Substance Abuse and Abuse Q 47
During a prenatal assessment, the clinic nurse suspects that her client was abused. Which of the following questions would be most appropriate?
A. "Are you being threatened or hurt by your partner?"
B. "Are you frightened of your partner?"
C. "Is something bothering you?"
D. "What happens when you and your partner argue?"
Correct Answer: A. “Are you being threatened or hurt by your partner?”
The use of simple, direct questions, asked in an emphatic manner, is best to validate the presence of an abusive situation. The evaluation should start with a detailed history and physical examination. Clinicians should screen all females for domestic violence, and refer to females who screen positive. This includes females who do not have signs or symptoms of abuse. All healthcare facilities should have a plan in place that provides for assessing, screening, and referring patients for intimate partner violence. Protocols should include referral, documentation, and follow-up.
Option B: 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. Although professional and public awareness has increased, many patients and providers are still hesitant to discuss abuse.
Option C: Domestic violence victims may have emotional and psychological issues such as anxiety and depression. Complaints may include backaches, stomachaches, headaches, fatigue, restlessness, decreased appetite, and insomnia. Women are more likely to experience asthma, irritable bowel syndrome, and diabetes.
Option D: The other questions are indirect and may not lead to the discussion of an abusive situation. 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.