Analyzing Cues
Linking the cues, Maryam recognized Liza may be experiencing intimate partner violence. Which of the following signs and symptoms indicates Liza may be experiencing intimate partner violence? (Select all that apply)
a. BP:150/90 mmHg
b. Chronic anemia
c. Previous hospitalization for sprains
d. Symptoms of anxiety
e. HR: 80 bpm
f. Cancer
g. Pain
a. BP:150/90 mmHg
c. Previous hospitalization for sprains
d. Symptoms of anxiety
g. Pain
Which hypothesis should the nurse Maryam identify as the priority and why? (open-ended)
Signs of physical and emotional abuse (IPV)
Liza’s and her baby's life could be in immediate danger.
As her nurse, what would be the desired outcomes for Liza’s situation? (open-ended)
The patient will identify that the violence exists
The patient will understand that removing herself from the situation is a process that occurs over time
The patient will demonstrate willingness to accept help and assistance by following through with plans and referrals
The patient will demonstrate understanding and awareness in available support and have the knowledge to use them appropriately
The patient will demonstrate trust to the HCP and will gain confidence in disclosing relevant information
Now that nurse was able to separate Liza and her husband, in terms of taking action, what should Maryam do?
a. Continue the prenatal assessment
b. Directly ask if she is experiencing abuse
c. Skirt around the topic of abuse but do not directly mention it
d. Wait until the husband returns then ask about the abuse
b. Directly ask if she is experiencing abuse
To effectively evaluate outcomes the nurse must be able to: (Select all that apply)
a. Examine the results of care according to collected patient cues.
b. Compare achieved outcomes with goals and expected outcomes.
c. Focus only on the subjective outcome /cues.
d. Understand the patients condition reflect on the situation and adjust the plan to correct errors.
e. Identify the expected outcomes and possible interventions.
a. Examine the results of care according to collected patient cues.
b. Compare achieved outcomes with goals and expected outcomes.
d. Understand the patients condition reflect on the situation and adjust the plan to correct errors.
Linking the cues, Maryam recognized Liza may be experiencing intimate partner violence. Which of the following is true about intimate partner violence? (Select all that apply)
a. It is violence perpetrated by a spouse or a partner
b. Examples of IPV include physical abuse, psychological abuse, sexual assault and isolation
c. Violence occurs in a small percentage of the population
d. Being pregnant protect the patient from abuse
e. It is violence that occurs in repeated cycles
f. It is the most common form of violence experienced by women worldwide
a. It is violence perpetrated by a spouse or a partner
b. Examples of IPV include physical abuse, psychological abuse, sexual assault and isolation
e. It is violence that occurs in repeated cycles
f. It is the most common form of violence experienced by women worldwide
After 15 minutes, Maryam reassessed Liza’s blood pressure and got 150/90 again. What are the risks of ignoring hypertension in pregnancy? (Select all that apply)
a. Placental abruption
b. Pre-eclampsia
c. Acute renal failure
d. Pulmonary edema
e. Preterm birth
a. Placental abruption
b. Pre-eclampsia
c. Acute renal failure
d. Pulmonary edema
e. Preterm birth
Determine what ethical considerations should you as her nurse address and why? (Open-ended)
- Challenges the Therapeutic Relationship
- Power dynamic challenges
Name three resources or interprofessional team members that Maryam could provide/collaborate with to provide support to Liza. (Give 3)
Interprofessional team members:
- Social Workers
- Mental health counsellors
- Therapists
Resources:
- Community organizations
- Crisis hotlines
- Shelters
- Support groups
- Financial/Legal aid
In Liza’s case, what findings will show that the interventions are working? (open-ended)
The client life is no longer in immediate danger
The client is able to speak up for herself.
The client shows up for the next appointment and is able to communicate concerns with the nurse.
Clients blood pressure is being managed.
Shows up to the appointment by herself.
No new bruises - previous bruises healing
List three cues Maryam recognized as risk factors for intimate partner violence. (Give 3)
Gender: “women are in greater danger of experiencing violence from intimate partners in their own homes” (Jarvis, 125).
Isolated: Refugee from Ukraine, language barrier
Power imbalance, economically dependent on others: Currently unemployed and dependent on her husband for financial needs
Age: Young women aged 15 to 24 are most vulnerable to IPV
Husband: Controlling behaviour and asserting dominance
What are some risks if Maryam ignores the signs of intimate partner violence Liza may be experiencing? (open-ended)
Complications with the pregnancy.
Health risks for the mother and child.
Chances for miscarriage.
Chronic Mental health issues.
Fetal injury, preterm delivery
Increased risks for depression, anxiety and suicide attempts.
For nurses to work towards a safe therapeutic environment, it is imperative that they educate themselves, address their own biases, and identify barriers that affect their clients. In light of this, determine three barriers individuals face when seeking medical care for intimate partner violence. (Give 3)
Fear for own safety, or safety of children or other family
Denial or disbelief
Emotional attachment to, or love for partner
Commitment to relationship
Hope the behavior would change
Shame and embarrassment
Depression and stress
Isolation
Lack of faith in other people’s ability to help
Lack of faith to the health care team
Values of self reliance and independence
Access to resources
Discrimination
What are three community health nursing standards that are relevant to this scenario? (Give 3)
- Health Promotion
- Prevention and health protection
- Professional relationships
- Health maintenance, restoration and palliation
- Professional responsibility and accountability
- Health equity
Which statements or actions by Liza would show that the interventions are not working? (Select all that apply)
a. Liza states “ I am scared of him beating me again if I share anything with you”
b. Liza blames herself for her husband's actions and reports she will remain with him.
c. The client states that she is feeling much better after talking to the nurse.
d. The client is not willing to open up to the nurse.
e. Liza's blood pressure lowered to 110/70
a. Liza states “ I am scared of him beating me again if I share anything with you”
b. Liza blames herself for her husband's actions and reports she will remain with him.
d. The client is not willing to open up to the nurse.
List three determinants of health relevant to Liza’s situation and explain how they affect this scenario. (Give 3)
Gender: Violence against women is rooted in structural determinants of health including persistent economic and sociopolitical inequities
Income and social status: Income insecurity is a major barrier to leaving abusive relationships
Employment: Her refugee status or her husband's controlling behaviour may be impeding her from finding or keeping work
Social support networks: Due to her refugee status, she may be experiencing social exclusion which means she has no one to rely on
Refugee status: Cultural insensitivity creates a barrier to accessing help
Access to health services: Fear of their abuser or concerns about stigma and confidentiality may prevent Liza from seeking help
List three hypotheses relevant to Liza’s scenario. (Give 3)
Signs of intimate partner violence (IPV)
High blood pressure
Social isolation
Dependency on the spouse on all her needs
Liza had just confided with you that her partner slapped her and hurt her this morning. What is your best response?
a. “Oh my goodness, I cannot believe that happened to you. You poor thing, I feel terrible for you.”
b. “It’s very brave of you to tell me all this. Help is available if you choose it.”
c. Tell Liza that it was just probably her husband’s response to something to something she did unknowingly
d. In front of Liza, tell the husband not to abuse her again.
b. “It’s very brave of you to tell me all this. Help is available if you choose it.”
What are some interventions that Maryam could implement to create a safe environment for Liza? (Select all that apply)
a. Listen in a nonjudgemental and accepting manner
b. Inquire about abuse using trauma and violence-informed approach about needs and concerns.
c. Contact the police as it is the nurses mandatory obligation to report
d. Enhance safety by creating a safety plan
e. Provide support by connecting them to different resources
f. Validate their worth
a. Listen in a nonjudgemental and accepting manner
b. Inquire about abuse using trauma and violence-informed approach about needs and concerns.
d. Enhance safety by creating a safety plan
e. Provide support by connecting them to different resources
f. Validate their worth
After taking action, Liza discloses she is experiencing IPV, what assessment or additional information does Maryam needs to collect to assess the situation and provide appropriate care? (Select all that apply)
a. Assess for immediate danger.
b. Complete physical examination
c. Help the patient formulate a safety plan
d. Collect more specific details about the abuse including the type of abuse, frequency, and severity, and any physical or emotional symptoms.
a. Assess for immediate danger. If the patient is in immediate danger, the nurse should assist the patient in leaving the situation and accessing appropriate resources.
b. Complete physical examination is needed to assess for injuries
c. Help the patient formulate a safety plan
d. Collect more specific details about the abuse including the type of abuse, frequency, and severity, and any physical or emotional symptoms.