Domestic Violence: Nursing Case Study with Mrs. Perez

Domestic Violence: Nursing Case Study with Mrs. Perez
Part -1
Q1. Why might you be concerned about domestic violence, in this case? I will suspect and be concerned with the probability of domestic violence to Mrs. Perez, based on her body language and communications. Since, on probing for the health issue, Mrs. Perez remained passive. She was suffering from a problem in the chest, and definitely she could speak. However, her husband was putting forward the explanations. Since, she had the ability to speak and still took a passive role in probing, made me suspect an act of domestic violence on her (Gelen et al., 2000). Such behavior may be due to a fear from the presence of an intimate partner, who himself may be involved in the act of violence (Chang et al, 2003). Moreover, the body language reflected that she lost eye contact with me. This made my apprehensions clear regarding the act of domestic violence. This is because eye contact reveals the level of comfort enjoyed by a patient with their health care provider. She might have concerns regarding the dignity and respect of her family members in the presence of another person (Gelen et al., 2000). It is evidenced that individuals do not like to disclose domestic violence in healthcare settings as they do not feel it is appropriate (Gelen et al., 2000). Moreover, she was brought to my care after two days, after the so called “fall from stairs.” This point also ensured my concern regarding a possible violence.
Q2. How would you go about screening Mrs.

Perez for domestic violence? I would initiate a compassionate and patient-centric nursing approach (Glass, Dearwater & Campbell, 2001). This means, I should take her into confidence and provide the lead, in disclosing any act of domestic violence. First of all, I would ensure that Mrs. Perez should be interviewed in a confidential and one to one manner. I would ask her husband to step aside. I would ensure Mrs. Perez that I sincerely want to understand the act of violence, so as to provide an evidence based healthcare. I would inquire the verbal and non-verbal relationship of Mrs. Perez with her husband. I would directly ask Mrs. Perez about any family abuse or domestic violence in the family, which is responsible for her physical debility (Gelen et al., 2000).
Q3. Specific to Mrs. Perez’s current condition, using recommendations, from the Abuse Assessment Screen, even if you do not suspect domestic violence, would it be appropriate to screen Mrs. Perez for domestic violence? Why? Yes, it would be appropriate to screen Mrs. Perez for domestic violence based on her shyness in speaking, the dominant role of her husband in answering questions, the injury she suffered, the time when she was brought to care after the incidence (Berlinger, 2004). Thus, I would categorically screen for the above responses based on NRCV (1988) guidelines. This means, I would screen her regarding the relational aspects and behaviors exhibited by her partner towards her at different stages in their relationship. Even evidenced based literature has indicated that direct inquiry by a healthcare provider has helped patients in disclosing domestic violence. Simple asking for domestic violence in healthcare settings is mandatory for all nurses and especially in emergency settings, where the rate of disclosure is very high with direct inquiry (Gelen et al., 2000).
Part -2
Q. During the physical exam, you observe bruising to the left lateral chest and old and new bruises on the forearms and upper arms. Mrs. Perez denies abuse, but you suspect otherwise. What is an appropriate response? Provide a rationale for your response citing your text or the Berlinger Article. On denial from Mrs. Perez regarding domestic abuse, I should take certain steps which may make her confident in disclosing her issue to either to me or any of my peers or support group at any moment of time. Since, data from various studies have reflected that women like to be asked for incidences of abuse. I would ensure the ambience for disclosure, by making exemplification. I would inform her that I come across a lot of women who are victims of violence. Moreover, I would also prompt her for disclosure by explaining, that often delay in accessing healthcare, is due to domestic violence. This would make her feel that I am not only concerned, but I am also aware of domestic violence to women, in my routine practice settings. I would wear awareness badges on my uniform “Is someone hurting you”. I would ensure that adequate posters on domestic violence and health care problem in women are available in my practice settings (Glass et al, 2001). After gaining her confidence, I would document acts of domestic violence, by taking photographs of old and new bruises or injuries. I should also use audio-recording of my conversation with Mrs. Perez, as a chat transcript, for future reference and planning care needs (Berlinger, 2004). I should proactively provide her with the hot line numbers to access care options in terms of need and provide her a thorough confidence that “Nurses Understands Violence and they do care for their patients”. I would also ensure keeping safety cards in bathrooms and in places privately visited by patients in healthcare set ups so that she can gather necessary information regarding help without any visual disclosure to health care providers (Glass et al, 2001). Finally, I should praise her for her courage, since she is living under conditions of domestic violence (Berlinger, 2004).
Works Cited
Berlinger, J.(2004). “Taking an intimate look at violence.” reuters.com. Retrieved
20 November 2015
Chang, J.(2003) “What Happens when Health Care Providers Ask about Intimate Partner
Violence? A Description of Consequences from the Perspectives of Female
Survivors’ Journal of the American Medical Women’s Association. 58(2), 76- 81
Gielen, A.C., O’Campo, P., Campbell, J.C., Schollenberger, J., Woods, A.B., Jones, A. S.,
Dienemann, J. & Kub, J. (2000). “Women’s opinions about domestic violence
screening and mandatory reporting.” American Journal of Preventive Medicine 19(4),
279-285.
Glass, N.E., Dearwater, S., and Campbell, J.C. (2001). Intimate partner violence screening
and intervention: Data from eleven Pennsylvania and California community Hospital
emergency departments. Journal of Emergency Nursing 27(2),141-149.