NR 305 Assessing for Family Violence

NR 305 Assessing for Family Violence

NR 305 Assessing for Family Violence

The topic this week is important yet can be emotionally charged to discuss. I encourage students to be in touch with their feelings on violence and caring for both the patients and families as this is not isolated to Pediatrics. I have seen a variety of situations over the years and am sure you all have as well so sharing experiences with each other will help us learn.

Remember that you may start posting Sunday for credit. You should have your initial post and one peer responses by Sunday 8/9 @ 1159pm MT. Support your statements in the discussions with current literature; for example, articles dated 8 years or less with responses to the questions and peers reflecting depth and insight. Your posts are interesting each week, I look forward to what the discussions will bring this week!

Weber states, the long-term consequences of child abuse and neglect, according to the Child Welfare Information Gateway (2013a), include: Physical: emotional conditions such as chronic fear, hypervigilance, impulsivity, psychological: isolation, fear, and an inability to trust—can translate into lifelong psychological consequences, including low self-esteem, depression, and relationship difficulties; behavioral: adolescent issues such as grade repetition, substance abuse, delinquency, truancy, or pregnancy, and sexual risk-taking; greater likelihood of being raped in adulthood; correlation with juvenile delinquency and adult criminality; abuse of alcohol and other drugs; greater likelihood to become abusive parents. (Page 163). Our goals as nurses are to assess immediately assess and detect abuse and refer to child protective service for close monitoring and removal from harmful situations of abuse. There are communicative approaches to use with Elizabeth who is only ten, and ongoing through the developmental stage of industry versus inferiority-task at this stage are developing social, physical, and learning skills with successful competence; therefore an unsuccessful result to Elizabeth’s situation is sense of inferiority; difficulty learning and working (Silvestri pg. 258).

Elizabeth needs to first be in a comfortable setting with the nurse and mother. Elizabeth’s mother is initially invited to demonstrate to Elizabeth the nurse’s purpose of interviewing her is not for intimidation or to elevate the stress. Simple questions through a physical assessment will be conducted to Elizabeth, and engage in conversations that encourage thinking, providing reassurance to help alleviate fears and anxieties, using clear terms, patience by the nurse to allow time for composure and privacy, and using photographs, books, dolls, and even videos to demonstrate and explore Elizabeth’s situation ( Silvestri 267). Thereafter of the physical assessment, the mother will be kindly asked to provide Elizabeth privacy, and assure the mother her child is safe, and the interview will stop at any point Elizabeth expresses so. With all these communication approaches, the nurse allows Elizabeth to be in a mental state to freely speak, where the nurse and Elizabeth find a trusting rapport, and the nurse is assessing within the trust. This approach can assist in intervening this potential psychological and physical abuse by Elizabeth’s father.

In the article of the Scandinavian Journal of Primary Health Care, it states from a database with general physicians reporting suspected abuse cases from that gut feeling “all groups discussed the gut feeling described as there is something wrong here and considered it a valuable diagnostic tool. In such cases, GPs got an uneasy feeling, while listening to complaints or observing a child, which put them on the alert. An odd symptom or unusual behaviour, such as a child behaving like ‘an unguided missile in my office’ [FG4,1] and the intimidating reaction of its parents might make GPs think there is something wrong.” (117).

References:

Stolper, Erik; Verdenius, Jan Paul; Dinant, Geert-Jan; van de Wiel, Margje June 2020. Scandinavian Journal of Primary Health Care. GPs’ suspicion of child abuse: how does it arise and what is the follow-up? 38(2): 117-123. (7p)

https://chamberlainuniversity.idm.oclc.org/login?url=https://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=144636703&site=eds-live&scope=siteLinks to an external site.

 

Silvestri, Linda Anne. (2011) Saunders comprehensive review for the NCLEX-RN examination /St. Louis, Mo.: Elsevier/Saunders

Weber, J.R. & Kelley, J.H. (2018). Health assessment in nursing (6th ed.). Wolters Kluwer.

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I cannot work with pediatrics. Reading Elizabeth’s story made me angry and flood with emotions. Elizabeth’s father has hurt her before, and she was again in an environment where abuse was ample to take place again.

In researching articles, I found a case of abuse that was deplorable that happened while a child was intubated in this

NR 305 Assessing for Family Violence
NR 305 Assessing for Family Violence

PICU (Wilkins, et al, 2016). The child could have been suffocated by the visitor who was allowed at this PICU, but later it was found that abuse had previously occurred – it was never screened for in the emergency room (Wilkins, et al, 2016). Had there been a procedure in place for staff to screen for child abuse as a norm, perhaps this visitor would not have been able to further harm this child (Wilkins, et al, 2016).

To make Elizabeth feel safe and secure, her mother needs to step away for a time (Weber & Kelley, 2018). She needs that private one on one setting to build a rapport with the nurse and she may feel uncomfortable to speak in front of her mother who reported there had been previous abuse as well (Weber & Kelley, 2018). We need subjective data from the child and further information from the mother too as well as other diagnostic objective data like x-ray (Weber & Kelley, 2018). We do not know that Elizabeth’s mother has never abused her in addition to her father. We must explore if there is a safe environment for the patient to return to a little bit. Thankfully, we would also have to report the abuse to our supervisor and other departments who would get child protective services involved as we are mandated reporters (Weber & Kelley, 2018). Elizabeth’s mom may be a victim of physical abuse and threats as well. That needs to be a side conversation as well as exploring her own goals for this matter for her daughter and herself.

If Elizabeth were up for it, we could discuss what hurts her first. She could point to areas that hurt. We can ask how bad the pain feels. We can explain that we need to take a picture of her arm to see what we can do to make it feel better. We can discuss likes and dislikes to build a rapport. Maybe tuning into a favorite character on TV helps build a conversation quicker. Maybe offering her some stickers just for getting her vital signs taken can open a door for conversation to asking if someone hurt her today or in the past and who. I think as a nurse it is OK to ask sensitive questions, but we must be careful not to push someone who is not ready to talk. She may not be able to talk. There is an important factor involved that we know there was previous abuse, and this is likely further abuse, we must be careful to not rip of a band-aid too soon. People that experience traumatic things must go through years of therapy sometimes to really make the conversation begin.

Always validate, always ask permission and explain how you may have to touch an abused person before you feel you have the right to examine them. My children’s pediatrician always reminds, “It’s only OK to take off your underwear because I’m your doctor and this is your mom, right?”

References

Weber, J.R. & Kelley, J.H. (2018). Health assessment in nursing (6th ed.). Philadelphia, PA: Wolters Kluwer.

Wilkins, G. G. , Ball, J., Mann, C., Nadkarni, M., and Meredith, W. (2016). Increased screening for child physical abuse in emergency departments in a regional trauma system: Response to a sentinel event. Society of Trauma Nurses. 23 (6).