Barriers to Screening Despite the importance of screening for IPV, not all providers do so. A systematic review found that in some acute care settings, less than half of providers routinely screened their patients for IPV and/or SA (Miller et al., 2021) . Another study reported that IPV screening rates in the primary care setting were less than 10% and significantly lower than screenings for other concerns such as depression and anxiety (Perone et al., 2021) . The low rates of routine screening for IPV are most likely due to the numerous barriers healthcare facilities and providers face when implementing such screening and response programs (Burton & Carlyle, 2020) . From an intake or assessment perspective there are two essential reasons that IPV and/ or SA may not be identified: (1) The provider does not ask and/or (2) the individual does not tell. The most common reasons why providers do not screen for IPV include personal discomfort with the issue, lack of knowledge about how to screen and what to do when screening results are positive, and time constraints(Burton & Carlyle, 2020) . It is Documentation Written documentation should be completed after identifying actual or suspected IPV, conveying all relevant information in a brief yet descriptive manner, and using the survivor’s own words where possible. Written description by the provider should be concise and specific (Nash et al., 2021) . Although providers and organizations may use a variety of documentation formats, many have standardized the format to maintain consistency. Electronic medical records often provide checklist/charting by exception but will usually have a place for narrative documentation that should include subjective and objective findings, interventions, and response to interventions. The provider should also document the client’s written consent or declination of consent to notify law enforcement. Documentation of law enforcement notification should include date/time of notification, jurisdiction, who the provider spoke with, and any report number assigned. Most providers are familiar with the “ SOAP ” note format, which can be used in health records for a narrative notation: S = Subjective data: Notes record the client’s (and/or family member’s) description of the symptoms he or she is experiencing, situations that may have occurred since the last appointment, and so forth, using the client’s own words whenever possible. If this description is provided by an interpreter, that fact should be noted along with the interpreter’s name. These notes do not include the provider’s assessment of the client. O = Objective data: This information includes observations that are measurable, such as the client’s affect and behavior (e.g., weepy, pacing), data from a symptom rating scale, or the presence of a physical injury. A = Assessment: The assessment is an analysis and interpretation of the client’s current issues based on both subjective and objective data. The assessment may include a diagnosis or a statement about therapeutic progress. Role of Forensic or Sexual Assault Nurse Examiner In some organizations, specially trained nurses may serve as the first point of care for victims of IPV and/or SA once abuse is identified after the patient enters the healthcare system. These nurses may be broadly referred to as forensic nurse examiners or sexual assault nurse examiners for those with specific certification. Other titles include advanced forensic nurse or nurse investigator, depending on the training and capability of the individual provider. In the following discussion, the term forensic nurse is used.
important for providers to recognize these potential barriers and take steps to address them in their own practice. In addition, numerous factors may influence the likelihood of a person disclosing IPV to a provider. These can be related to the person’s personal characteristics and feelings, experiences with the system, self-efficacy, exposure/ opportunities to disclose, and relationship with the provider. Common reasons that victims do not disclose abuse include feeling ashamed, fearing the partner, protecting the partner, fearing loss of the children, not perceiving IPV as a problem, not believing it was relevant to discuss with the provider, and not being ready to discuss it (Spangaro et al., 2021; Ullman et al., 2020) . These concerns should be respected, but it is important for the provider to have knowledge of potential indicators of abuse as well as perpetrator and victim dynamics in order to elicit pertinent information during the clinical encounter. P = Plan: The plan portion of the notes describes how the provider intends to address the client’s issues. It should note therapeutic interventions performed as specified in the treatment plan. It may also reflect any follow-up needed or performed. Regardless of the format used, documentation should contain the following information: ● A description of the history of abuse ● Details of the present injury or illness ● Medical history ● Sexual history, including documentation of any SA ● History of sexually transmitted infections ● Medication history ● Any relevant social history The following specifics of the abusive incident are also important: ● Who inflicted the abuse ● The abuser’s conduct and condition ● The health effect on the victim ● Whether weapons (particularly firearms) are available to the perpetrator Documentation of violence should always be as specific as possible. Documentation that is vague does not reflect what the client said. For instance, a chart with the chief complaint of “assault” is vague and is not helpful for later investigation of the abuse. A better way to document this might be “My boyfriend hit me.” The best documentation, however, reflects specific details that establish the abuser’s identity and relationship to the patient as well as details of the abuse, for example, “My boyfriend, John Smith, hit me in the face with his fist in the grocery store parking lot next to his apartment at 20 Constitution Way, near downtown” (Nash et al., 2021) . One of the major benefits of having a forensic nurse available to provide direct support and/or provide care and treatment to individuals who have experienced IPV and/ or SA is that he or she is specifically trained in the many aspects of this care and follow up required both long and short term. A forensic nurse can evaluate and examine a patient experiencing IPV or SA as any other nurse would, but he or she also knows how to preserve evidence that may assist law enforcement or other processes. The International Association of Forensic Nurses (2022) defines
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Book Code: SWFL1825
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