Ask questions in a private place
August 1, 2000 3 minutes read
Ask questions in a private place
Triage is not the best place to screen patients about domestic violence, according to Alice Kramer, MS, RN, CEN, clinical nurse specialist for emergency services at St. Luke’s Medical Center in Milwaukee.
"Don’t try to have a conversation about domestic violence across the triage desk with other patients waiting nearby. Instead, create a private opportunity in the ED," she advises.
The only way you should ask questions at triage is if you have a separate examination area or booth, says Kramer. "Most EDs are not big enough for that type of structure," she notes. "We don’t have a good private place, so we don’t ask questions there because people can overhear."
Asking patients about domestic violence in a public place is also risky, Kramer stresses. "You have no idea who they are coming in with, so putting them in a position to reveal this kind of information is very unsafe," she says.
Keep record from being seen
Here are some ways to ensure privacy while screening for domestic violence:
• Keep patient records private.
Some nurses might be reluctant to document statements such as "women state they are being battered" for fear of their batterer seeing the chart, Kramer explains. Protect patient confidentiality by making sure charts are not visible to others, she suggests.
"It may not occur to you, but there is risk in laying the chart down on a counter," Kramer explains.
Put charts in racks in separate areas or keep them upright, she suggests. "If you have automated charting, you need to turn the computer screens down," Kramer advises.
• Bring patients back alone.
Create a system where family members routinely wait in the triage area, while patients are given a private health screening, Kramer suggests.
"If you do that for all patients, you can also ask about alcohol and drug-related issues and sexual activity, she says. "All those things require privacy. If you change your system so that your family members know and understand the policy, it will be easier."
Previously, family members came immediately back with patients, but that system was changed so that patients could be screened in private, says Kramer.
"The policy change is posted in the ED. It states that patients will be accompanied back for a confidential history taking and exam, and then the family will come back," she explains. "This creates about 15 minutes of confidentiality."
Because the policy exists for all patients, it doesn’t put the batterer on the defensive, says Kramer. "If the perpetrator believes you are only doing it for them, they get upset. This way, we can explain that the policy is not unique to your wife or girlfriend. It’s for all patients.’"
Posters in the bathroom
• Take moments of opportunity.
You might need to be creative to obtain private moments with the patient, says Kramer. "When we take the patient for a urine specimen, we accompany her to the bathroom, where we have posters about domestic violence resources and tear strips with hot line numbers," she explains. "If that’s the only moment of privacy we have, we can offer information there."
It’s sometimes necessary to fabricate procedures to bring the woman out of the ED and into another department, Kramer says. "We can say to an abusive partner, We need to get an X-ray, and you wouldn’t want to be radiated yourself, so wait here,’" she says.
• Don’t slip information into a woman’s purse.
If an abusive partner refuses to allow privacy, don’t slip information into the patient’s purse, says Kramer.
"It may be tempting, but someone that controlling will look in there," she explains. "For that reason, it’s just not safe. You always want the woman’s permission to receive information."
Sources
For more information about women and heart attacks, contact:
• Mary M. Hand, MSPH, RN, National Heart Attack Alert Program, National Heart, Lung, and Blood Institute, 31 Center Drive, MSC 2480, Room 4A16, Bethesda, MD 20892-2480. Telephone: (301) 594-2726. Fax: (301) 402-1051. E-mail: [email protected].
For more information about symptoms of myocardial infarction in women, contact:
• Barbara Riegel, DNSc, RN, CS, FAAN, School of Nursing, San Diego State University, San Diego, CA 92182-4158. Telephone: (619) 594-6173. Fax: (858) 499-4665. E-mail: briegel@ mail.sdsu.edu.
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