Nursing_and_Domestic_Violence

Class Participation: Describe how patients in your setting are screened for intimate partner violence; child abuse and neglect; and elder abuse and neglect' What behaviors or physical findings lead you to suspect abuse' What does your hospital policy state about reporting abuse' Response should be 3-4 well developed paragraphs with references (2 points Jarvis (2012) reminds us that any facility that provides health care must have in place policies to that allow healthcare providers to assess for domestic violence; and that once the assessment has been done, the healthcare provider has a clear avenue to with which they may document and report their findings. There is a distinction made between neglect, physical abuse, sexual abuse and emotional abuse: all of these categories of abuse are incorporated into the state statutes that deal with intimate partner violence, child and elder abuse and neglect (Jarvis, 2012). In previous healthcare settings where I have been employed, screening questions related to abuse/neglect were provided on our preprinted assessment forms. They were specific to the department where the assessment was being performed: PICU assessments were different than what we used on an adult floor because much of the information had to be obtained from caregivers (some of whom were suspected to have been the ones who had inflicted the abuse) and many of our patients were non verbal and we relied on our observation and physical assessment skills to detect signs of physical and emotional abuse. Particular attention was paid to pervious hospitalizations for injuries or findings that substantiated previous injuries that were not treated, such a poorly healed fracture or scars. The parent’s level of emotional stress was also monitored closely especially when there were several young children in the home, or in the case of a special needs child. According to Jarvis (2012) one of the risk factors that could contribute to child abuse includes caregiver stress related to the care of a disabled or mentally retarded child. When I was working in a NICU, there was less focus in this regard on the infants because they had been observed from birth; however, monitoring for signs and symptoms of narcotic/stimulant/noxious substance or ETOH withdrawal was routinely performed. The prenatal history was scrutinized by the assigned nurses, especially in cases of IUGR. Further, the interaction between parents and infant, grandparents and parents, and parents with each other was also monitored for any signs of controlling behavior, physical contact outside of accepted norms and emotional distress of any kind. When I was practicing nursing on an adult Med-Surg floor, we had many patients who came to us from nursing homes, or from home environments where they were cared for by family members. Some of our assessment questions included questions about if the patient felt safe at home; if they felt a family member, friend or acquaintance was abusing them financially, physically or emotionally; if the patient felt they had sufficient opportunities for social interaction and religious expression; did they wish to return to where they had admitted from; did they always have their medications when they needed them; was their pain managed well at home, and did they always have pain medication available when it was needed—this last to determine if there was a risk of narcotic diversion by family members or caregivers. We performed physical assessments to determine the skin condition, heights and weights were obtained and a nutritional evaluation was performed. Behavior toward family and caregivers was monitored, and any anxiety or distress noted and investigated further by our social workers. If there was need for further investigation, it was initiated by the assigned nurse through the charge RN, unit manager, physician and social work department. CPS and APS involvement occurred when warranted. As nurses, we are mandated reporters. In my current position, I review clinical information provided to me by the acute facility case managers and social workers related to acute inpatient hospital admissions. Any time a patient is admitted with injuries that are suspect in any way, I expect the clinical review to indicate that a CPS/APS or social work consult has been ordered. I review for unexplained injuries, children hurt in accidents that appear to have been totally preventable (unrestrained passengers in auto accidents, injuries sustained that have no explanation, children or adults who require medication that has not been refilled timely, treatments that have been missed, patients admitted with failure to thrive or other diagnoses that indicate proper care, nutrition or supervisions has not been provided at home, or elders admitting from home with wounds, sores, infections, and uncontrolled chronic diseases). If I do not see evidence that a consult was ordered, I always call and have a discussion with the case manager or social worker. Most of the time, I find that a reporting was completed on the facility’s end and that this information was inadvertently left out of the report that was submitted to me. Occasionally I find that what I may have been concerned about has already been investigated by the facility, and that there has been no harm done. Just this past month, I have been reviewing a patient about whom I was extremely concerned. Further contact with the facility case manager confirmed that an APS consult had actually been ordered prior to the patient’s admission to the hospital, based on a neglect report made by a concerned relative; and was already underway. In this case, I have reported up through my management chain and an investigation as well as legal dept reporting has been completed per our company’s policy. According to my company policy, anyone who has reason to believe that abuse, neglect or violence has been or is occurring is mandated to report this information through our internal processes. Because we do business all across the country, the reporting to local authorities, if any is indicated, is handled by our designated staff in the legal dept after the nursing staff has completed the initial reporting documentation. I am continuing to follow this patient, and am very hopeful that alternate placement is arranged for him before it is time for him to be discharged. We already have our CM, MSW, legal dept, CM mgmt and UM mgmt teams working on my patient’s case alongside the facility CM and MSW depts and local authorities (outside of CA). I know it can be uncomfortable asking our patients these questions sometimes, and many nurses admit to shying away from asking the tough questions that have to be asked. I have also experienced discomfort with that part of the assessment, especially when I was a new nurse: to me it felt like prying, even though I realized that it was important information. It’s unfortunate that as nurses we always have to keep this kind of assessment in the back of our minds when working with our patients. However, if we do this routinely with every patient and don’t hesitate to follow through on our mandated reporting duty, we could save the life of someone’s grandparent, spouse, parent, friend, teacher, or child. Reference Jarvis, C. (2012). Domestic Violence Assessment. Physical examination & health assessment (6th ed. pp. 103-114). St. Louis, MO: Elsevier Saunders.