Be ready to handle domestic abuse victims
Be ready to handle domestic abuse victims
Ensure patient safety, meet legal responsibilities
A woman went to see her physician about a health problem that resulted in the physician’s recommendation for a dilation and curettage (D&C). During the visit, the woman admitted that she was a victim of domestic abuse and asked for help.
"The patient worked with a crisis counselor to make arrangements to have her D&C, then go to a shelter," says Debra P. Hastings, CNR, MSRN, a New Hampshire same-day surgery nurse.
Unfortunately, another same-day surgery nurse, not realizing the patient’s special situation, called the patient’s home to conduct the pre-op interview and left the message with the husband who had been unaware of the surgery. "The plan fell apart, and the woman had to return to the home following surgery," Hastings says.
Make sure communication is open between community agencies, your physicians, and your staff when domestic abuse is involved, and don’t leave messages about surgeries with people other than the patient, she suggests. Hastings conducted a study, co-authored by Glenda Kaufman Kantor, PhD, research professor at the University of New Hampshire in Durham, that looks at the correlation between surgery and domestic violence. The study was presented at the recent meeting of the National Conference on Health Care and Domestic Violence sponsored by the Family Violence Prevention Fund (FUND) in San Francisco.
In addition to keeping communications channels open to ensure patient safety, be sure to teach your staff the right way to ask questions, says Lisa James, senior program specialist at FUND, an organization that focuses on domestic violence education, prevention, and public policy reform.
"You should first frame your question so the patient doesn’t become defensive," says James. A phrase such as "We see so much violence in our patients lives that we are asking the following questions of everyone" lets the patient know that he or she has not been singled out, she explains. Also, be sure to interview the patient alone, she says. A domestic abuse victim will not be forthcoming if the abusive family member or even another family member is present, she adds.
At Fairview Health System in Minneapolis, MN, staff members tell patients that because the health system is committed to quality health care, screening questions address all aspects of a patient’s life, says Sherrie Munson, MSW, department manager of WomanKind, the domestic violence program at Fairview Health System.
Once you have established that the questions are part of the standard screening or preadmission procedure, ask specific questions about violence in the patient’s life, says James. Ask if the patient is currently in, or has ever been in a relationship that involved physical, emotional, or sexual abuse, she suggests. Follow up by asking if the patient would like to talk to someone about it, she adds.
You can be specific if you notice bruises and evidence of old injuries, says Debra A. Zillmer, MD, an orthopedic surgeon in LaCrosse, WI. "When the patient is awake in pre-op, ask what caused the bruises." If the explanation is not consistent with the actual injury or if there are several injuries in different stages of healing, follow up with a statement and question such as, "When I see injuries like this, it is usually because someone has been hurt by another person. Did this happen to you?" she suggests.
Once a patient has told you about an abusive situation, make sure you let the patient know that you understand by saying that you are glad he or she told you and that it is a problem that affects a lot of people, says James. Then offer to provide the names and telephone numbers of a person within your organization or a community agency that can help, she adds.
From an accreditation standpoint, only the Joint Commission on Accreditation of Healthcare Organizations in Oakbrook Terrace, IL, requires that health care organizations have a procedure to identify potential victims of abuse and refer them to appropriate resources. The Joint Commission standards also require organizations to collect and safeguard evidence and notify authorities in accordance with the laws that govern the health care organizations’ area.
Make sure you research your legal responsibility and check with your facility’s lawyer, because laws that govern a health care provider’s response to domestic abuse reports vary from state to state, says James. Make sure your procedures reflect your state’s requirements for reporting and collection of evidence, she adds.
It’s important to remember that even the same-day surgery setting should address domestic violence, says Zillmer. "Whenever we can make contact with patients and tap resources that help them improve their lives, we have accomplished a great deal."
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