Domestic violence

[ehcaseyAPRN]

I am a family NP in a family practice setting, and I have a dilemma. We have several families that we see both parents and the child(ren). The mom came in on Wed. and she is a victim of abuse. We had not noticed it previously. Previously, she & her husband came in together. He was not present this time. There is a restraining order in place on him.

What do I/we do about caring for him? We are his primary care provider. It is likely that he will be back to see me. I found the arrest record. Obviously, I do not disclose anything about her health or otherwise to him. But what are the logistics of providing care to an abuser?

Thanks for the insights.

[Rnis, BSN, DNP, APRN, NP]

You will likely hear a totally different story from him. I have had this happen before and I generally try to direct to counseling (from the perspective of marital counseling) when I can but I don't disclose what I know .

[Oldmahubbard]

I don't think you can bring the issue up. Not directly. Medically, you might screen for depression or ETOH abuse, which are commonly co-morbid, but beyond that, not much.

I would like to hear from people who have dealt with this situation.

[djmatte, ADN, MSN, RN, NP]

You treat him like a completely independent person as of the two never knew each other. You screen him for the things you should screen for and treat the conditions he needs treatment for. You don't judge his poor choices or treat him any different medically than if he was a saint. His restraining order isn't your concern to manage or enforce. If he busts it by showing up to the same place at the same time, that's on him.

This is one of the many reasons I refuse to see spouses or significant others in the same room or in back to back appointments where they are roomed together. Independent individuals with no mental or age related dependence should be able to see their pcp without someone else there (outside complex situations where someone needs a second set of ears).

[OyWithThePoodles, RN]

You treat him like a completely independent person as of the two never knew each other. You screen him for the things you should screen for and treat the conditions he needs treatment for. You don't judge his poor choices or treat him any different medically than if he was a saint. His restraining order isn't your concern to manage or enforce. If he busts it by showing up to the same place at the same time, that's on him.

This is one of the many reasons I refuse to see spouses or significant others in the same room or in back to back appointments where they are roomed together. Independent individuals with no mental or age related dependence should be able to see their pcp without someone else there (outside complex situations where someone needs a second set of ears).

Personally, for the most part, I would rather have my husband with me at my appointments. At times I have been asked questions that were hard for me to answer but easier for him (anxiety: has your anxiety gotten better or worse? Well, seeing as how he helps me through my panic attacks, he would have a better answer as to whether or not they've gotten better or not. Thyriod: I was sleeping 15 hours a day. She asked if I snore when I sleep, not a clue. He had the answer to that.) Just a couple examples where it helped having him there.

I like going with him because he's a man. And sometimes likes to pretend he is not as sick as he actually is

I go with my dad (perfectly capable of taking himself) to his appointments in regards to his diabetes because it can be overwhelming for him and by the end of the appointment he forgets what was discussed at the beginning.

[Gods_nurse]

I, personally, would go for the jugular. Go for the heart of the matter. What is REALLY bothering him. Is he depressed? Is he worried about finances? Is he under pressure at the job? Are his parents ill? Is he ill and doesn't want to acknowledge it? Is he caught in the middle of an extra-martial affair? Is he involved in some type of crime?

Does he need to see a psychiatrist? a minister/priest? Where/who is his support system? Does he have any friends?

Focus on him. Maybe no one ever really cares about HIM. Maybe he grew up in a home where no one ever said, "I love you" or "I'm proud of you" maybe he just needs to know you care.

[trytounderstand]

Personally, for the most part, I would rather have my husband with me at my appointments. At times I have been asked questions that were hard for me to answer but easier for him (anxiety: has your anxiety gotten better or worse? Well, seeing as how he helps me through my panic attacks, he would have a better answer as to whether or not they've gotten better or not. Thyriod: I was sleeping 15 hours a day. She asked if I snore when I sleep, not a clue. He had the answer to that.) Just a couple examples where it helped having him there.

I like going with him because he's a man. And sometimes likes to pretend he is not as sick as he actually is

I go with my dad (perfectly capable of taking himself) to his appointments in regards to his diabetes because it can be overwhelming for him and by the end of the appointment he forgets what was discussed at the beginning.

For the most part having someone alone who is being abused is not going to get them to reveal it to you unless the evidence is so clear they have no other choice. Speaking from personal experience, they will be conditioned not to tell anyone and if you insist on treating them alone especially just for normal visits will trigger a bad response in the abuser. Remember they have to go home with that person.

Speaking as to how to deal with the abuser, treat them as you normally would perhaps try to get them to open up as to things that may be bothering them. Sometimes abuse does come from a bad, stressful situation at home others it is just there.

As a patient, if our primary care provider would not allow my spouse to be in the normal visits I believe I would be finding another doctor. There have been times when we have helped each other out....you know it isn't necessary for the anesthesiologist or doctor to know that you gasp for breath in your sleep, or that your blood pressure has been sky high and you have complained of chest pain...it isn't necessary for someone to be there to say doc get them off that medicine he/she has been crying, angry, sad, up all night and no you are not prescribing an anti-depressant you are stepping them down and we are moving on....it isn't necessary for someone to be there and so no you are not prescribing opiates what else can we try....

It is important to have the other half of the couple there especially folks who have been married for years. They see things and know things that the other may have just come to accept as par for the course and oh I'll be in the hospital anyway and they'll take care of me.

Just the same as separating a couple after a tragic accident or heart attack because you have to speak to the patient alone to rule out abusive situation at home is just cruel. All that does is add more aggravation and stress to a life threatening situation.

Who knows in the hospital situation one might forget to tell that I am allergic to a specific antibiotic and low and behold later after heart palpitations, blood pressure off the charts, and emergency care given that would have been avoided if the spouse had been there to say stop. Or in prescribing such a simple thing as a laxative that one reacts strongly too may result in a very sick patient and very unhappy nursing staff from the projectile vomiting and terrible cramping that is going to ensue.

[Rnis, BSN, DNP, APRN, NP]

You treat him like a completely independent person as of the two never knew each other. You screen him for the things you should screen for and treat the conditions he needs treatment for. You don't judge his poor choices or treat him any different medically than if he was a saint. His restraining order isn't your concern to manage or enforce. If he busts it by showing up to the same place at the same time, that's on him.

This is one of the many reasons I refuse to see spouses or significant others in the same room or in back to back appointments where they are roomed together. Independent individuals with no mental or age related dependence should be able to see their pcp without someone else there (outside complex situations where someone needs a second set of ears).

I don't believe this for a second. That is not holistic care to try and dictate who a person can and can't bring with them to an appointment. A lot of people have anxiety about medical professions and they bring others for support. I also like having others there because it gives me a lot insight. I do pap smears with boyfriends , moms, grandmas ...whoever they want in there...... sometimes all of those relations at the same time. :)P

[djmatte, ADN, MSN, RN, NP]

I don't believe this for a second. That is not holistic care to try and dictate who a person can and can't bring with them to an appointment. A lot of people have anxiety about medical professions and they bring others for support. I also like having others there because it gives me a lot insight. I do pap smears with boyfriends , moms, grandmas ...whoever they want in there...... sometimes all of those relations at the same time. :)P

It certainly isn't an absolute. But I do try to mix it up as best as possible. I have seen instances where people open up more without a spouse there and equally some where spouses volunteered information that the patient isn't telling. But I do think there are cases that warrant different situations. Though I will say, if patients are there for their own visit be it back to back or separated, I never see the in the same room and instruct my MAs accordingly. Too many times have people loaded on Norco and Xanax have tried to gang up and maintain or increase their doses on me that I won't room them together. Especially if pain meds are involved.

[Neats, BSN]

Treat them like two separate individuals I would also not have them come in on the same day, what we have done in the past and patient did not even know one could come on even days and one could come on odd days. Only the staff knew this. If there was a special circumstance they would come to me the office manager and we would accommodate a different day but always kept the even odd, it worked for us.

If the patient wanted to speak about their loved ones/significant others I just cite HIPAA and say I cannot talk about that-change the subject.