Identifying the Need for Specialized Assessments in Holistic Patient Care
In nursing practice, evaluating and identifying such issues as substance use and domestic violence is important due to their huge negative impact on patients’ health conditions and general psycho-emotional well-being. Drug abuse may be the cause of a variety of physical and mental health issues for an individual. In contrast, domestic abuse can result in injuries, emotional trauma, and long-term psychological effects. These aspects should be identified and rectified as they play a significant role in patient safety, holistic care provision, and the steps to prevent more such occurrences. In this regard, the purpose of this discussion is to investigate the possibility of domestic violence and substance use screening tools in clinical practice and look at the community resources regarding the issues as well as the ethics and legalities of nurses in addressing complex societal issues.
Real-World Clinical Example
A few days back, there was an interaction in a clinical setting wherein I discovered a middle-aged woman who was going through dual problems of chronic back pain and anxiety. As the evaluation of their cases and partnering with them had moved on, she admitted being a victim of domestic violence from her partner. Despite her attempts to keep this truth from coming into the open by hiding the violence, a physical examination revealed bruises and lacerations. Besides, by heightening the terror she felt that was a result of abuse, she explained symptoms of anxiety. In addition, the patient relied on alcohol to somehow numb the emotional pains that the abusive relationship created. The combined impact of domestic violence and substance abuse on her health is clearly obvious when one looks at her physical and mental health conditions, with her overall health outcomes at risk from the unrelenting correlation between health outcomes and social determinants.
Not only drug abuse and domestic violence but also many other implications of the patient’s health were plentiful and complex. Besides the fact that substance abuse amplified her mental health problems, the cycle of violence, which was created by her partner, worsened the situation, and she also lost the ability to get the appropriate treatment and the support she needed. Additionally, the stress, which dragged on for months, resulted in the development of various illnesses like musculoskeletal and gastrointestinal problems. It was necessary to develop a multi-disciplinary and integrated approach that involved social workers, psychologists, and community resources to ensure that the patient got the necessary treatment, safety, and self-respect. At the same time, HIPAA guidelines were taken into account to protect her rights as a patient.
Screening Tools for Substance Use and Domestic or Family Violence
A screening instrument that is widely accepted for substance use control is the CAGE questionnaire. This tool comprises four simple questions aimed at identifying potential alcohol abuse: “Have you at one point wondered whether you would like to Cut back on drinking?”; “Does Criticism of your alcohol use make you Annoyed?”; “Have you felt Guilt after drinking?”; and “Have you taken an eye opener?” The quick assessment by using this mnemonic CAGE questionnaire might be completed during first patient meetings, or nurses can ask patients, without judgment or making them feel uncomfortable, for information about alcohol intake when the patients feel comfortable (Grant et al., 2019). Suppose the patient answers positively to two or more questions. In that case, follow-up checks regarding substance abuse are done vigorously, and further intervention could include referral to tobacco-specialized services for thorough evaluation and management.
Screening for domestic or family violence is done with the widely used HITS screening tool. HITS stands for Hurt, Insult, Threaten, and Scream, and it comprises four questions: “Have you ever been physically Harmed by someone?”; “Has anyone Insulted you?”; “Have you ever been threatened with harm?”; and “Has anyone Screamed or cursed at you?” The use of the HITS screening tool as part of routine evaluations enables nurses to identify possible victims of domestic violence and provide assistance and required resources (Collins et al., 2023). It can be conducted privately, and the patient’s privacy and comfort should be safeguarded if a patient responds positively to one of the questions; nurses have to follow the institution’s reporting regulations and intervene to ensure the patient’s safety immediately and provide adequate support services.
Community Resources for Substance Use and Domestic and Family Violence
One community resource for substance use is Alcoholics Anonymous (A.A.). A.A. is a fellowship of people who fight with or recover from alcoholism all over the world. According to its mission statement, Alcoholics Anonymous functions to provide support, hope, and a feeling of camaraderie for those who are recovering from alcohol addiction (Wnuk, 2022). The mission of Alcoholics Anonymous is succinctly summarized in its statement: A.A. is a fellowship of men and women who join to triumph over alcohol (Alcoholics Anonymous, 2024). A.A.’s primary purpose is to help people with alcohol use disorder achieve sobriety. A.A. organizes different meetings and support groups and offers resources to help people withstand the challenges of alcohol dependence.
On the other hand, an acclaimed source for domestic and family violence is the National Domestic Violence Hotline (NDVH). The NDVH supplies necessary instruments and helps people who have suffered from this kind of abuse (Kofman & Garfin, 2020). The primary objective of its mission statement is to strengthen individuals, assert awareness among the masses, and encourage society to take action to stop domestic violence. NDVH’s mission statement is succinctly expressed as follows: “The Hotline of the National Domestic Violence organization is a crucial resource that offers guidance and assistance to the survivors of domestic violence (Kofman & Garfin, 2020). The NDVH is run to make available confidential helplines, online support conversations, safety planning tools, as well as referrals to local help and support services to help survivors communicate and get the help they need to exit abusive relationships.
Conclusion
Conclusively, conducting substance use and domestic violence assessments is imperative, given the holistic treatment of patients. Screening tools allow nurses to detect high-risk patients; thus, they can initiate appropriate and timely measures. Nurses aim to promote patient safety and health by abiding by the ethical and legal principles of patient confidentiality, non-judgmental support, and integrating interdisciplinary teams and community resources.
References
Alcoholics Anonymous. (2024). What is A.A.? | Alcoholics Anonymous. Alcoholics Anonymous World Services, Inc. https://www.aa.org/what-is-aa
Collins, K., Sebastian, S., & Franck, G. (2023). Improving domestic violence screening and follow-up in a community health clinic. Journal of Primary Care & Community Health, 14. https://doi.org/10.1177/21501319231189074
Grant, G. G., Wolfe, A. E., Thorpe, C. R., Gibran, N. S., Carrougher, G. J., Wiechman, S. A., Holavanahalli, R., Stoddard, F. J., Sheridan, R. L., Kazis, L. E., Schneider, J. C., & Ryan, C. M. (2019). Exploring the burn model system national database: Burn injuries, substance misuse, and the CAGE questionnaire. Burns. https://doi.org/10.1016/j.burns.2019.12.016
Kofman, Y. B., & Garfin, D. R. (2020). Home is not always a haven: The domestic violence crisis amid the COVID-19 pandemic. Psychological Trauma: Theory, Research, Practice, and Policy, 12(S1), S199–S201. https://doi.org/10.1037/tra0000866
Wnuk, M. (2022). The beneficial role of involvement in alcoholics anonymous for the existential and subjective well-being of alcohol-dependent individuals? The model verification. International Journal of Environmental Research and Public Health, 19(9), 5173. https://doi.org/10.3390/
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Question 
As a professional nurse, you need to be able to identify times that specialized assessments may be needed to adequately assess the patient holistically. The patient’s environment and lifestyle choices may have put them at risk for health-related issues. Two risk factors that the nurse must be aware of from a legal, as well as ethical standpoint, are the possibility of substance abuse and domestic or family violence. Assessment for risk factors should be done on each patient and interventions are dependent on many factors but need to be instituted immediately as health is promoted in the client.
Identifying the Need for Specialized Assessments in Holistic Patient Care
Upon successful completion of this discussion, you will be able to:
• Discuss the integration of substance use and domestic, and family violence assessments into clinical practice.