Health Education

Scenario:

Patient Em came in the ER Department at midnight. Upon

notice, you assessed areas of bruises in the arms, legs,
back and neck with different stages of healing. Patient Em
was extremely suffering from dehydration and weight loss.
Nurse Eve suspects for some abuse, what is the priority and
appropriate nursing interventions?

Scene 1: ang patient is naglalakad ng hirapan, dahan dahan

at pumunta sa emergency room. Nurse Rose will perform
assessment to the patient.

Nurse Rose: Ma’am ano pong nangyari sa inyo, may kasama po

ba kayo?

Pateint: meron po nurse, asawa ko po(mukhang takot)

Nurse: ok lang po ba na sa private room ko kayo iassess?

Patient: tumango lang pero natatakot)

Kung may kasama si patient at suspected na abuser agad na

ihiwalay si patient dito,the exam should take place without
that person in the room. humanap ng ibang room para doon
mas makausap si patient. Maaring sabihin sa kasama na

Nurse:“ma’am/sir pwede ko po bang makausap si ma’am em/

pwede ko po bang ilipat si ma’am sa mas pribadong room?”

Abuser: sige po saglit lang nagmamadali kami, gamutin nyo

lang nmag kailngang gamutin

Mahalaga na sa pagdating ng pasyente na suspect for abuse

is mag provide tayo ng safe environment sa client at
therapeutic communication iwasang magtanong ng bakit? Dapat
mga open ended question kung saan mas mapapalalim pa natin
ang conversation kay patient.

Like for example:

Nurse: ma’am saan po kayo may masakit pa?
May gusto po ba kayong pag-usapan?
Huwag po kayong mag alala everything na sasabihin mo
po will be safe and confidential.

Patient: may cp po ba kayo, kailngan ko lang po tumawag sa

kamag anak ko?

Nurse: meron po ma’am

: maayos lang po ba ang pagsasama nyo mag asawa ma’am
: huwag po kayong matatakot ma’am humingi ng tulong
kapag ready na po kayo

Patient: salamat nurse

Nurses should provide a calm, comforting environment and

approach the patient with care and concern. Mahalagang
iparamdam ni nurse kay patient na ang ospital ay isang safe
environment kay patient na maaari syang mag open sa ano
mang pinagdadaanan nya kaya isang mahalagang factor na si
nurse iparamdam na lagi syang nandyan for the patient 24/7
remember nurse is the most selfless person na dapat we
offer our self to the patient in order for the client na
mag open up sa atin at maibigay ang essentially at
immediate needs ni patient not just physically but also
mentally, emotionally, socially and sprituality remember
that we need to assess and intervene the patient
hollisticaly in order to heal as whole and return its
integrality.

Assessment

If a nurse suspects abuse or neglect, they should first

report it to the attending doctors or supervisor

Kapag si patient is nasa private room na, nurse must check

its vital signs,(blood pressure, pulse rate, respiratory
rate, temperature) and head -toe physical examination. The
chief complain/subjective data and objective data of
patient is kailangan isulat sa nurses notes or patient
chart for diagnosis and patient medical chart is also a
legal documents and can be produced in court as as
evidence. Nurses therefore, need to provide an accurate and
complete documentation of the nursing care provided to
clients.

Nurse: ma’am kunin ko lang po vital sign nyo at check ko

narin pomga bruises nyo po

(si nurse magcheck ng BP,T,PR maghead to toes examination

sya like check ng arm, in abdominal region,dorsal part of
the patient hanggang sa legs)

Nurse: ma’am naaksidente po ba kayo?

: may nananakit po ba sa inyo
Patient : di magsasalita pero tutungo lang sya

A complete head-to-toe examination should take place,

looking for physical signs of abuse. A chaperone or witness
should be present if possible as well. Thorough
documentation and description of exam findings, as well as
patient statements, non-verbal behavior, and
behavior/statements of the suspected abuser should also be
included.

as the final diagnosis shows a physical abuse, don’t ever

do anything to patient that will compromise the evidence.
Remember that the role of the nurse in legal approach is to
preserve the evidence and present it to the authorities.

Report your nursing diagnosis to the attending doctors and

supervisor in order for them to give permission if nurses
will give IV drop due to dehydration, oxygen if needed and
proper nutrition due to weight loss and also alternative
treatment and examination without compromising the evidence
before law enforcement occur.

Nurses, in their many roles (e.g., home health nurse,

pediatric nurse, emergency department nurse), can often
identify and assess cases of violence against others. As a
result, they are often included as mandated reporters.
Brent (2001) states that "when an identified instance of
injury appears to be present and the result of
abuse,neglect or exploitation, the mandated reporter must
report the situation to the proper authorities"

The nurse should notify law enforcement as soon as

possible, while the victim is still in the care area.
However, this depends on the victim and type of abuse.
Adults who are alert and oriented and capable of their
decision-making can choose not to report on their own and
opt to leave. Depending on the state, nurses may be
required to report suspicious injuries to law enforcement
whether or not the patient consents or wishes to press
charges.

Nurse : ma’am gusto yo po ba ireport ang kaso nyo

: lumabas po na positibo po kayo na pisikal na
naabuso

Patient: natatakot ako nurse nasa labas lang ang asawa ko

baka malaman nya(umiiyak nagpanic sya)

Nurse : ma’am tiwala ka po kami po ang bahala we will call

the athourities, mga pulis at social organization and
request to dress as civilian para di mahalata ng mister nyo
sa labas
: makakatulong po ito para sa seguridad at proteksyon
nyo po

Patient: sige nurse salamat po

Kapag si patient ay tumanggi na tumawag ng authorities o

hindi kaya ay ayaw na kasuhan ng tao sa likod ng abuso nya
nurses can give an option to the patient na ireserve ang
evidences para if the patient that is physically abuse
dumating ang panahon na gusto na nya gamitin para sa legal
purposes ang evidences also medico legal, ospital could
preserve and present it

Depending on the type of abuse, the nurse is required to

call Adult Protective Services or Child Protective Services
like DSWD and follow it up with a written report.
Contacting additional resources, such as social services,
may also be a requirement (depending on the organization).
Before giving the the patient medical chart to the
authority always ask for client permission/consent because
it is a client property and confidentiality.

Nurse rose: ma’am is it ok na ibigay ang inyong medical

chart also evidences sa authority for legal purposes only
kapag gusto nyo po na matulungan po kayo sa kalagayan nyo?

Patient: ok lamg nurse kapag kailangan sana wala ng mas

marami pang maka-alam ayaw ko rin kase mapag usapan sa
labas.

Nurse: also ma’am mamaya po may dadating from counseling

department na tutulong po sa inyo na mas mabilis na
makarecover at makabangon muli

While not required by law, nurses should also offer to

connect victims of abuse to counseling services. Many
times, victims fall into a cycle of abuse which is
difficult to escape. Offering mental help to cope with
abuse can help break the cycle.

Nurses should be familiar with their state's mandated

reporter laws. Employers are typically clear with outlining
requirements for their workers, but nurses have a
responsibility to know what to do in case they care for a
victim of abuse.

The right of patients to make decisions about their medical

care without their health care provider trying to influence
the decision. Patient autonomy does allow for health care
providers to educate the patient but does not allow the
health care provider to make the decision for the patient.

Respecting patients confidentiality and privacy are

considered as the patients’ rights. Confidentiality is the
key virtue for trust building in nurse-patient
relationship. While law considers confidentiality as
absolute except for legal situations, despite efforts to
maintaining confidentiality, sometimes breaching
confidentiality is unavoidable but not necessarily
unethical.
Creating a trusting environment by respecting patient
privacy encourages the patient to seek care and to be as
honest as possible during the course of a health care
visit. It may also increase the patient's willingness to
seek care.