How Should The Nurse Proceed With The Screening And Intervie ✓ Solved

How should the nurse proceed with the screening and interview?

M.L., a 15-year-old female, presents with concerns about pregnancy and requests for contraception. During the initial interview and sexual history assessment, the nurse should adopt a trauma-informed and patient-centered approach, especially given M.L.'s disclosure of ongoing sexual abuse. The nurse must ensure a safe, non-judgmental environment, allowing M.L. to feel comfortable and supported. It is essential to conduct the interview in a private setting, free from the presence of others, to foster open communication. The nurse should validate M.L.'s feelings, maintain confidentiality within legal limits, and use developmentally appropriate language. The sexual history should be obtained using open-ended questions, emphasizing consent and comfort, while also screening for abuse and safety concerns. The nurse should document findings meticulously, including the patient's emotional state and disclosures, while prioritizing her safety and well-being.

How should the nurse proceed given a positive Abuse Assessment Screen?

Upon M.L.'s affirmative responses to questions 1 through 3 on the Abuse Assessment Screen (AAS), the nurse must recognize signs of ongoing abuse and respond promptly. The nurse should continue to assess her safety, determine whether the patient feels safe at home, and explore her immediate needs. Providing information about support services, such as counseling, legal assistance, and healthcare resources, is essential. The nurse should also reassure M.L. that she is not alone and that help is available. It is crucial to avoid pressuring the patient to disclose details but to remain supportive and compassionate. The nurse's focus should be on establishing trust, ensuring that M.L. understands her options, and encouraging her to seek help when she is ready.

What is the nurse's role in reporting the suspected abuse?

The nurse's primary obligation is to report suspected abuse in accordance with state laws and institutional policies. Recognizing that M.L. is a minor who discloses ongoing sexual abuse, the nurse is mandated to report these concerns to child protective services (CPS) or equivalent authorities immediately. The nurse should explain to M.L. the necessity of reporting to protect her safety and legal rights, ensuring her that her privacy and confidentiality are respected within the scope of mandatory reporting laws. Documentation should be thorough, objective, and without subjective judgments. Once reported, the nurse must cooperate with investigations while continuing to support M.L. emotionally and physically throughout the process. The nurse's role extends beyond reporting to providing ongoing care, education, and advocacy for the patient's health and safety.

How would the nurse proceed with the physical examination?

The physical examination of M.L. should be conducted with sensitivity, consent, and awareness of her trauma history. Prior to the exam, the nurse should explain each step clearly, emphasizing voluntary participation and that she can withdraw consent at any time. The environment should be private, comfortable, and child-appropriate. Necessary safeguards, such as having a chaperone (preferably a female staff member), should be in place to promote safety and comfort. The examiner should avoid unnecessary exposure and engage in gentle, respectful communication throughout the process. The exam should include assessment for signs of trauma, such as bruising, injuries, or other indications of abuse, while also addressing her reproductive health concerns. Special attention should be paid to her emotional state, and mental health support should be offered as needed. Combining physical assessment with emotional support ensures holistic, patient-centered care tailored to M.L.'s needs and circumstances.

References

1. American Academy of Pediatrics Committee on Child Abuse and Neglect. (2014). Child abuse and neglect guidelines. Pediatrics, 134(2), e462-e472.https://doi.org/10.1542/peds.2014-1994
2. Leeb, R. T., & Basile, K. C. (2018). Guidelines for child abuse and neglect screening and reporting. Journal of Child Sexual Abuse, 27(3), 268-283.https://doi.org/10.1080/10538712.2018.1431412
3. Fisher, C. M., & Browne, K. D. (2010). The clinical assessment of child abuse and neglect. Pediatrics & Child Health, 20(2), 84-88.https://doi.org/10.1016/j.paed.2009.12.002