Substance Abuse and Abuse Q 46
Sheila tells the community nurse that her boyfriend has been abusive and she is afraid of him, but she doesn’t want to leave. The client asks the nurse for assistance. Which nursing interventions are appropriate in this situation? Select all that apply.
A. Help Sheila to develop a plan to ensure safety, including phone numbers for emergency help.
B. Help Sheila to get her boyfriend into an appropriate treatment program.
C. Communicate acceptance, avoiding any implication that Sheila is at fault for not leaving.
D. Help Sheila to explore available options, including shelters and legal protection.
E. Tell Sheila that she should leave because things will not improve.
F. Reinforce concern for Sheila's safety and her right to be free of abuse.
Correct Answer: A, C, D, F
These are all appropriate nursing interventions for the victim of domestic violence. The client is not responsible for seeking help for the abuser, and encouraging her to do so may reinforce the client’s feeling responsible for the abuse. Advising the client must decide for herself whether to leave, and the nurse must respect any decision the client makes. Making the decision for the client will erode her self-esteem and reinforce her sense of powerlessness.
Option A: Initiate referral to a social worker, public health nurse, psychological counselor before discharge to home. Provides support to the client and family, and monitors behaviors following discharge. A considerable body of empirical data (cited earlier) indicates that women’s readiness to act in ways that help them achieve nonviolence is shaped by (a) the level of violence they experience, (b) the supports and resources available to them, and (c) their appraisals of the nature of the abuse and the costs and benefits of taking action.
Option B: Nurses can raise women’s awareness that they are in abusive relationships and that they do not deserve to be in them by expressing concern for women’s (and their children’s) safety and pointing out the degree of vulnerability and danger they face. It can be useful in this context to note Walker’s concept of “the cycle of violence, in which periods of violence alternate with periods of reconciliation” (1979).
Option C: In the third stage, preparation, Brown (1997) claimed that women realize the abuse is not their fault and become determined to end the violence. Many acknowledge the loss of the relationship, begin to let go of the hope that abuse will end, and start to work through the associated grief. At this point, women may shift from reevaluating the violent components of the relationship to reevaluating the entire relationship and its meaning for them (Mills, 1985).
Option D: Health care providers in most states cannot intervene directly to prevent women’s partners’ use of violence (the exceptions are a few states where reporting is mandatory and could lead to the arrest of an abusive partner). Nevertheless, they can intervene in ways that “shore up” women’s resources, modify their appraisals of abuse, and help them consider taking actions that may prove beneficial in their quest for nonviolence. Ultimately, it is the responsibility of nurses to help women themselves determine what strategies will work best to achieve nonviolence in their specific situations and then provide support for those actions.
Option E: Barriers to change may include fears related to retaliation from the intimate partner and loss of child custody, employment, or financial support and housing. Each setting should have a plan for assisting women in immediate danger, social service resources for dealing with economic issues, and protocols for providing effective safety planning. Women’s past safety strategies should be assessed, and planning should build on strategies they have found effective.
Option F: Self-liberation involves supporting women’s own plans to achieve safety in their lives by listening to their deliberations about the meaning of change, identifying resources that will support change, discussing means for removing barriers to change, and providing safety planning. All health care settings should have a list of resources that are available to victims of IPV; these include hot lines, shelters, legal advisors, as well as counselors with experience in IPV.