The nurse in the Emergency Department is taking a history from a family accompanying a child with traumatic injuries that are suspicious for abuse. Which of the following actions is most appropriate for the nurse to take?
Avoid responding to hints that abuse has occurred.
Separate the family from the child during the interview.
Report the concern for potential abuse to the immediate supervisor.
Obtain information as covertly as possible.
The Correct Answer is B
Rationale:
A. Avoid responding to hints that abuse has occurred is not appropriate. The nurse should address and assess any signs or suspicions of abuse openly.
B. Separate the family from the child during the interview is appropriate as it allows the nurse to obtain information from the child without potential coercion or influence from the family members.
C. Report the concern for potential abuse to the immediate supervisor is important but should be done after gathering sufficient information. The immediate action should focus on separating and interviewing the child.
D. Obtain information as covertly as possible is not ideal. It is important to obtain accurate information while ensuring the safety and comfort of the child, rather than being covert.
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Correct Answer is C
Explanation
Rationale:
A. Asking the client if they are comfortable calling 9-1-1 is an appropriate action. It involves assessing the client's readiness and comfort level in seeking emergency help.
B. A nurse-client dialogue about specific steps the client can take to stay safe is important for empowering the client with knowledge and strategies for protection.
C. Insisting that the client act on the plan the next time their safety is threatened may be inappropriate as it can impose undue pressure on the client, who might feel trapped or fearful. The nurse should support the client's choices and provide options rather than insist on actions.
D. A nurse-client dialogue about the potential barriers to safety is crucial for understanding and addressing obstacles that might prevent the client from seeking help or staying safe.
Correct Answer is ["A","C","D"]
Explanation
Rationale:
A. Nurses and other healthcare workers may be the primary or only point of contact for trafficking victims, providing crucial opportunities for identification and support.
B. Nurses are obligated to report suspected abuse but are generally required to report abuse or neglect for minors rather than all ages; trafficking often involves minors, but this is not a universal rule.
C. Nurses work in many different settings, which increases their opportunities to encounter and assist trafficking victims.
D. Nurses are trained to view a patient holistically and can recognize subtle signs of maltreatment that others might miss, making them critical in identifying trafficking.
E. Nurses do not have the legal authority to remove victims; their role involves identification and reporting rather than enforcement actions.