A 35-year-old woman presents to the emergency department with a sprained ankle. During the physical examination, the nurse notices fading bruises on her upper arms and torso. The patient appears nervous and frequently checks her phone. When asked about the bruises, she says she's 'clumsy' and changes the subject. Which of the following interventions is most appropriate for the nurse to implement next?
Directly ask the patient if she feels safe at home
Consult with social services about the patient's presentation
Use a validated screening tool for intimate partner violence
Offer the patient a private room away from the waiting area
The correct answer is to use a validated screening tool for intimate partner violence. While all options have merit, using a validated screening tool is the most appropriate next step in this situation. These tools are designed to sensitively and systematically assess for potential abuse, providing a structured approach that can help overcome communication barriers and patient reluctance. It allows for a more comprehensive evaluation than simply asking direct questions, which the patient might deflect. Offering the patient a private space is important but should be done in conjunction with screening. Consulting social services or law enforcement may be premature at this stage and could potentially alienate the patient if done too hastily. Documentation is crucial but should follow the screening process. The use of a validated tool not only aids in identifying abuse but also provides documentation that can be used for potential legal proceedings. This approach balances the need for thorough assessment with maintaining patient trust and comfort, which is essential when dealing with sensitive issues like potential abuse.
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