When you suspect abuse, ask the right questions
When you suspect abuse, ask the right questions
Patients won't reveal abuse unless asked
A simple fall in a healthy person shouldn't result in multiple facial injuries, except if the patient was intoxicated, says Regina Curry, RN, an ED nurse at Thomas Jefferson University Hospital in Philadelphia. Instead, patients might break their wrist or skin their knees and hands from trying to break the fall, she says.
However, if no one asks about abuse, your patient isn't likely to volunteer information. Robin Ketchum, RN, MSN, nurse practitioner in the division of trauma and critical care and former emergency nurse at University of California-Irvine Medical Center, says, "Now that I'm on the other end, managing inpatient trauma patients, it's amazing what the patients reveal. When I ask if they told anyone else about it, they respond that no one ever asked them."
However, victims of abuse are "edgy" and might leave without treatment, warns Curry. "I once witnessed an ED nurse saying, 'Why do you put up with him? Where is your sense of pride?' Sure, we all want to say that, but it is the worst thing you can do," she says. "EDs should be a safe haven, period. Leave the counseling for the experts."
Ketchum recommends asking your patient, "Do you feel safe in your home environment?"
"I developed that habit several years ago and found most patients were appreciative. On occasion, I was able to provide appropriate resources and referrals," she says.
At University of Colorado in Aurora, ED nurses ask all patients, "Are there situations in your relationship where you have felt afraid?" and "Do you have concerns for your safety at home?"
However, those standard questions might just get asked because they are required, without the degree of seriousness that is needed to elicit a true response if the person is at risk for domestic violence, says Jean M. Marso, RN, BSN, the hospital's trauma coordinator.
This is why you need to pay close attention to the person giving the history, she says. Is there poor eye contact? Is the patient hesitant to give complete details? Or is there someone else doing the talking or preventing the patient from telling the real story? "If so, intervene during the ED visit. Get the patient alone to ascertain if there is something more," Marso says.
A simple fall in a healthy person shouldn't result in multiple facial injuries, except if the patient was intoxicated, says Regina Curry, RN, an ED nurse at Thomas Jefferson University Hospital in Philadelphia. Instead, patients might break their wrist or skin their knees and hands from trying to break the fall, she says.Subscribe Now for Access
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