Treating Patients of Violence & Abuse

helpingpatients Abuse occurs in many areas of society and takes many forms. Some examples may involve the abuse of a child by a parent or caregiver; the abuse of a parent by an adult child; or the abuse of a spouse. In addition to the physical aspects, abuse can include emotional battering, financial exploitation and sexual assault. Many of these result in health problems for the victims. Your role in dealing with victims of abuse is multifaceted.

One of the most common and deadly forms of child abuse is not physical violence, but neglect. According to data from the National Child Abuse and Neglect Data System, neglect was a contributing factor in more than 71 percent of child maltreatment fatalities in 2011.

Possible signs of child maltreatment may include:

◗ Developmental delays
◗ Speech disorders
◗ Failure to thrive
◗ Poor hygiene
◗ Inappropriate seasonal clothing
◗ Lack of supervision
◗ Unattended medical needs
◗ Chronic truancy
◗ History of psychological disorders

When assessing a patient, you should be aware of the following physical signs of injuries related to domestic violence:

◗  Black eyes
◗  Bruises in various stages of healing, particularly on breasts or genitalia
◗  Symmetrical bruises on upper arms, wrist or neck
◗  “Bathing-suit pattern” marks that are covered by clothing
◗  Subdural hematomas
◗  Patches of missing hair
◗  Fractured mandibles
◗  Ruptured tympanic membranes
◗  Lacerations around the eyes and lips
◗  Rib fractures
◗  Unexplained venereal disease or genital infections
◗  Recurrent urinary tract infections
◗  Anal or genital bleeding or injury
◗  Marks consistent with the size of objects such as cigarettes or belts
◗  Signs of neglect, such as malnutrition, poor hygiene or skin ulcers
◗  Use of makeup or other methods to hide indicators
◗  Injuries not consistent with explanation of how they occurred

However, it is unlikely the patient will present with a physical injury. They will more likely present with issues such as:

  • A stress-related illness
  • Anxiety, panic attacks, stress and/or depression
  • Drug abuse including tranquilizers and alcohol
  • Chronic headaches, asthma, vague aches and pains
  • Abdominal pain, chronic diarrhea
  • Sexual dysfunction
  • Joint pain, muscle pain
  • Sleeping and eating disorders
  • Suicide attempts, psychiatric illness
  • Gynecological problems, miscarriages, chronic pelvic pain

The patient may also:

  • Appear nervous, ashamed or evasive
  • Describe their partner as controlling or prone to anger
  • Seem uncomfortable or anxious in the presence of their partner
  • Be accompanied by their partner who does most of the talking
  • Give an unconvincing explanation of the injuries
  • Be recently separated or divorced
  • Be reluctant to follow advice

All Nursing schools include information about how to detect child and domestic abuse within the curriculum, but the practice of detection can be difficult. Most inpatient and outpatient facilities now require questions about personal safety and domestic violence screening questions as part of the intake process. In your role as the attending Nurse, it's important to ask these questions with intent and ensure the patient has enough time to answer. Do not rush the patient as they are most definitely scared. Some practitioners even wear buttons or badges that say, "It's okay to talk with me about domestic violence." Only ask questions about domestic violence when the patient's partner is out of the room.

The following questions may be helpful when assessing a patient for abuse, maltreatment, or neglect: 

  • I noticed that you have a number of bruises. Can you tell me how they happened? Has anyone hurt you?
  • You seem frightened. Has anyone ever hurt you?
  • Have you been hit, slapped, kicked, pushed, shoved, or otherwise physically hurt by someone within the last year?
  • Sometimes patients tell me that they've been hurt by someone at home or at work. Could this be happening to you?
  • Are you afraid of anyone at home or work, or of anyone with whom you come in contact?
  • Has anyone forced you to engage in sexual activities within the last year?
  • Has anyone prevented you from seeing friends or other people whom you wish to see?
  • Have you signed any papers that you didn't understand or didn't wish to sign?
  • Has anyone forced you to sign papers against your will?

In a clinical setting, your most important role is to provide a safe environment for your patient; treat your patient's injuries; and observe, listen, and document the facts. Treatment focuses on the consequences of the abuse and preventing further injury. If the patient is in immediate danger, separate the patient from the perpetrator whenever possible.

Your next important job is to refer your patient to the appropriate authorities and/or agencies. Even if you aren't sure but suspect that your patient is a victim of abuse, report your suspicions. You won't be penalized and you may save your patient's life.

Additional resources are only a phone call away. These include hotlines such as:

* National Domestic Violence Hotline: 1-800-799-SAFE (7233); TTY: 1-800-787-3224

* ChildHelp USA National Child Abuse Hotline: 1-800-4-A-CHILD (422-4453); TDD: 1-800-2-A-CHILD (222-4453)

* National Youth Crisis Hotline: 1-800-442-HOPE (4673)

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