NR305 Week 5 Discussion, Assessing for Family Violence Week 5: Assessing for Family

NR305 Week 5 Discussion, Assessing for Family Violence Week 5: Assessing for Family Violence 1. What considerations should be made by the nurse, to provide a physically and emotionally safe environment for the interview and assessment of this client who has experienced domestic abuse? 2. In your response, include some special considerations that should be taken when interviewing a child. In the scenario provided, the client is a 10-year-old child. The growth and development stage for a client of this age needs to be taken into consideration. Weber and Kelley explain that in Piaget’s stages of cognitive development, this client is likely in the Concrete Operational stage which is from 7-11 years of age. Children in this stage are learning to reason in certain situations, consider thoughts and views of others, and begins to think logically about things in the environment (Weber & Kelley, 2018, p. 104). I would first take Elizabeth and her mother into a quiet room, free from other people being able to listen in to the discussion. I would ensure the place is a comfortable temperature, as some rooms that aren’t often used are sometimes kept at a much cooler temperature. I would then start talking in a quiet tone and be relaxed. I would begin by asking what brings them into the center and take note of Elizabeth’s reactions, taking note if she appears anxious or afraid with her mother present. I would make sure to speak directly to Elizabeth and assure her that she is in a safe location and that no one can hurt her here. I would reassure her that nurses and doctors can help if something is wrong. Using open-ended questions, I would allow extra time for both Elizabeth and her mother to answer each time. I would evaluate Elizabeth’s actions, and identify if there is a sense of fear. I would ask if it is OK to speak with her mom for a few minutes outside the room if I have another nurse come to sit with her while her mom is gone. I would alert my coworker of the concern, and ask for her to sit with Elizabeth while I speak with her mom. I would ask the mom what brings them in, and inform the mother that I would need to report any findings of abuse for the child's safety. I would then assess for any developmental or school concerns with Elizabeth. I would review for any unexplained injuries, history of depression or developmental concerns, bullying, or family history of drug and alcohol use. I would return to Elizabeth and ask if she would want to talk to me on her own, or with her mom. Some kids may feel more comfortable with a safe parent present. I need to consider that she may not speak freely if her mom is present, but if I try talking to her without her mom and she is scared, I may not get answers either. I would need to use my judgment- if she appears fearful with her mom present, I may want to talk more with her without her mom in hopes that she will talk and explain what happened. If she appeared comfortable with her mom present, I would then proceed with asking questions to Elizabeth, including if she is ok, if anyone in her home hurt her, and if she feels safe. I would avoid the use of yes and no questions, and instead, use open-ended or multiple choice questions. I may use an activity such as playing with her doll (assuming she brought one) and asking her to show me where she hurts with her doll. I may also ask her if she wants to draw a picture of what happened. Some children may feel more comfortable using drawing or using a toy to show what happened after an act of violence. I may also consider asking a social worker to come to talk with the mom or Elizabeth, or both depending on the answers provided. I would also alert the attending doctor of the events to complete a physical exam for old or healing injuries, current injuries, and further assess the situation. “Healthcare providers in all practice environments must maintain an open attitude of caution and awareness for suspicion for injuries and illness that may be because of maltreatment so that recognition is not missed” (Jordan & Steelman, 2015, p. 112). I feel this would be a challenging situation to be placed in, which is one reason I chose not to work in emergency care and pediatrics in my nursing career. I have been affected personally and socially with child abuse and have a difficult time not becoming angry with the situation. I would work very hard to maintain a calm demeanor to keep trust with Elizabeth, and would definitely alert the doctor of the concern and situation. When interviewing a child, it is essential to take into consideration the state of growth and development, any disabilities the child may have, and the social ability of the child. If the child has a speech delay or issue, it may be more difficult for the child to explain what happened and staff may need to use other methods such as a picture board, drawing, or playing and asking the child to show what happened and where they hurt. You never want to “coerce the child to answer questions by offering a reward” (Weber & Kelley, 2018, p. 171). Children may also be scared that if they say the wrong thing, their parents will not be happy and may be upset/angry with them. It is vital to assure the child that they are safe and that medical people are here to help them. I would make sure to avoid yes and no questions, and instead, use open-ended questions allowing plenty of time for the child to respond, and make sure not to interrupt or sway the conversation. Reference Jordan, K. S., & Steelman, S. H. (2015). Child maltreatment: interventions to improve recognition and reporting. Journal Of Forensic Nursing, 11(2), 107–113. Weber, J.R. & Kelley, J.H. (2018). Health assessment in nursing (6th ed.). Philadelphia, PA: Wolters Kluwer