

Yon Y, Ramiro-Gonzalez M, Mikton CR, Huber M, Sethi D. The prevalence of elder abuse in institutional settings: a systematic review and meta-analysis. European Journal of Public Health. 2019;29(1):58–67. doi:10.1093/eurpub/cky093

Luo Z, Chen Y, Epstein RA. Risk factors for child abuse and neglect: systematic review and meta-analysis. Public Health. 2025;241:89–98. doi:10.1016/j.puhe.2025.01.028

Çetinkaya H, Bezgin S. Ebe adaylarının aile içi şiddete yönelik tutumları ve aile içi kadına şiddet belirtilerini tanıma düzeylerinin belirlenmesi. Sağlık Bilimleri ve Klinik Araştırmaları Dergisi. 2025;4(1):1–10. doi:10.63695/jhscr.1580048

Chia AYY, Hartanto A, Wan TS, Teo SSM, Sim L, Kasturiratna KTAS. The impact of childhood sexual, physical and emotional abuse and neglect on suicidal behavior and non-suicidal self-injury: a systematic review of meta-analyses. Psychiatry Communications. 2025;5(1):100202. doi:10.1016/j.psycom.2025.100202

Halls S, Baiden P, Fuller-Thomson E. The role of protective adults in mitigating health outcomes linked to childhood physical and sexual abuse. Journal of Child Maltreatment. 2025;30(1). doi:10.1177/10775595251322084

Johnson L, Chen Y, Stylianou A, et al. Examining the impact of economic abuse on survivors of intimate partner violence: a scoping review. BMC Public Health. 2022;22:1014. doi:10.1186/s12889-022-13297-4

Walk Free Foundation. Global Slavery Index. 2025. Available from: https://www.walkfree.org [Accessed 29th Oct 2025].

Social Care Institute for Excellence. Social Care Institute for Excellence. 2020. [Erişim tarihi: 29 Ekim 2025]. Erişim adresi: https://www.scie.org.uk

Edwards BM, Meudell A, Thomas E, Broeckelmann E, Roberts E, Farmer M, Ghafoor N, Markham S, Robinson CA, et al. Institutional abuse, neglect and harm in UK community mental health services: a scoping review of the peer-reviewed evidence. Health Expectations. 2025. doi:10.1111/hex.70403

World Health Organization (WHO). Abuse of older people. 15 June 2024. Available from: https://www.who.int/news-room/fact-sheets/detail/abuse-of-older-people [Accessed 29th Oct 2025].

Reynolds C, Ejaz F, Rose M. Adult maltreatment outcomes of a targeted case management intervention for self-neglect. Innovation in Aging. 2022;6(Suppl 1):406. doi:10.1093/geroni/igac059.1598

Tümer EÖ. İşyerlerinde Psikolojik Taciz (Mobbing) Bilgilendirme Rehberi. Ankara: TC Çalışma ve Sosyal Güvenlik Bakanlığı, Özel Matbaası; 2014.

Çimrin AH, Ege GB. Bilim, güç ve güç istismarı: psikososyal mesleki risk faktörü olarak akademik kurumlarda gücün kullanımı ve istismarı: geleneksel derleme. Turkiye Klinikleri Journal of Medical Ethics-Law and History. 2022;30(2):199–208. doi:10.5336/mdethic.2021-87122

Öztürk İ. Türkiye’de mobbing ile ilgili sağlık alanında yazılan lisansüstü tezlerin incelenmesi. Uluslararası İktisadi ve İdari İncelemeler Dergisi. 2019;(25):119–136. doi:10.18092/ulikidince.594721

Dalgıç PN, Şahman O, Mansur F. Mobbingin sağlık alanına yansıması: lisansüstü tezlerin içerik analizi; 2024.

Türkiye İnsan Hakları ve Eşitlik Kurumu. İşyerlerinde psikolojik taciz (mobbing) bilgilendirme rehberi. 2021. Available from: https://www.tihek.gov.tr/upload/file_editor/2021/02/1612789982.pdf [Accessed 29th Jan 2025].

Akkaya B, Çöl M. Halk sağlığı bakışıyla yaşlı istismarı ve ihmali. Turkish Journal of Family Medicine and Primary Care. 2022;16(2):456–464. doi:10.3390/ijfs13020081

Arun Ö. Senex İzleme: yaşlılara yönelik şiddet ve ihlallerin izlenmesi: Eylül ayı raporu. Yaşlanma Çalışmaları Derneği Yayınları; 2021.p.1–4. Available from: https://api.senex.org.tr/Upload/Publication/4e82139a632b4c82a86ef63f6b1128ec.pdf [Accessed 29th Oct 2025].

Turhan S, Güncan F, Ercan M, Erkoyuncu G. Yaşlı ihmali ve istismarı. Sosyal Araştırmalar ve Yönetim Dergisi. 2019;(1):28–43. doi:10.35375/sayod.533862

World Health Organization (WHO). Global status report on preventing violence against children 2020. 2020. Available from: https://www.unicef.org/media/70731/file/Global-status-report-on-preventing-violence-against-children-2020.pdf [Accessed 29th Oct 2025].

Luo Z, Chen Y, Epstein RA. Risk factors for child abuse and neglect: systematic review and meta-analysis. Public Health. 2025;241:89–98. doi:10.1016/j.puhe.2025.01.028

American Academy of Pediatrics (AAP). Child abuse and neglect. Available from: https://publications.aap.org/collection/673/Child-Abuse-and-Neglect [Accessed 29th Oct 2025].

Centers for Disease Control and Prevention. About child abuse and neglect. 2024. Available from: https://www.cdc.gov/violenceprevention/pdf/CAN-Prevention-Resource_508.pdf [Accessed 29th Oct 2025].

United Nations International Children's Emergency Fund (UNICEF). Nearly 400 million young children worldwide regularly experience violent discipline at home. 11 June 2024. Available from: https://www.unicef.org/press-releases/nearly-400-million-young-children-worldwide-regularly-experience-violent-discipline [Accessed 29th Oct 2025].

World Health Organization (WHO). Child maltreatment. 2022a. Available from: https://www.acf.hhs.gov/sites/default/files/documents/cb/cm2022.pdf [Accessed 29th Oct 2025].

Topaloğlu Ören ED, Dereli F, Yıldırım Sarı H. Engelli bireylerin sağlık hizmetine ve bakıma erişimi ile ilgili yaşadıkları sorunlar. İzmir Katip Çelebi Üniversitesi Sağlık Bilimleri Fakültesi Dergisi. 2021;6(3):185–192.

McCormick F, Marsh L, Taggart L, Brown M. Experiences of adults with intellectual disabilities accessing acute hospital services: a systematic review of the international evidence. Health & Social Care in the Community. 2021;29:1222–1232. doi:10.1111/hsc.13253

Helton JJ, Gochez-Kerr T, Gruber E. Sexual abuse of children with learning disabilities. Child Maltreatment. 2018;23(2):157–165. doi:10.1177/1077559517733814

Maclean MJ, Sims S, Bower C, Leonard H, Stanley FJ, O’Donnell M. Maltreatment risk among children with disabilities. Pediatrics. 2017;139(4):e20161817. doi:10.1542/peds.2016-1817

Ledingham E, Wright GW, Mitra M. Sexual violence against women with disabilities: experiences with force and lifetime risk. American Journal of Preventive Medicine. 2022;62(6):895–902. doi:10.1016/j.amepre.2021.12.015

Kahonde CK, Johns R. Knowledge, perceptions and experiences of risk to sexual violence among adults with intellectual disabilities in Cape Town, South Africa. African Journal of Disability (Online). 2022;11:1–11. doi:10.4102/ajod.v11i0.837

Kmett JA, Eack SM. Characteristics of sexual abuse among individuals with serious mental illnesses. Journal of Interpersonal Violence. 2018;33(17):2725–2744. doi:10.1177/0886260516628811

World Medical Association. Declaration of Helsinki: ethical principles for medical research involving human subjects. JAMA. 2013;310(20):2191–2194. doi:10.1001/jama.2013.281053

Czech H, Weindling P, Druml C. From scientific exploitation to individual memorialization: evolving attitudes towards research on Nazi victims’ bodies. Bioethics. 2021;35(4):393–402. doi:10.1111/bioe.12860

UNESCO. Universal Declaration on Bioethics and Human Rights. Paris: United Nations Educational, Scientific and Cultural Organization; 2005.

Yorulmaz DS. Hemşirelerin etik duyarlılığı ve etkileyen faktörlerin incelenmesi. Turkiye Klinikleri Journal of Medical Ethics-Law and History. 2021;29(1):86–93. doi:10.5336/mdethic.2020-73404

Köktürk Dalcalı B, Şendir M. Determining the relationship between nurses’ personal values and their ethical sensitivity. Florence Nightingale Journal of Nursing. 2016;24(1):1–9. doi:10.17672/fnhd.72011

Alan H, Şen HT, Şıpkın S. Yoğun bakım ve ameliyathane hemşirelerinin etik ikilemlere karşı duyarlılıkları: üniversite hastanesi örneği. Cumhuriyet Hemşirelik Dergisi. 2017;6(1):26–33.

Nova Scotia Department of Health and Wellness. Protection for persons in care – 2019–20 Q1–Q4 data. 2020. Available from: https://novascotia.ca/dhw/ppcact/Protection-for-Pesons-in-Care-2019-20-Q1-Q4-Data.pdf [Accessed 30th Oct 2025].

Goodman O. Preventing patient abuse: why abuse happens and how to stop it (IAHSS-F RS-20-04). IAHSS Foundation. 1 December 2020. Available from: https://www.iahssf.org [Accessed 30th Oct 2025].

Papalia N, Mann E, Ogloff JRP. Child sexual abuse and risk of revictimization: impact of child demographics, sexual abuse characteristics, and psychiatric disorders. Child Maltreatment. 2021;26(1):74–86. doi:10.1177/1077559520932665

Reader TW, Gillespie A. Patient neglect in healthcare institutions: a systematic review and conceptual model. BMC Health Services Research. 2013;13(1):156.

Moyer VA. Primary care interventions to prevent child maltreatment: U.S. Preventive Services Task Force recommendation statement. Annals of Internal Medicine. 2013;159:289–295. doi:10.7326/0003-4819-159-4-201308200-00667

Nyberg A, Ferm U, Bornman J. Signs of abuse in children with disabilities: a rapid review with expert panel social validation. Journal of Intellectual & Developmental Disability. 2021;47(3):206–217. doi:10.3109/13668250.2021.1984083

Kildahl AN, Helverschou SB, Oddli HW. Clinicians’ retrospective perceptions of failure to detect sexual abuse in a young man with autism and mild intellectual disability. Journal of Intellectual & Developmental Disability. 2020;45(2):194–202. doi:10.3109/13668250.2019.1680821

Hughes RB, Robinson-Whelen S, Goe R, et al. “I really want people to use our work to be safe”: using participatory research to develop a safety intervention for adults with intellectual disability. Journal of Intellectual Disabilities. 2020;24(3):309–325. doi:10.1177/1744629518793466

Bahji A. Navigating the complex intersection of substance use and psychiatric disorders: a comprehensive review. Journal of Clinical Medicine. 2024;13(4):999. doi:10.3390/jcm13040999

Türk Ceza Kanunu. Yayımlandığı Resmî Gazete Tarihi: 12.10.2004, Sayı: 25611. Available from: https://www.resmigazete.gov.tr/eskiler/2004/10/20041012.htm [Accessed 30th Oct 2025].

Kılınç O. Adli hemşirelik ve hemşirelikte adli vakaya yaklaşım. In: Uyar Hazar H (ed.) Sağlık & Bilim 2024: Hemşirelik-I. İstanbul: Efe Akademi; 2024. p.49. doi:10.59617/efepub2024109

Sayfalar

145-164

Yayınlanan

19 Ocak 2026

Lisans

Lisans