Substance Abuse and Abuse Q 41
Nurse Angela is working in the emergency department of Nurseslabs Medical Center. She is conducting an interview with a victim of spousal abuse. Which step should the nurse take first?
A. Contact the appropriate legal services.
B. Ensure privacy for interviewing the victim away from the abuser.
C. Establish a rapport with the victim and the abuser.
D. Request the presence of a security guard.
Correct Answer: B. Ensure privacy for interviewing the victim away from the abuser.
Privacy, away from the abuser, is important. This allows the victim to discuss the problem freely, without fear of reprisal from the abuser (especially if she decides to return to the abusive situation). If there is no immediate danger, the assessment should focus on the mental and physical health and establish the history of current or past abuse. These responses determine the appropriate intervention. Assuming the patient is stable and not in pain, a detailed assessment of victims should occur after disclosure of abuse. Assessing safety is the priority. A list of standard prepared questions can help alleviate the uncertainty in the patient’s evaluation. If there are signs of immediate danger, refer to advocate support, shelter, a hotline for victims, or legal authorities.
Option A: In this situation, it is not the nurse’s responsibility to make the decision to report the abuse. However, whenever the injury is inflicted with a gun, knife, or other weapons, the nurse is obligated to report the abuse. If there is a risk to life or limb, or evidence of injury, the patient should be referred to local law enforcement officials. Typical domestic injury patterns include contusions to the head, face, neck, breast, chest, abdomen, and musculoskeletal injuries. Accidental injuries more commonly involve the extremities of the body. Abuse victims tend to have multiple injuries in various stages of healing from acute to chronic.
Option C: Although the nurse would want to establish rapport with the victim, her initial concern would not be to establish rapport with the abuser. Patients that have suffered domestic violence may or may not want a referral. Many are fearful of their lives and financial well-being and hence may be weighing the tradeoff in leaving the abuser leading to loss of support and perhaps the responsibility of caring for children alone. The healthcare provider needs to assure the patient that the decision is voluntary and that the provider will help regardless of the decision. The goal is to make resources accessible, safe, and to enhance support.
Option D: The situation does not describe the abuser as currently violent or under the influence of substances; therefore requesting a security presence is inappropriate at this time. Approximately one-third of women and one-fifth of men will be victims of abuse. The most common sites of injuries are the head, neck, and face. Clothes may cover injuries to the body, breasts, genitals, rectum, and buttocks. One should be suspicious if the history is not consistent with the injury. Defensive injuries may be present on the forearms and hands. The patient may have psychological signs and symptoms such as anxiety, depression, and fatigue.