What information can the nurse give Jennifer about the effects that violence in the home can have on children? 4. The nurse screens Jennifer for IPV using the HITS tool and learns that Jennifer’s partner: ● Physically hurts her never (score: 1) ● Insults or talks down to her frequently (score: 5) ● Threatens to harm her fairly often (score: 4) ● Screams or curses at her frequently (score: 5) How should the nurse explain these results to Jennifer? Responses Jennifer recognizes that she experienced physical and sexual IPV at the hands of her ex-husband; however, she does not think her current boyfriend’s actions constitute abuse. The CDC describe four types of abuse that can be perpetrated by a current or former intimate partner (including boyfriends/girlfriends) in situations of IPV: physical violence, sexual violence, stalking, and psychological aggression (Leemis et al., 2022). The actions of Jennifer’s boyfriend meet the definitions of stalking and psychological aggression. Stalking is a pattern of repeated, unwanted attention and contact that causes fear or concern for one’s safety or the safety of someone else (e.g., a family member or friend). Psychological aggression is the use of verbal and nonverbal communication with the intent to harm another person mentally or emotionally and/or to exert control over another person. It is important to note that psychological aggression is often one of the earliest forms of violence in a family and can lead to other forms of abuse (e.g., physical violence). Jennifer’s chronic physical health symptoms may be related to her experiences of violence with both her current boyfriend and her ex-husband. IPV victimization is associated with numerous adverse health outcomes (Mahoney et al., 2020; Stubbs & Szoeke, 2021; Walker et al., 2022). These outcomes include not only acute injury as a result of the violence but also long-term consequences such as chronic gynecological, central nervous system, and stress-related health problems. In addition, victims often experience severe mental health outcomes such as depression, posttraumatic stress disorder, substance abuse, and suicidality (Kafka et al., 2021; Spencer et al., 2019), thus, it is important to assess Jennifer’s mental health as well. Jennifer’s frequent use of healthcare may also be related to her experiences of violence. Children who are exposed to IPV can also experience negative consequences. Jennifer’s son may be having problems with school performance and fighting because of the situation currently going on at home or the violence he may have been exposed to in Jennifer’s past relationship. Children who are exposed to violence have higher rates of anxiety, depression, poor school performance, physical health problems, posttraumatic stress disorder, substance abuse, poor conflict resolution skills, and subsequent violence perpetration and revictimization than children who are not exposed to violence (Bounds et al., 2022; Forke et al., 2019). The HITS screening tool is used to identify IPV among patients in the healthcare setting. It consists of four questions – about Hurting, Insulting, Threatening, and Screaming – that help determine whether a client is being physically and/or verbally abused (Bounds et al., 2022). Jennifer has a score of 15 on the HITS screening tool. A HITS score of 10 or higher is considered positive for IPV.
5. What is the nurse’s legal obligation in this case? 6. Jennifer tells the nurse she does not want to leave her boyfriend because she loves him and that he is good to her son. She also reveals that she does not make enough money to afford a place of her own. If she were to leave, she and her son would have no place to live. What resources can the nurse provide Jennifer to help her with this decision? When the results are explained to Jennifer, she should be shown that physical violence is not needed for a positive score and that the other factors alone can add up to a high score. Use of therapeutic messages is also important when explaining the results to reassure Jennifer and validate her experiences. This may include statements such as “No one deserves to be yelled at or have her privacy invaded” and “I want to help you in any way I can.” Some state laws require certain professionals to report to law enforcement and/or social services cases in which there is reasonable cause to suspect adult abuse or neglect inflicted by a spouse or other intimate partner. Jennifer’s experiences with her boyfriend may constitute abuse; as such, mandatory reporting may be warranted depending on in which state they are located. In addition, some states have statutes that require reporting when a child witnesses IPV in the home. It is critical that the nurse be familiar with their state’s mandatory reporting statutes to ensure compliance. Regardless of Jennifer’s decision to stay or leave her boyfriend, it is important to support her decision and make sure she knows what resources are available to her. Resources are available at the national, state, and local levels. For example, The National Domestic Violence Hotline (1-800-799-SAFE) has trained advocates available to help callers with issues related to domestic violence 24 hours a day, 365 days a year. In addition, all states have a domestic violence coalition that can provide information about local resources as well as information about state laws, policies, and training programs available to providers who care for victims of IPV. Finally, local resources may include domestic violence service agencies, programs, and shelters. These resources can provide Jennifer and her son with safe, secure emergency housing and additional support, such as help navigating the legal system, access to counseling and support services, and case management services. They can also provide information about local intervention programs and treatment options for perpetrators. Providing Jennifer with information about these services will help her make decisions about her current relationship. If Jennifer is interested in knowing more about these resources, the nurse can help her by calling the National Domestic Violence Hotline or another domestic violence hotline available in their state or local area. These hotlines will provide Jennifer with referrals to local agencies as well as advice on how to handle her immediate situation. Even if Jennifer is not ready to call the hotline or seek services from these resources, the nurse can be a point of safety and help create a safety plan in case Jennifer is in danger in the future and needs to leave her living situation.
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Book Code: SWFL1825
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