care plan for battered woman, need experienced nurses help!!

[anangelsmommy]

:bugeyes:I need help with care planning for a battered woman! I posted under the student section but I think it is mostly other students and I really want experienced help. I looked this up on the internet and in every care planning book I have and cant find anything besides diagnosis. I have no experience with this so here goes:

battered woman comes in with headaches, one week after her husband gave her a concussion. So obviously headache is diagnosis of pain. but I am more concerned with the woman in the violent situation that still lives with the husband. So I said diagnosis violence, other directed? but does that mean other directed at her or her directing violence at others? next, I have no idea what goals or nursing actions to take other than to give her information to a shelter or womans group and goal of her leaving the violent situation?

for this care plan I need long and short term goals and at least 3 nursing actions for each. So lets just say I said a short term goal of no further injury? how would you possibly have her avoid injury if it is the husband that has control over that? I cant tell her not to make him angry - she is not the one that controls his anger,right? and that just seems so wrong. but I have no experience with this and not sure what else to include? I know in our previous classes, they had talked about having the woman make an escape plan with a code word but I dont really know how to go about this and I sort of invision that if she trys to pick up the phone in the middle of a violent episode, it might make him more angry and he might just hit it out of her hand?

what do you think? anyone with actual experience that can help or anyone that may have even just learned about this situation in more detail than I did?

thanks!!!

[donsterRN, ASN, BSN]

i am glad my explanations are helpful for you. i have a number of others that explain the nursing process and how to construct a nursing diagnostic statement that i think are posted on the help with care plans thread (https://allnurses.com/forums/f50/help-care-plans-286986.html)

i really didn't start understanding care plans and the nursing process until i was several years out of nursing school and had started doing care plans at work. it is because of having a few years of clinical experience under my belt. i was a slow learner. however, once the light bulbs get turned on in my brain there is no getting them turned off!

you've certainly helped me more than you'll ever know during my schooling. i expect you'll be teaching me even more in my career!

[Daytonite, BSN, RN]

You've certainly helped me more than you'll ever know during my schooling. I expect you'll be teaching me even more in my career!

Thanks, Don. You know, it used to scare me that there were so many people read what I posted. If people only knew that I am sitting in a quite little corner with a pile of books around me. I really don't think of myself as being anybody special. For me, this is something I do to keep me out of trouble and off the streets! Ha! Ha! Ha! I should be doing the dishes, but this is more fun!

[anangelsmommy, ADN, BSN, RN]

i have been working on this and i came up with a list ( not complete but i am having trouble with the aeb statement....i had no trouble last year when it was something simple like constipation r/t poor fluid intake aeb hard stool but for some reason this is a lot more complicated. i think part of what is stumping me is that we havent done the physical assessment so it is sort of piecemeal and i have to make up part of it. this is what i have so far...heading to bed, will work on it a bit more tomorrow.

1. acute pain r/t trauma aeb headache

2. fear r/t violent domestic situation aeb verbalization of being afraid of partner and that he will hurt her again.

3. post trauma syndrome r/t physical abuse aeb head trauma, feelings of guilt, anxiety

4. denial r/t fear aeb client blames herself for recent physical abuse resulting in concussion.

5. social isolation r/t inadequate personal resources aeb patients statement of not having any money or anywhere to go if she leaves husband.

6. powerlessness r/t physical abuse aeb

7. chronic low self esteem r/t aeb need for excessive reassurance, expressions of self negating thoughts

angels mommy

[Daytonite, BSN, RN]

you need to look at a nursing diagnosis reference (the nanda taxonomy) that includes the definition, defining characteristics, and related factors for each nursing diagnosis. just as you read about and learn about medical diagnoses, you do the same for nursing diagnoses. unfortunately, in many cases, we only have the nanda taxonomy information to refer to. the defining characteristics are the same as your aebs--they are the signs and symptoms of the diagnosis and are a guide as to what you look for in the patient. if you do not have your own copy of taber's cyclopedic medical dictionary (this information is in the appendix), luckily, some of this diagnostic information is on the internet:

1. acute pain r/t trauma aeb headache

2. fear r/t violent domestic situation aeb verbalization of being afraid of partner and that he will hurt her again.

• fear
  

3. post trauma syndrome r/t physical abuse aeb head trauma, feelings of guilt, anxiety

• post-trauma syndrome
  

4. denial r/t fear aeb client blames herself for recent physical abuse resulting in concussion.

• ineffective denial
  
• you need to be more specific about the type of fear as the related factor here since you have another nursing diagnosis about fear. is this fear of separation (losing her relationship with her husband), fear of being independent (if she leaves him), fear of death (if she aggravates him to commit violence on her)?
  

5. social isolation r/t inadequate personal resources aeb patients statement of not having any money or anywhere to go if she leaves husband.

• defining characteristics:
  
  • objective: absence of supportive significant other(s), developmentally inappropriate behaviors, dull affect, evidence of handicap (e.g., physical, mental), exists in a subculture, illness, meaningless actions, no eye contact, preoccupation with own thoughts, projects hostility, repetitive actions, sad affect, seeks to be alone, shows behavior unaccepted by dominant cultural group, uncommunicative, withdrawn
    
  • subjective: expresses feelings of aloneness imposed by others, expresses feelings of rejection, developmentally inappropriate interests, inadequate purpose in life, inability to meet expectations of others, expresses values unacceptable to the dominant cultural group, experiences feelings of differences from others, insecurity in public
    

6. powerlessness r/t physical abuse aeb

• powerlessness
  
• http://www1.us.elsevierhealth.com/merlin/gulanick/constructor/index.cfm?plan=42 - powerlessness
  

7. chronic low self esteem r/t aeb need for excessive reassurance, expressions of self negating thoughts (i already gave you this information)

[ShayRN]

I would like to add my two cents, not that it will be anywhere near as helpful as Daytonite's hard work. How about knowledge deficit r/t domestic violence. Do some teaching on what it really is and what it means. Many times women have been raised in a violent home and expect that when they are married. It isn't abnormal for them, just a way of life. Goals can be r/t verbalizing understanding of domestic violence, impact of family/children, and patient verbalizes understanding of community support systems available. Just a thought.

[anangelsmommy, ADN, BSN, RN]

daytonite,

first let me say that you are more helpful than any instructor that i have had! this is why i love this website and i just hope that others will also learn from this!!

the defining characteristics are the same as your aebs--they are the signs and symptoms of the diagnosis (i am not sure how much or little i should put here and whether they are in the client words or more medical terms?)

and are a guide as to what you look for in the patient. if you do not have your own copy of taber's cyclopedic medical dictionary (i have one but never used it except to look up a few terms in lpn school):

i did look these up in gulanick nursing care plans and sparks nursing diagnosis but they do not list examples of aeb so i was unsure how to write this.

i need to choose three so i tried to come up with as many as i could and then figured i would narrow down based on symptoms reported and based on heirarchy.

these are my final three diagnosis - i think maybe the reason i had trouble with the others was that i didnt have enough supporting data. i absolutely know that these are diagnosis for her so now i need to work on all the supporting data, the outcomes and interventions.

1. acute pain r/t trauma aeb headache –physiological need

2. chronic low self esteem r/t?? conditioning of low self worth, or inability to recognize self worth, or inability to trust oneself or altered self image or disturbed self image or impaired or altered thought process aeb need for excessive reassurance, expressions of self negating thoughts, expressions of self blame for spousal abuse- self esteem

3. powerlessness r/t fear of death aeb apathy, inability to recognize effects of violence on herself and her children and feelings of inability to change the situation. – safety and security or self actualization?

i will be working on this and some other subjects today. i will post when i have gotten it a little further - i cant thank you enough for all your help. it is so wonderful that you are willing to do so much work to help someone with so little experience!! thank you!!

angels mommy

found a couple more good resources on battered women:

http://findarticles.com/p/articles/mi_qa3689/is_200108/ai_n8960935/?tag=content;col1

http://findarticles.com/p/articles/mi_qa3836/is_199807/ai_n8796392/?tag=rbxcra.2.a.11

[anangelsmommy, ADN, BSN, RN]

Shay,

I read your reply and after reading a ton of articles (if you google these diagnosis, then the articles pop up like crazy!) there was something that resonated with me, one article studied women that had left the abuser to find out why they finally left and one thing stood out, they left when someone they loved - mostly kids or yes you are reading right - the family dog, was threatened. they valued the dog more than themselves. So I asked my client who has left her husband but for the sake of this she has not, what finally made her leave? she said she saw her son starting to treat his sister the same way her husband treated her, so she said when it started to affect the kids, she was ready to leave. Now mind you he gave her a concussion, but she said that she probably would have gone back to him but the state police (he is a police officer) had to do an investigation so he wasnt allowed back and then she started to see the affects on her son.

So I agree - it IS deficient knowledge!! if she could know how it affects her children and herself - the available resources, her legal rights etc then maybe she will (would have) left him. So I am changing powerlessness to deficient knowledge!

thanks for all your input. I picked a hard one but that is how we learn, right!

JP

[Daytonite, BSN, RN]

that is the nature of nursing diagnoses. they are very broad and depending on how you tweak them one can be just as good to use as another as long as you keep within the parameter of the nursing problem that each describes. nursing diagnoses are not as specific as medical diagnoses and there is a lot of elbow room in each nursing diagnosis. that's how i get out of using the psychosocial ones all the time! teaching interventions can be put into any diagnosis because essentially there are 4 types of nursing interventions and several of my care plan books do address at least one of each type in a care plan:

• assess/monitor/evaluate/observe (to evaluate the patient's condition)
  
• care/perform/provide/assist (performing actual patient care)
  
• teach/educate/instruct/supervise (educating patient or caregiver)
  
• manage/refer/contact/notify (managing the care on behalf of the patient or caregiver)
  

[anangelsmommy, ADN, BSN, RN]

oh yes, they can be tweaked which is making this harder instead of easier....my perfectionism is showing thru! I could leave it powerlessness and then use the education to help her to feel empowered....? hhhhmmmm, well boards are next friday, I have two other classes and have to clep out another class on tues so I can officially be accepted into the rn class - of course I am already taking the classes! They will do anything for money. HEEE HAAA HAAA HOOO HOOO - yes the stress is starting to affect me!!

JP