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Fundamentals · chapter 9 · Safety and Security

Safety: Violence

The 14 things this section of the textbook says that you are most likely to be asked about — quoted word for word, not retold. Then 6 practice questions with the reasoning.

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Key points

  1. Workplace violence sources

    Violence may come from patients or family members as well as from colleagues or other workers in the healthcare system. It can take various forms, ranging from verbal abuse to physical assault, and can have long-lasting effects on the individual’s well-being.

  2. Violence prevention training

    This can include implementing comprehensive violence prevention programs, providing training and education to healthcare workers, improving communications between staff and patients, and ensuring that appropriate support is available to those who have experienced violence. Nurses must participate in organizational training and be well informed about the steps to take when a potential threat is identified.

  3. Physical abuse assessment

    Nurses should assess patients to identify signs of physical abuse, such as unexplained injuries or bruising. The patient may keep bruised areas covered or have inconsistent stories or explanations regarding how injuries occurred.

  4. Private abuse conversation

    It is important to ensure the patient is alone when initiating any conversation about abuse to prevent angering the abuser. The victim of abuse may be too frightened to talk to anyone, so ensure there is a follow-up assessment in place.

  5. Suspected abuse reporting

    A nurse who suspects abuse should inform their supervisor and the attending provider and follow protocol to assess the patient and preserve any and all evidence for potential legal proceedings. The nurse must also be aware of reporting requirements in their state or organization, as there may be requirements to contact adult protective services.

  6. Psychological abuse response

    A nurse who suspects a patient is experiencing psychological abuse should follow similar steps to those for physical abuse. The patient should be given information that may assist them in leaving the abusive situation.

  7. Financial abuse indicators

    Some signs that financial abuse may be occurring include sudden changes in a person’s financial situation, such as unexplained bank withdrawals or transfers, missing funds or assets, or unpaid bills.

  8. Sexual abuse reporting

    If a nurse suspects sexual abuse, follow state and facility guidelines regarding reporting. Sexual abuse may require police reports, so it is essential to be aware of legally required steps nurses must take.

  9. Family violence cycle

    Family violence is cyclic, meaning that children exposed to violence in the home may themselves go on to demonstrate violence toward others. Early intervention can disrupt this cycle by focusing on healing the victims through therapeutic interventions.

  10. IPV nursing assessment

    The nurse is often the initial healthcare professional in contact with a victim of IPV. Prompt recognition of a potential or actual threat to patient and staff safety is crucial.

  11. Child abuse intervention

    In the event of a child facing abuse, it is crucial to intervene to safeguard their well-being and ensure their safety. This may involve reporting the abuse to Child Protective Services, providing the child with access to medical or mental health care, or working with law enforcement to hold the abuser accountable.

  12. Elder abuse reporting

    Most victims of elder abuse are seen in the emergency department several times before they are admitted to the hospital. Nurses must be alert to any indications of elder abuse, such as suspicious injuries or behaviors, and report suspected incidents to local adult protective services agencies.

  13. Social violence response

    If a nurse suspects that someone may be at risk of social violence, it is important to take action to protect them. This may involve contacting law enforcement or other authorities, encouraging the person to seek shelter or other forms of protection, or providing them with emotional support.

  14. Bullying identification

    It is important to identify bullying early. Signs that an individual may be experiencing bullying include unexplained injuries, changes in behavior or mood, reluctance to go to school or work, or difficulty sleeping or eating.

Terms to know

abuse
The term abuse refers to physical, emotional, verbal, or sexual acts toward another which can cause harm.
physical abuse
The act of physical abuse involves any use of force or violence to cause physical harm, serious injury, or even death, such as hitting, kicking, or choking.
psychological abuse
In psychological abuse, also referred to as verbal or emotional abuse, words or actions are used to manipulate or control a person’s feelings and behavior.
financial abuse
In financial abuse, a person’s financial resources are exploited or misused, often by a trusted individual, such as a family member or caregiver.
sexual abuse
Any unwanted sexual behavior such as touching, groping, or rape is considered sexual abuse and is a violation of a person’s bodily autonomy and consent.
family violence
A form of abuse that occurs within a family or intimate relationship is called family violence, also known as domestic violence.
intimate partner violence (IPV)
In intimate partner violence (IPV), there is physical or sexual violence, stalking, and psychological or coercive aggression by current or former intimate partners.
social violence
The intentional use of force or power to harm individuals or groups within a community is referred to as social violence, also known as community violence (National Institute of Justice, 2021b).

Practice questions

Stuck on select-all-that-apply? How to take them one option at a time.

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Every question here, with the answer

  1. A nurse is assessing a patient with bruises on areas usually covered by clothing. The patient gives inconsistent explanations, and the partner remains at the bedside. What is the nurse’s best next action?

    1. Tell the patient that reporting is optional and no follow-up is needed.
    2. Ensure the patient is alone, then ask whether they feel safe at home.
    3. Ask the partner directly whether they caused the injuries.
    4. Wait to discuss abuse until visible wounds are confirmed.

    Answer: Ensure the patient is alone, then ask whether they feel safe at home.

    The nurse should create a private setting before asking about abuse to avoid increasing danger for the patient. Inconsistent explanations and covered bruises are concerning, but the conversation should not be initiated in front of the possible abuser.

  2. An older adult reports sudden missing funds and unpaid bills. A caregiver insists on managing all financial matters and refuses to let the patient make decisions. What should the nurse do?

    1. Focus only on whether the patient has physical injuries.
    2. Seek support from trained professionals such as social workers or elder abuse advocates.
    3. Tell the patient to confront the caregiver alone after discharge.
    4. Assume the caregiver is helping and take no further action.

    Answer: Seek support from trained professionals such as social workers or elder abuse advocates.

    The findings suggest possible financial abuse, which may occur behind closed doors and involve a trusted person. The nurse should involve trained professionals to protect the patient and help them regain financial control.

  3. A school-age child has unexplained injuries, becomes fearful when asked about going home, and is reluctant to spend time with a certain caregiver. What is the nurse’s priority action?

    1. Report the suspected abuse to authorities immediately.
    2. Document the findings and reassess at the next routine visit only.
    3. Wait until the child gives a detailed verbal report of abuse.
    4. Ask the caregiver to explain the injuries in front of the child.

    Answer: Report the suspected abuse to authorities immediately.

    Children may be unable or reluctant to report abuse, and abusers may hide their actions. When child abuse is suspected, immediate reporting is required to protect the child’s safety.

  4. A nurse is caring for a patient who may have experienced sexual abuse. Which physical findings should increase the nurse’s concern? Select all that apply.

    1. Unpaid bills and missing funds
    2. Unexplained vaginal or anal bleeding
    3. Bruises around the breasts or genital area
    4. Genital infections
    5. Unexplained sexually transmitted disease

    Answer: Unexplained vaginal or anal bleeding, Bruises around the breasts or genital area, Genital infections, Unexplained sexually transmitted disease

    Bruising around the breasts or genital area, unexplained sexually transmitted disease, genital infections, and unexplained vaginal or anal bleeding are listed physical signs of sexual abuse. Unpaid bills and missing funds are more consistent with financial abuse.

  5. A patient experiencing intimate partner violence appears afraid but says they are not ready to leave the relationship. Which nursing responses are appropriate? Select all that apply.

    1. Use effective communication to help the patient share their experiences.
    2. Tell the patient they must leave immediately for care to continue.
    3. Assume intimate partner violence is unlikely because the patient is male.
    4. Approach the patient with compassion and understanding.
    5. Recognize that the patient may not initially consider leaving the abuser as an option.

    Answer: Use effective communication to help the patient share their experiences., Approach the patient with compassion and understanding., Recognize that the patient may not initially consider leaving the abuser as an option.

    The section emphasizes compassion, effective communication, and understanding that leaving may not initially feel like an option for the victim. Forcing the patient to leave or assuming IPV cannot affect male patients is inconsistent with the section.

  6. A nurse learns that a patient may be at risk for social violence after threats are made and dangerous objects are present. Which actions are appropriate? Select all that apply.

    1. Encourage the person to seek shelter or another form of protection.
    2. Focus only on preserving evidence for future legal proceedings.
    3. Wait until violence occurs because social violence is unpredictable.
    4. Contact law enforcement or other authorities.
    5. Provide the person with emotional support.

    Answer: Encourage the person to seek shelter or another form of protection., Contact law enforcement or other authorities., Provide the person with emotional support.

    When social violence may be imminent, the nurse should take action to protect the person, including contacting authorities, encouraging shelter or protection, and providing emotional support. Waiting for violence to occur does not protect safety, and evidence preservation is not the primary intervention described for social violence.

Where every quote comes from

Section 9.2 Safety: Violence of Fundamentals of Nursing by Christy Bowen, Lindsay Draper, Heather Moore, OpenStax, 2024. Read the whole section free at openstax.org.

The textbook is licensed under CC BY-NC-SA 4.0. This page quotes it word for word and adds the headings, the order and the practice questions; references to the book's figures and stray spaces left by its formatting are removed. The page is shared under the same licence. Nothing here is sold.