Learning Objectives
By the end of this section, you will be able to:
- Recognize different types of abuse to make informed clinical decisions regarding patient care
- Identify forms of family violence and provide appropriate nursing interventions for patient care
- Describe various categories of social violence
Healthcare workers play a crucial role in providing care to patients, but their job can also come with significant risks to their own health and safety. One of the most pressing risks is workplace violence, which can cause physical and psychological harm. 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. Additionally, healthcare workers may become aware of violence or abuse suffered by their patients. Nurses play an integral role in keeping themselves and their patients safe.
Ensuring the safety of healthcare workers is critical to the delivery of quality healthcare services. However, addressing this issue requires a multifaceted approach that involves collaboration between healthcare organizations, policymakers, law enforcement agencies, and other stakeholders. 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.
Forms of Abuse
The term abuse refers to physical, emotional, verbal, or sexual acts toward another which can cause harm. Abuse can take many different forms and occur in a variety of settings, including at home, in the workplace, and in institutions such as schools or care facilities. Abuse is not limited by factors such as age, gender, or sexuality. The effects of abuse on an individual can be far reaching and devastating. Depending on the type, severity, and duration of the abuse, the impact can be physical, emotional, and psychological.
A victim of abuse may experience physical injuries, such as bruises, broken bones, or internal injuries, and may require medical attention. They may also experience emotional distress, such as fear, anxiety, and shame, and psychological trauma, such as post-traumatic stress disorder or dissociative disorders. Long-term effects of abuse can be even more profound. Victims may struggle with low self-esteem, trust issues, and difficulty forming healthy relationships. They may self-blame or feel ashamed to be in the situation. They may also be at higher risk for developing mental health disorders, such as depression, anxiety, or substance misuse. In some cases, the impact of abuse can be so severe that it can lead to suicidal thoughts or behaviors.
It is essential for anyone who has experienced abuse to seek help and support from trained professionals as well as from family and friends to begin the healing process and move forward with their lives. With the right help and support, healing from abuse is possible. In some instances, the perpetrators of abuse, such as financial abuse of elders, sexual abuse, or child abuse, may face legal charges for their actions.
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. Physical abuse may look different across the life span. For instance, there are higher rates of physical abuse reported by pregnant women (Symes, 2011). The rates of physical abuse toward those identifying as female are higher than those identifying as male; however, all genders are at risk (Symes, 2011).
A person who experiences physical abuse may have visible wounds, bruising, or unexplained injuries (Washington State Department of Social and Health Services, n.d.). 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. Often abusers will purposely use force on bodily areas that can be covered with clothing to prevent any questions from being asked (Washington State Department of Social and Health Services, n.d.). However, the nurse should not assume a lack of an apparent wound means the patient is not a victim of abuse. Other signs of physical abuse may include social isolation and withdrawal by the victim. The nurse may suspect abuse if any of these signs are present, especially if the patient seems fearful in the presence of their abuser.
Most facilities have requirements to assess all patients for safety. If a nurse suspects someone is being abused, they can ask the patient if they feel safe at home. 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. 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.
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. This may include name-calling, belittling, or using insults or threats, and it can lead to long-term psychological harm. It may also involve isolating a person from friends and family or controlling their access to resources, such as money or transportation. All genders are susceptible to psychological abuse (Symes, 2011).
Signs of psychological abuse may include being withdrawn or isolated, emotional reactions that are not consistent with the situation, or other behavior outside the norm for that person (Washington State Department of Social and Health Services, n.d.). The patient may also share they are experiencing psychological abuse to trusted friends or caregivers (Washington State Department of Social and Health Services, n.d.).
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. Additionally, the nurse should inform the treating provider or supervisor. It is important for patients to know that psychological abuse is as significant as physical abuse.
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. This type of abuse can take many forms, including theft, fraud, forcing the individual to give away money, or the misuse of financial accounts or assets. The impact of financial abuse on an individual can be severe, as it can leave them financially at-risk and potentially destitute, leading to poverty, debt, or even housing insecurity. Financial abuse can also have a significant impact on a person’s mental health and well-being, as it can erode their sense of trust and security as well as their confidence in their own judgment and decision-making abilities.
Spotting financial abuse can be challenging, as it often occurs behind closed doors. 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. Other red flags may include a caregiver who seems overly interested in a person’s finances, refuses to let the person make their own financial decisions, or insists on managing all financial matters without input from the person. If a nurse suspects someone is experiencing financial abuse, seek support from trained professionals, such as social workers or elder abuse advocates, to protect the person and help them regain control over their finances.
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. It can occur within relationships, in the workplace, or in institutions, such as schools or care facilities. Victims of sexual abuse often experience long-term psychological and emotional trauma as well as physical injuries. Sexual abuse is a criminal act in most countries and can result in serious legal consequences for the perpetrator.
Signs of sexual abuse may be physical or psychological. Physical signs of sexual abuse can include bruises around the breasts or genital area, unexplained sexually transmitted disease, genital infections, or unexplained vaginal or anal bleeding (Washington State Department of Social and Health Services, n.d.). Psychological signs may include depression, anxiety, anger, or in the case of a child or adolescent, “acting-out” behaviors. The patient may also report they have been sexually abused. 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.
Substance Misuse
Substances such as drugs, alcohol, and tobacco are increasingly prevalent in many communities and can have serious consequences for health and safety. Drugs, both legal and illegal, can impair an individual’s ability to make safe decisions (National Institute on Drug Abuse, n.d.). While there are variations by state, in 2022 there were 287 arrests per 100,000 citizens for driving while impaired (SafeHome, 2022). Similarly, alcohol use can impair an individual’s ability to make safe decisions and result in serious health problems (Davis-Stober, 2019).
The consumption of excessive alcohol is associated with liver disease, while the excessive use of cannabis may elevate the risk of experiencing depression and anxiety. Despite the adverse effects of substance use on health, if someone chooses to use substances, it is crucial to prioritize safety. Key considerations include refraining from using substances when alone, ensuring the absence of flammable objects during use, and carrying drugs like Naloxone to address potential drug overdoses. Substance abuse heightens the risk of suffocation, primarily due to the suppression of the respiratory system by the ingested drug. Therefore, promoting safe substance use practices is imperative to mitigate the potential harm associated with these substances.
Family Violence
A form of abuse that occurs within a family or intimate relationship is called family violence, also known as domestic violence. It can take many forms, including physical, psychological, sexual, and financial abuse. Anyone can be at risk of family violence, regardless of their gender, age, or socioeconomic status. However, women and children are disproportionately affected, with women being the most common victims of intimate partner violence (Huecker et al., 2023). 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.
Identifying family violence can be challenging, as it often occurs behind closed doors. Some signs that family violence is occurring include unexplained injuries or bruises, isolation from family and friends, changes in behavior or personality, or a partner who tries to control or dominate their partner’s thoughts or actions. Remember that family violence is never the victim’s fault, and there are resources available to help those who are experiencing abuse. If a nurse suspects that a patient is experiencing family violence, seek help from trained professionals, such as domestic violence advocates or social workers, to ensure the patient’s safety and well-being.
Intimate Partner Violence
In intimate partner violence (IPV), there is physical or sexual violence, stalking, and psychological or coercive aggression by current or former intimate partners (Figure 9.6). Intimate partner violence is widespread in the United States and is the most prevalent adult safety issue. Victims can be female or male, and sexual orientation can be heterosexual or lesbian, gay, bisexual, transgender, queer/questioning, intersex, asexual, or others (LGBTQIA+). 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. It is often the nurse’s assessment that plays an important role in identifying a patient experiencing IPV. Compassion and understanding are important to show to this at-risk population. Effective communication is necessary to help victims come forward and share their experiences of abuse. IPV is a complex issue, and the victim may not initially consider leaving the abuser as an option.
Link to Learning
The Danger Assessment tool is a self-administered survey that is free to use and available in several languages (Campbell, 2004). Nurses can refer patients experiencing IPV to the National Center on Domestic Violence, Trauma, and Mental Health for resources, and the National Domestic Violence Hotline for free and confidential support (National Center on Domestic Violence, n.d.).
Child Abuse
Any form of physical, emotional, or sexual harm or neglect inflicted upon a child is child abuse. It can take many forms, including physical abuse (such as hitting or kicking), emotional abuse (such as verbal threats or manipulation), sexual abuse (such as inappropriate touching or sexual exploitation), and neglect (such as failing to provide for a child’s basic needs, such as food, shelter, or medical care) (CDC, 2021b). Children of all ages and backgrounds can be at risk of abuse, but those who are at-risk due to factors such as poverty, disability, or family dysfunction may be at increased risk (CDC, 2021b). Identifying child abuse can be challenging, as children may be reluctant or unable to report abuse, and abusers may go to great lengths to hide their actions.
Some signs that a child may be experiencing abuse include unexplained injuries, changes in behavior or mood, reluctance to go home or spend time with a certain caregiver, or sudden changes in academic or social performance (CDC, 2021b). It is important to remember that child abuse is a crime and should be reported to authorities immediately if suspected. 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. It is also important to provide the child with emotional support and connect them with resources such as counseling or support groups to help them heal from the trauma of abuse.
Clinical Safety and Procedures (QSEN)
QSEN Competency: Patient-Centered Care: As Related to Abuse
Definition: Recognize the patient or designee as the source of control and full partner in providing compassionate and coordinated care based on respect for the patient’s preferences, values, and needs.
Knowledge: Demonstrate comprehensive understanding of the concepts of pain and suffering, including physiological and psychological models of pain and comfort.
Skill: The QSEN initiative emphasizes the importance of providing safe and effective care to patients, including those who are at risk for abuse. One way nurses can promote clinical safety and apply QSEN principles related to abuse is by using screening tools to identify patients who may be experiencing abuse. For example, a nurse working in an emergency department might use a screening tool like the ICAST data tools to assess for possible child abuse (ISPCAN, n.d.). Nurses can also apply QSEN principles related to abuse by helping to promote clinical safety and improve the quality of care for patients who are at risk for abuse.
Elder Abuse
A form of mistreatment of an older adult is elder abuse. In most reported cases of elder abuse, a caregiver or a person in a trusted relationship is the perpetrator. For various reasons such as fear and disappointment, most of these cases go unreported. Abuse, including neglect and exploitation, is experienced by about one in ten people aged 60 years and older who live at home. From 2002 to 2016, more than 643,000 older adults were treated in the emergency department for nonfatal assaults, and over 19,000 homicides occurred (CDC, 2021a).
Link to Learning
Older patients may be targets for financial exploitation. The National Adult Protective Services Association (NAPSA) provides information about adult protective services and getting help in specific geographic regions.
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. Common signs of elder abuse or maltreatment include (Hartford Institute for Geriatric Nursing, n.d.):
- bruises, cuts, burns, or broken bones that are unexplainable or suspiciously explained
- malnourishment or weight loss
- poor hygiene, an unkempt appearance, unclean clothing, or dirty, matted hair
- foul odor from clothing or body
- anxiety, depression, or confusion
- unexplained transactions or loss of money
- withdrawal from family members or friends
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). This can take many forms, including gang violence, hate crimes, and mass shootings. Those who are at risk of social violence may include individuals who belong to marginalized communities, such as communities of color, the LGBTQIA+ community, or those experiencing housing insecurity or living in poverty (National Institute of Justice, 2021b).
Identifying social violence can be challenging, as it often occurs suddenly and unpredictably. Some signs that social violence may be imminent include threats or acts of violence, the presence of weapons or other dangerous objects, or social media posts or other communications that indicate an intent to harm. 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.
Addressing social violence requires a multifaceted approach that addresses the root causes of violence and promotes community safety and well-being. This may involve investing in programs that provide education, job training, and other opportunities to help individuals in at-risk communities to build better lives. It may also involve promoting policies that reduce access to weapons and other dangerous objects as well as addressing issues such as poverty, discrimination, and inequality that can contribute to social violence. Finally, it is important to provide support and resources to those who have been impacted by social violence, including counseling, mental health care, and other forms of support to help them heal from the trauma of violence.
Bullying
The term bullying can be defined as physical or emotional acts, such as hitting or making harmful comments, toward another person. Bullying can also involve excluding the victim from activities. Bullying is a pervasive issue that can have serious consequences for both the victim and the perpetrator. Those who are at risk of bullying include individuals who are perceived as different or vulnerable, such as individuals with a higher weight, with disabilities, or from underrepresented groups. Bullying can take many forms, including physical aggression, verbal taunts, and exclusion from social groups, and it can have a profound impact on an individual’s mental and physical health. Bullying has been linked to a range of health risks, including depression, anxiety, substance abuse, and even suicide. Bullying has an impact on everyone involved, including witnesses and the person who is doing the bullying. When it occurs during childhood, it can have devastating effects and is considered an adverse childhood experience, which is a potentially traumatic event with lasting impacts through adulthood (stopbullying.gov, 2020).
Technology has added a new layer of complexity to bullying, and individuals of all ages may be the victims of cyberbullying, a form of bullying that occurs via social media, texting, or emails. The type of bullying that takes place face-to-face can also occur virtually, generally targeting the victim by posting photos, videos, or information intended to cause emotional harm.
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. It is also important to be aware of signs that an individual may be bullying others, such as aggression or a lack of empathy for others. If bullying is suspected, it is important to take action to address the issue.
Nurses play a pivotal role in addressing and preventing bullying within healthcare settings. A primary responsibility is advocating for a healthy work environment that prioritizes respect, collaboration, and support. Encouraging open communication, nurses foster an atmosphere where patients and colleagues feel safe reporting incidents without fear. Serving as role models, nurses should exhibit respectful and collaborative behavior, setting a positive example for their peers and other members of the healthcare team. Additionally, nurses can provide emotional support and assistance to individuals who are targets of bullying, guiding them through the reporting process and connecting them with available resources.
School nurses play a pivotal role in addressing bullying within the school environment. In addition to actively promoting awareness and education about bullying, they serve as a trusted resource for students, providing a safe space for discussions related to bullying concerns. The nurse is instrumental in prevention efforts by collaborating with school staff to implement antibullying programs. When incidents occur, the nurse supports both victims and perpetrators, offering guidance and collaborating with other staff members for targeted interventions. Their regular interactions with students enable them to identify potential signs of bullying, and they collaborate with parents and guardians to ensure a coordinated approach in addressing and preventing bullying.
Incivility
Rude or disrespectful behavior that can have a negative impact on individuals or groups is known as incivility (Porath & Pearson, 2013). It can take many forms, including name-calling, shouting, interrupting, and making derogatory comments. Incivility can occur in any setting, including workplaces, schools, and public spaces, and it can have a profound impact on the mental and emotional well-being of those who are affected.
There are several types of incivility, including verbal, behavioral, and environmental. Verbal incivility involves the use of disrespectful or derogatory language, while behavioral incivility may include actions such as ignoring or excluding others or making inappropriate physical contact. Environmental incivility involves creating a hostile or unpleasant atmosphere, such as by playing loud music or using offensive scents (Cortina et al., 2008).
Anyone can be at risk of experiencing incivility, but some groups may be particularly at risk. These groups may include individuals who belong to marginalized groups, such as women, people of color, and members of the LGBTQIA+ community, as well as those who work in high-stress or high-pressure environments. It is important to identify and address incivility early to prevent it from escalating into more serious forms of aggression or violence (Porath & Pearson, 2013). This may involve promoting a culture of respect and civility in all settings, providing education and resources to help individuals recognize and prevent incivility, and holding those who engage in uncivil behavior accountable for their actions.
Workplace Violence
Any act of aggression or violence that occurs in the workplace, including physical assault, verbal abuse, threats, and harassment, is referred to as workplace violence (Lamborghini et al., 2020). Workplace violence can have serious consequences for employees, including physical injuries, psychological trauma, and decreased job satisfaction. Healthcare workers face a particularly high risk of workplace violence due to the nature of their work. This may include physical assaults, verbal abuse, and even sexual harassment from patients or their family members (Yusoff et al., 2023).
To identify workplace violence, it is important to be aware of the warning signs. These may include increased tension or hostility, threats or aggressive behavior, and a history of violent incidents. It is also important to create a culture of respect and zero tolerance for violence in the workplace and to provide education and training to employees on how to prevent and respond to workplace violence. Employers should have clear policies in place for reporting incidents of violence and providing support to employees who have been affected. This may include strategies such as de-escalation techniques, training in self-defense, and the use of panic buttons or other safety devices.
Horizontal Violence
A form of workplace aggression called horizontal violence(also called lateral violence) occurs between colleagues who are at the same level of authority or hierarchy within an organization. This type of violence can take many forms, including verbal abuse, undermining, sabotage, and exclusion. Horizontal violence can have serious consequences for the workplace, including decreased job satisfaction, increased staff turnover, and decreased patient safety. Anyone can be at risk of horizontal violence, but it is particularly prevalent in high-stress work environments such as health care. A review of the literature on horizontal violence in nursing found that 87 percent of nurses included in the studies reported experiencing horizontal violence (Zhang et al., 2022).
To identify horizontal violence, it is important to be aware of the warning signs, which may include frequent conflict between colleagues, gossiping and spreading rumors, and frequent complaints about a colleague’s work performance. It is also important to create a culture of respect and zero tolerance for violence in the workplace and to provide education and training to employees on how to prevent and respond to horizontal violence. Employers should have clear policies in place for reporting incidents of violence and providing support to employees who have been affected, including access to counseling and mediation services. Addressing horizontal violence requires a collective effort from all staff, management, and administration to promote a positive work culture that prioritizes open communication, respect, and teamwork.
Researchers have identified a specific category of lateral violence that can occur between or among members of historically marginalized groups (Gaia & Hayes, 2018; Robinson 2018). These behaviors can include gossiping, bullying, or undermining, and the practice can be difficult to identify or address because it occurs within a community and may be seen as isolated or expected. However, like other types of lateral violence, this type can have significant impact on a person's mental health and well being.
Client-on-Worker Violence
The most common type of workplace violence in healthcare settings is violence perpetrated against heathcare workers by clients, patients, or others receiving services or support, including patient family members. Research indicates that this type of violence occurs most frequently in emergency or psychiatric/mental health settings, but is not limited to those. It may occur suddenly on only one occasion, or may be committed as a part of a pattern. Violence by patients can be especially problematic when it is trivialized, or considering unimportant, unpreventable, or expected. Nurses, administrators, and others may feel that enduring violence is "part of the job," and reports or prevention may not be taken seriously.
Preventing client-on-worker violence usually involves extensive procedures and training. Nurses can look for patterns and behaviors, such as agitation, raised voices, drug-seeking behavior, and a sense of either victimization or entitlement. While violence can occur in any setting, those that completely isolate the nurse and patient, such as a room out of eyesight and earshot of anyone else, may pose greater risk. Nurses working in tandem with other professionals can also prevent or somewhat mitigate occurences of violence.
Hate Crimes
Criminal offenses called hate crimes are motivated by prejudice or bias against an individual or group based on their race, ethnicity, religion, sexual orientation, gender identity, or other characteristics (Levin & Nolan, 2019). Hate crimes can take many forms, including physical assault, verbal harassment, property damage, or even murder (Federal Bureau of Investigation, 2020). Anyone who belongs to a group that is historically marginalized or discriminated against can be at risk of being the target of a hate crime.
It is important to be aware of the signs of hate crimes, such as the use of hate speech, symbols of hate, or a pattern of similar incidents in the area. If a nurse witnesses a hate crime or suspects that one has occurred, the nurse should report it to the appropriate authorities, such as the police or a community organization that supports victims of hate crimes (McDevitt & Levin, 2021). To prevent hate crimes from occurring in the first place, it is essential to promote education and awareness about the harmful effects of prejudice and discrimination and to foster a culture of inclusion and respect for diversity.
Human Trafficking
The crime of human trafficking involves the exploitation of individuals for forced labor or commercial sex (United Nations Office on Drugs and Crime, 2020). Anyone can be a victim of human trafficking, regardless of age, gender, or nationality. However, some groups are at higher risk, including women and children, those living in poverty, migrants, and those with a history of abuse or trauma (International Labour Organization, 2022). Identifying victims of human trafficking can be challenging, as they may be kept in isolation, have limited contact with others, or be forced to deny their situation.
Signs that someone may be a victim of human trafficking include being forced to work excessively long hours, living in overcrowded or unsafe conditions, showing signs of physical abuse or malnourishment, and being unable to move freely or leave their place of work or residence (Hodge & Lietz, 2018; Piscitelli & Pienaar, 2019). Tattoos can also serve as potential indicators of human trafficking. Traffickers may brand or tattoo their victims with symbols, numbers, or names as a form of control and marking ownership. Symbols can vary widely and may include barcodes, dollar signs, or specific words, reflecting the trafficker’s tactics and the type of exploitation involved, such as forced labor or sex trafficking (National Association of Pediatric Nurse Practitioners Partners for Vulnerable Youth, n.d.) (Figure 9.7). Identification of these tattoos is complex, as victims may conceal them due to fear of reprisals. Awareness about the potential connection between certain tattoos and human trafficking is crucial for recognizing and aiding victims.
Intervening in cases of human trafficking is crucial to prevent further harm to victims. Many victims are forced to remain in their situation because they do not have a way out. If a nurse suspects someone is a victim of human trafficking, it is important to contact law enforcement or a local anti-trafficking organization. In some cases, it may be necessary to involve a professional interpreter, as victims may not speak the local language or be hesitant to share their experiences.
Patient Conversations
Having Difficult Conversations Regarding Intimate Partner Violence and Human Trafficking
Scenario: This scenario involves a nurse initiating a conversation with a patient they suspect is the victim of IPV. The nurse demonstrates gentle questioning techniques and supportive listening to help develop trust with the patient.
Nurse: Hi, Ruhi, I wanted to ask you a few questions to make sure that you are safe and okay. Have you been feeling okay lately?
Patient: Yeah, I’m fine.
Nurse: Okay, that’s good to hear. I noticed that you have some bruises on your arms and legs. Can you tell me how you got those?
Patient: Oh, I just fell.
Nurse: Okay, do you feel comfortable telling me a little bit more about what happened? We’re here to help you, and we want to make sure that you’re safe.
Patient: Well, I don’t know if I should say anything.
Nurse: That’s okay. If you don’t feel comfortable talking to me, that’s all right. But I want you to know that we’re here to help you, and we’re not going to judge you or get anyone in trouble without your permission. Sometimes, when people are hurt or scared, they need someone to talk to.
Patient: Okay, well, my boyfriend gets angry sometimes. He hits me and makes me do sexual things I don’t want to do with his friends. He does not allow me to see or talk to my family and friends.
Nurse: I’m so sorry to hear that, Ruhi. It sounds like you might be experiencing something called human trafficking and IPV. That’s when someone is forced to do things against their will, like work or have sex. It’s not your fault, and you’re not alone. We can help you get the support you need to stay safe.
Patient: Really? You can help me?
Nurse: Absolutely. We have a team of people who are specially trained to help people who have been trafficked. We can connect you with resources like counseling, legal help, and safe housing. And we can make sure that you’re not in danger while you’re here in the hospital.
Patient: Thank you so much. I didn’t know what to do.
Nurse: You’re welcome, Ruhi. We’re here for you, and we’re going to do everything we can to help you.