If you are completing an admission on a patient who you suspect is being abused, it is important to approach it in the right way. You don’t want to jump to conclusions and become biased on the situation. As a nurse we must remember to use therapeutic communication to allow the patient to feel they are in a safe non-judgmental environment. We must ask the questions regarding abuse in a natural way in order to make the patient feel comfortable with giving this information (Jensen, 2019).
In our hospital we are mandated to ask certain questions regarding abuse including if the patient feels safe at home and within the community, and if the patient says no, we then have to dig deeper as to why they are feeling this way. If a nurse was to act surprised that a patient does not feel safe this may make the patient feel uncomfortable giving this information. It is important prior to asking these questions that you ensure that the patient is alone especially if you suspect abuse (Jensen, 2019). The nurse must not assume who the abuser is and if someone refuses to leave the patient’s side then that should be considered a red flag (Jensen, 2019). Abusers will often refuse to leave the patients side because that will give the patient an opportunity to reveal the abuse.
During the assessment it was noted that the patient had multiple unusual bruises and several abrasions. If there was anyone that was with the patient, I would ask them to leave the room so I could ask some personal questions and assess the patient. I would approach the patient with basic questions at first in order to earn their trust and as to not scare them by going directly to questions regarding the bruises and abrasions. I would ask questions about the bruises and abrasions once I was doing my assessment. Questions could include where the bruises and abrasions came from, how it happened, if they usually have these marks on their body, etc. If I did think it was abuse related, I would start a conversation with the patient about the trust they can have with me, and that I am there to help them. I feel by keeping a safe and comfortable environment it would allow the patient the ability to be open about the topic. Questions should be direct and straight to the point, so the patient knows exactly what you are asking.
In Rhode Island, we are mandated reporters of child, elder, and developmentally delayed patients (DCYF, 2020) & (RI.GOV, 2019). Besides reporting these areas of abuse, the physician is responsible to report 2nd or 3rd degree burns that cover more than 5% of the body, upper respiratory tract burns, burns that will likely result in death, and wounds that are a result of a gunshot (Durborow et al., 2010). If abuse is suspected in a middle-aged individual where reporting is not mandatory it does not mean it should be ignored. Nurses should still try to get these patients the same amount of help as the ones that need to be reported. Resources should be offered to the patient and could be directed towards a social worker within the hospital. There are certain advocacy centers within the state of Rhode Island that could be useful for these patients as well as reporters who have questions including Day One for sexual abuse and the Women’s Center of Rhode Island. Overall, abuse and neglect are topics that are going to be difficult for patients to be open with healthcare providers. It is our job as their nurse to help them feel they are in a safe and comfortable environment that they can be open and honest without being judged by anyone.
DCYF. (2020). Reporting child abuse and/or neglect. Retrieved from: http://www.dcyf.ri.gov/policyregs/reporting_child_abuse_and_or_neglect.htm#
Durborow, N., Lizdas, K., O’Flaherty, A., Marjavi, A. (2010). Compendium of state statutes & policies on domestic violence & health care. Family Violence Prevention Fund. Retrieved from: https://www.acf.hhs.gov/sites/default/files/fysb/state_compendium.pdf
Jensen, S. (2019). Nursing health assessment: A best practice approach (3rd ed.). Wolters Kluwer.
RI.GOV (2019). Protect. Rhode Island Office of Healthy Aging. Retrieved from: http://oha.ri.gov/what-we-do/protect/
Lynn Costello posted
As nurses, we are strategically positioned to identify potential victims of abuse immediately upon entry to the healthcare system. Whether in the ED, in an outpatient clinic, during the pre-operative interview, or during the admission process to the patient floor, it is incumbent upon us to possess the skills and knowledge necessary to recognize potential abusive situation and act on behalf of our patient. The nurse must then follow ethical and legal standards to protect the best interest of the patient. In Provision 3 of The American Nurses Association Code of Ethics for Nurses, the nurse promotes, advocates for, and protects the rights, health, and safety of the patient. In the state of Massachusetts, we are mandated to report cases of suspected abuse to the local police department where the abuse took place, if the practitioner feels that a criminal act was involved. During the nurse-patient interaction the patient shares information of a private and often intimate nature, encompassing physical, emotional, spiritual, cultural, and social concerns which requires mutual trust and respect during the development of the nurse-patient relationship. It is important to provide privacy for the encounter, to present a friendly and approachable demeanor, engage in therapeutic communication, be compassionate, empathetic, and respectful in order to develop a trusting relationship with the patient. Open-ended questions can be used to gather information and allow the patient to speak openly rather than answer simple yes or no questions. Non-verbal communication skills such as tone of voice, eye contact, and a welcoming body posture also contribute to building a respectful, trusting relationship (Jensen, 2019). Given these communication techniques, I would begin with broad questions about the patient’s home-life and overall health, which are part of the patient health assessment. If the conversation feels like she is engaging, I will mention that I noticed the bruising and abrasions, and I would then ask if she feels safe at home. The patient may be hesitant or completely refuse to answer any questions for various reasons: fear of retaliation from the abuser, the abuser is in the room and she/he cannot openly communicate, the patient is in denial regarding the abuse, the patient has sought help before and the abuse continues (feelings of hopelessness), or the victim does not want to leave the relationship (Power, 2004). In our institution, we have postings for domestic abuse hotlines that the patient can reach out to, and we also have a list of shelters that we can help the patient reach out to. We have social services available 24/7 and I would reach out for their expertise and guidance in offering safety planning for the patient.
Since domestic violence is a public health issue, and healthcare providers need the skills to recognize and address cases of abuse, The Massachusetts Board of Registration in Nursing requires on-line completion of a training and education course in domestic violence/sexual violence prior to applying for or renewing professional licensure.
Jensen, S. (2019). Nursing health assessment: A best practice approach (3rd ed.). Wolters Kluwer Health.
Power, C. (2004). Domestic Violence: What Can Nurses Do? https://www.crisisprevention.com/Blog/Domestic-Violence-What-Can-Nurses-Do