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Domestic Violence Screening

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by Nurse Mack Nurse Mack (New) New Nurse

Specializes in New Nurse.

Brand spanking new nurse here and I could use some direction. 

I'm working my first job giving vaccines at a local pharmacy. I see patients in a private room and it seems like an ideal time to ask someone if they feel safe in their relationships. 

I don't have any problem asking questions and talking with patients but I have no idea what to do if they don't feel safe. 

What should I do if I'm ever in this situation? 

Thanks! 

Mack

I think you need to ask your employer if that is a question normally asked at a pharmacy. I've never been asked by the pharmacist at Walgreen's giving me a flu shot if I feel safe at home. I might be offended really. What would you even do with that information if I said no?

Nurse Mack

Specializes in New Nurse.

At the moment, domestic violence and intimate partner murder is on the rise*.  And, because victims may have fewer moments alone, many are having a harder time reaching out for help.

Asking someone if they feel safe should be a standard quesation with any office visit. With virtual visits becoming the norm, that aspect of a visit is being overlooked more now than ever. 

When I do a vaccination, I have a couple of moments alone with my patient in a private setting where I'm already asking about their health. Offering the opportunity for someone to talk seems like basic holistic nursing care. 

*depression, anxiety, other mental health problems, and suicide are also on the rise 

I'm quite well aware of that; my question to you was what would you do with that information? Again, that is an issue for your employer to decide before you proceed. I don't see getting a flu shot at Walgreen's to be basic holistic health care.

On 10/28/2020 at 9:28 AM, Nurse Mack said:

Asking someone if they feel safe should be a standard quesation with any office visit.

You are not performing an office visit.

I would follow your employers' policies on this. If you feel that IPV screening should be taking place in this setting then you need to take this through correct channels. Where will you document your conversation? Etc. Also, you would need to collect resources that your employer endorses specifically and make sure you are giving out vetted information. As you already noted, you do also need a plan for what you will do if someone reports IPV.

ruby_jane, BSN, RN

Specializes in ICU/community health/school nursing. Has 12 years experience.

@Nurse Mack I appreciate the discussion on this. I am reminded every time I go to my PCP that there are questions he should be asking me (like, they're required) and on the discharge sheet I see that I have denied IPV, smoking, illicit drug use, abuse of RX meds, and a host of other things that he has LITERALLY never asked me (nor have the nursing staff).

The same was true for RJ Junior's pediatrician when she had one. The discharge sheet said we'd been counseled about obesity, wearing a helmet while biking, and that she'd discussed guns in the home. Never once. She knew I was a nurse, too.

I don't disagree with your rationale. One of my best nursing supervisors said "a decision to test is a decision to treat" and that has shaped my practice ever since.  What do you plan to do with the people who say yes?

Lots of places put posters for the local domestic violence hotline up in places where they're likely to be noticed. Without a mandate from your employer, that may be something that you could start? Good luck!

hppygr8ful, ASN, RN, EMT-I

Specializes in Psych, Addictions, SOL (Student of Life). Has 19 years experience.

On 11/20/2020 at 8:19 AM, ruby_jane said:

@Nurse Mack I appreciate the discussion on this. I am reminded every time I go to my PCP that there are questions he should be asking me (like, they're required) and on the discharge sheet I see that I have denied IPV, smoking, illicit drug use, abuse of RX meds, and a host of other things that he has LITERALLY never asked me (nor have the nursing staff).

The same was true for RJ Junior's pediatrician when she had one. The discharge sheet said we'd been counseled about obesity, wearing a helmet while biking, and that she'd discussed guns in the home.

@Nurse Mack Im glad Im no the only one who has this issue. I remember when my son (now 19) started going in the Dr on his own to to a rather personal health concern that he didn't want his mother in the room. He was fine if I talked to the doctor afterwards just not in front of him. So we arrive at the doctor's office and he is gien a standard questionaire. Two questions in about the middle were "Are their amy guns in your home?" and "Do you feel safe in your home? My sone answered yes to the first question and wrote in the 2nd "Yes see previous question and answer!" 

Hppy

hppygr8ful, ASN, RN, EMT-I

Specializes in Psych, Addictions, SOL (Student of Life). Has 19 years experience.

On 10/26/2020 at 4:37 PM, Nurse Mack said:

Brand spanking new nurse here and I could use some direction. 

I'm working my first job giving vaccines at a local pharmacy. I see patients in a private room and it seems like an ideal time to ask someone if they feel safe in their relationships. 

I don't have any problem asking questions and talking with patients but I have no idea what to do if they don't feel safe. 

What should I do if I'm ever in this situation? 

Thanks! 

Mack

What others have said here goes. You are not providing an office visit just a vaccination. Unless your employer has a clear policy on how to ask and what to do in the event a person answers yes. You should not ask. If your employer does not have a policy then what would you do with a yes answer. What if the person say's yes but declines any other help? What if their partner is in the waiting area? Then what would you do?  I don't know if it's still the case but I did read somewhere that victims of IPV are at greater risk in the days/weeks after making a report. 

Hppygr8ful

I applaud your goals of providing holistic healthcare and trying to screen for IPV. Unfortunately, however, without resources and a plan in place for what you would do in the event someone says they are unsafe, you're not actual providing holistic care, you're fishing for information. Real holistic care means you're not just screening and asking questions but you're ready to provide the necessary step to address any problems you identify.

As others have pointed out, the setting you are currently working is different from a primary care office visit for many reasons. Also, without a plan in place, you could just as likely be putting many people, including those you're looking to help, in greater danger since there is a good chance an abusive partner is in the facility with the patient and will not respond well to any delay. To make an effective plan, you would need to know not only who you could contact and refer this person to in order to get help (which has already been made more difficult with the pandemic and many shelters closing or being limited in space), a way to keep them safe in the facility while waiting for help to arrive, and a way to keep the rest of the staff and patrons safe from a potentially violent person who is becoming suspicious when getting a vaccine takes more than a few minutes. 

A better approach might be to see if your employer would allow you to post resources for local IPV resources such as a poster in the space where you do the vaccinations. You could also consider checking with your local community resources. Some of them provide "shoe cards" - cards with emergency numbers a victim can hide in their shoe to avoid detection by a partner. 

A pharmacy does seem like an inappropriate place to be asking domestic violence questions, but those questions do get asked anyway. At some point the nurse is going to have to address those questions. I'd recommend giving the most practical advice possible. If the person is struggling with abuse, then you can't be there to defend them. Law enforcement might take hours to reach the person; they can't reasonably defend the person at any given time. When seconds count, the police are only minutes away. I'd tell the patient: you have two options, defend yourself or don't. If you choose to defend yourself, use whatever methods of self-defense you have to to prevent yourself from being assaulted and maintain self-preservation. If this is a matter of verbal abuse, and you can evict the person, then you might benefit from calling the cops and ask them to remove the person who is being belligerent/disturbing the peace/trespassing. If they can't evict the person then they can either move away or not. This is an extremely unfortunate situation and the nurse can't solve all these problems. A referral to APS/CPS or law enforcement may be necessary. They might need a restraining order. They might need a lawyer. All you can do is point them in the right direction

Hannahbanana, BSN, MSN

Specializes in Physiology, CM, consulting, nsg edu, LNC, COB. Has 51 years experience.

Your local women's shelter can give you a pat on the back and some resources you can have on the table or in the restroom for anyone who needs them. Show them to your employer and tell them you would like to make them available since the current situation has resulted in more hidden DV and women are particularly vulnerable when isolated. Nurses are the most trusted profession; a DV victim always hopes she'll get a glimmer of hope. You could be it.