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Difficulty: Very hardAbuse or Neglect

A practical nurse (PN) in an emergency department is assisting with the care of a 28-year-old client who presents with facial contusions, defensive wounds on the forearms, and a lacerated lip. The client's partner is standing closely beside the bed, answering all questions on behalf of the client, and refusing to leave the room. The PN strongly suspects intimate partner violence (IPV). Arrange the following nursing actions in the correct priority sequence to safely manage this situation.

  1. 1Separate the client from the partner by citing a routine facility policy, such as needing to transport the client for an X-ray or collect a private urine specimen.
  2. 2Directly and non-judgmentally ask the client if they feel safe at home and inquire about the true cause of the injuries.
  3. 3Perform a thorough physical assessment and document the objective findings alongside the client's verbatim statements regarding the trauma.
  4. 4Report the assessment findings to the supervising registered nurse (RN) or healthcare provider to initiate an interdisciplinary response.
  5. 5Collaborate with the healthcare team to assist the client in developing a personalized safety plan and provide a list of community resources.

Answer

The correct sequence prioritizes immediate safety and isolation first, followed by direct assessment, objective documentation, escalating to the interdisciplinary team, and finally providing therapeutic interventions like safety planning.
In cases of suspected intimate partner violence, the practical nurse must prioritize safety above all else. This requires safely separating the client from the suspected abuser using a non-confrontational clinical excuse. Only when privacy is guaranteed should the nurse screen directly for abuse. Following disclosure or assessment, meticulous objective documentation must occur. The PN then escalates the findings through the chain of command to the supervising RN or provider to trigger a multidisciplinary approach, culminating in the provision of collaborative safety planning and resources for the client.

Step-by-Step Solution

1
Separate the client from the partner by citing a routine facility policy.
Privacy is established without escalating the partner's suspicion or anger.
Victims of abuse will rarely disclose information if the abuser is present due to fear of retaliation. Establishing a safe environment is the top priority.
2
Directly and non-judgmentally ask the client if they feel safe at home.
The PN gathers necessary data regarding the suspicion of intimate partner violence in a secure setting.
Direct screening for abuse is a required assessment step once the client is in a secure, private environment.
3
Document objective findings and use verbatim quotes from the client.
A legally sound and highly accurate medical record is created.
Precise documentation is crucial for potential future legal proceedings, ensuring the timeline and evidence are clear.
4
Report findings to the supervising RN or healthcare provider.
The interdisciplinary healthcare team is alerted to the situation to coordinate comprehensive care.
The PN works under the supervision of the RN or provider, who will often involve social workers and coordinate mandatory or voluntary reporting protocols.
5
Collaborate to assist with safety planning and provide resources.
The client is equipped with tools and information to improve their safety upon discharge.
Safety planning is a critical intervention that requires an interdisciplinary approach once the abuse is identified, documented, and reported internally.

Key Concept

Management of Suspected Intimate Partner Violence and Prioritization of Care
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Topics

Abuse or Neglect

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