Psychiatric Mental Health Nursing by Videbeck

232 Unit 3 CURRENTSOCIAL ANDEMOTIONALCONCERNS

continued from page 231

Clients in abusive relationships often are socially

isolated and lack social skills or confidence.

Abusive behavior often occurs when economic or

other stressors are present or increased.

Clients in abusive relationships often are isolated

and unaware of support or resources available.

Contacting people or groups before discharge can

be effective in ensuring continued contact.

*Encourage the client to interact with other

clients and staff members and to develop rela-

tionships with others outside the hospital.

Assist the client or facilitate interactions as

necessary.

*Refer the client to appropriate resources and

professionals to obtain child care, economic

assistance, and other social services.

*Help the client identify and contact support sys-

tems, crisis centers, shelters, and other commu-

nity resources. Provide written information to the

client (eg, telephone numbers of these resources),

especially if he or she chooses to return to an

abusive situation.

Adapted from Schultz, J. M.-Videbeck, S. L. (2002). Lippincott’s Manual of Psychiatric Nursing Care Plans (6th ed). Philadelphia:

Lippincott Williams & Wilkins.

*denotes collaborative interventions

They may believe that questions about abuse will of-
fend the client or fear that incorrect interventions
will worsen the situation. Nurses may even believe
that a woman who stays in an abusive relationship
might deserve or enjoy the abuse or that abuse be-
tween husband and wife is private. Some nurses may
believe abuse to be a societal or legal, not a health,
problem.
Listening to stories of family violence or rape is
difficult; the nurse may feel horror or revulsion. Be-
cause clients often watch for the nurse’s reaction,
containing these feelings and focusing on the client’s
needs are important. The nurse must be prepared to
listen to the client’s story, no matter how disturbing,
and support and validate the client’s feelings with
comments such as “That must have been terrifying”
or “Sounds like you were afraid for your life.” The
nurse must convey acceptance and regard for the
client as a person with worth and dignity regardless
of the circumstances. These clients often have low
self-esteem and guilt. They must learn to accept and
face what has occurred. If the client believes that the
nurse can accept him or her after hearing what has
happened, he or she then may gain self-acceptance.
Although this acceptance is often painful, it is es-
sential to healing. The nurse must remember that
he or she cannot fix or change things; the nurse’s role
is to listen and convey acceptance and support for
the client.

Nurses with a personal history of abuse or trauma

must seek professional assistance to deal with these is-

sues before working with survivors of trauma or abuse.

Such nurses can be very effective and supportive of

other survivors but only after engaging in therapeu-

tic work and accepting and understanding their own

trauma.

Points to Consider When Working

With Clients Who Have Been

Abused or Traumatized

• These clients have many strengths they
  may not realize. The nurse can help
  them move from being victims to being
  survivors.


• Nurses should ask all women about abuse.
  Some will be offended and angry, but it is
  more important not to miss the opportunity
  of helping the woman who replies, “Yes. Can
  you help me?”


• The nurse should help the client to focus on
  the present rather than dwelling on horrific
  things in the past.


• Usually a nurse works best with either the
  survivors of abuse or the abusers themselves.
  Most find it too difficult emotionally to work
  with both groups.