Question

The nurse in the emergency department suspects that a woman's broken arm may be the result of an intimate partner violence incident. The woman is waiting for the orthopedic team to evaluate the seriousness of the broken arm and to make decisions on the care that needs to be completed prior to discharge from the emergency department. A. The nurse begins the conversation with the woman saying "I ask all my patients about past or current abuse in their lives because I recognize the impact on one's well-being. I am asking you so that I am able to help my patients identify support and assistance needed." What specific questions could the nurse ask the patient? B. The nurse has to complete a mandatory report about this woman's injury. What consideration does the nurse need to keep in mind when making a mandatory report? C. There are several risk factors for intimate partner violence. What relationship factors can lead to intimate partner violence? D. Throughout the conversation with the patient, the nurse needs to keep in mind overarching trauma sensitive care principles. What are some examples of trauma sensitive care principles?

Answer 1

A. Clear and effective communication is very important in nursing profession. Nurse can ask the patient following direct and indirect questions in the above case-

Specific / direct questions

• Do you feel safe at home?
• Are you afraid of your partner?
• What kind of experiences of violence you had in your life?
• Have you been tried to hit or injured at home?
• Every relationship has fights. What happens when you and your partner disagree?

Indirect questions

• How are things going at home?
• How is your relationship with your partner/ spouse
• Are you stressed a lot lately

B. Mandatory reporting includes documentation of certain injuries, domestic violence or abuse.

The nurse in the above case should form a mandatory reporting by keeping in mind all the rules and guidelines for framing the report.

The nurse should strictly follow the patient privacy and confidentiality policy.

The nurse should include all the observations and assessment data. The nurse should document the case in detail with accurate and confirmative evidences.

C. Intimate partner violence is a cause of social concern. Sometimes it becomes very difficult to identify the intimate partner violence leading to serious consequences. Certain factors factors poses a higher risk for intimate partner violence.

The relationship factors leading to intimate partner violence are:

• Marital tension, disagreements and fights
• negative attitude towards the relationship, insecurity and jealousy
• separations or divorce
• Dominant and controlling behaviour of one partner over the other
• Financial crisis or stress
• Unhealthy relationships with family members
• aggressive and antisocial behaviour

D. Trauma sensitive care can be defined as delivering medical care to the victim of abuse or violence keeping in mind the trauma suffered by the patient and the coping mechanism and behaviour.

The principles of trauma sensitive care include :

1. Safety : the patient may be physically and psychologically disturbed and insecure. The medical environment of the must ensure that the patient feels safe physically and emotionally.

2. Transparency and trustworthiness : the patient should be fully informed about the treatments and procedures. Accurate and clear information should be given to patient.

3. Peer support : mental and physical support from family, friends and caregivers

4. Mutuality and collaboration : mutual understanding and collobaration between the hospital staff and the patient is important. The medical staff and patient should work together for achievement of goal.

5. Empowerment : the medical staff should identify patients strength and powers. The medical team should foster the positive attitudes and mental strength in the patient to promote healing and recovery from the trauma.