Starting with a new group at work need advice...

[PinkRocksLikeMe]

I signed up for starting a policy to help abused adults/peds/geri patients. I have to help think of ways to reconize someone that may need more resources to help them, or further help that is urgent for them right then. Right now the only thing we ask on intake/triage is how they feel at home ie:safe/unsafe. But I know it goes deeper than that. Can you guys give me some pointers as to how to pull up those that need help. Such as warning signs or such. Would it be appropriate to go into patients room and spend a few minutes talking to them about their family situation, there caregivers, etc. To see if you could get a feel of what was needed if anything. Of course I would ask the family to step out in hopes if their were problems they would feel more comfortable telling me if it was just one on one. I have never done this before but it is a passion of mine I would like to pursue through this program (personal reasons) just wondering if you can give me any thoughts to present to my boss or suggestions on what you all do.

I appreciate you all so much! Thanks for taking the time to read this!!

PINK

[littlewingrn]

Great job Pink! I don't really have any advice for you other than to possibly take a course or something on how to recognize an abusive relationship, whether mental or physical. Sometimes people exhibit signs that might need further investigating without saying a word at all.

I think it is great that you are expanding on the regulatory "do you feel safe" line. We are required to ask this of every patient and I really don't think this is effective at recognizing abuse. Good luck!

[Peetz, BSN]

I just typed a huge post and lost it when I tried to add a smiley. Here is the abridged version:

Do you have what you deem " abuse" outlined so you know what to look for?

Things to consider are, age, gender, culture, social status and economic status.

Things to look for are withdrawn body language, lack of eye contact, being submissive, and not wanting to talk with certain people in the room.[ always preform your abuse assessment in private, emphasizing provider/patient confidentiality to create a safe environment.

I applaud your efforts to better recognize patient abuse . Good for you!

[amarilla, RN]

First off, kudos for the work you are doing. Abuse screenings are woefully inadequate, IME. Have you contacted any victim advocate services in your area? How about RAINN? The DV Hotline? You can get some great insight and assistance developing screening tools / procedures from most organized groups, (who usually have people you can invite out and work with if you can link up with a local chapter.)

Some things I've learned: yes, conduct your assessment in private. Avoid trigger words like 'abuse', 'abuser', 'victim', etc. Most aren't willing or able to see it for what it is, let alone call it by such a name. Safety is important, but so is confidentiality. Aim to develop trust but never lie: if the situation requires mandatory reporting, you cannot promise what's said will stay between you.

On offering help: you won't always be able to help someone now, but you do want to plant the seed and give them important information on how to find help when they want to accept it...without judgement. Victims usually won't accept pamphlets or cards and you may not want to give them out unless they are alone; should their abuser find that material, the victim may be put in danger. There are so many other factors tied into these things: lack of resources (or abuser hoards the resources / financially deprives victim), children (who some may fear will be taken away if abuse is admitted against the spouse; also may be afraid of how they will manage in a shelter or supporting children alone), pets (who may be at risk if victim accuses / leaves abuser), and vulnerable family members (an older teenager may not want to leave siblings behind) and so much more. Starting with safety and moving along...

more things to look for: stories that don't match. Frequent admissions. Vague complaints, (particularly those appearing stress-induced - panic attacks, mystery pains, dry heaving, etc.) Injuries that are diffuse over the body rather than just the face. Broken nails, eyeglasses or the like, especially when the person appears otherwise put together. Have a healthy interest in any english-speaking, oriented patient of age whose spouse / significant other does all the talking or dominates the conversation. Notice if the patient looks at the person in question, particularly when the 'story' is being told. Usually once asked to step out, (or made to), this situation escalates and the control becomes very obvious. Something is at work in that dynamic! With children, I obviously am not surprised when the parent does the talking but I am concerned with a child (8+, say), who won't talk to me at all, shifts their gaze from mine, cries easily or appears very flat/distant. Ditto for a child acting inappropriately, especially with regard to the accompanying family member.

Elders: do they appear well-nourished? Check out their lips, gums, teeth, tongue - have they been brushed? Washed? Had enough water to drink? Bruises, fingermarks, skin tears? How long since they were out of (bed, house, etc)? Are they able to or allowed to speak for themselves? Can they tell you about their daily schedule and how (whoever) takes care of them? Ask about their home and living conditions, changing your questions to address their orientation and capability. Listen specifically to any mention of doing things 'when (I) can', that may mean they need assistance for something or are being denied same. Make sure nursing does a thorough physical assessment and documents skin condition at time of admission - usually there are things you can't see through clothing and you want that documented!

There is so much more, as you'll see, but I wish you luck!