Part B: Scholarly Written Paper

Part B: Scholarly Written Paper

Author: Adam McFarlan
Student Number: N00785737
Course: NURS 252
Instructor: John Stone
Humber College

Adam McFarlan

Introduction
This paper relates to a concept map made based off a scenario in which a 17 year old
female comes into a sexual health clinic inquiring about pregnancy testing. The client states she
has not had a menstruation in 3 months. The nurse also notes bruising on the clients arms and
legs, the client says she thinks she fell but that its hard to remember exactly. The concept map
identifies risk for physical abuse from family or partner as the highest psychosocial priority. The
concept map identifies the risk for ineffective relationship with family or partner as the highest
priority complication. The priority nursing interventions for the concept map include Consulting
with a social worker to offer additional services to protect the client from further possible
violence., Providing information on various organizations that support people suffering from
abuse., Administering an intimate partner violence screening test., Establishing external
supports such as friends and family that the client can rely on., Asking directly if the client is
suffering from abuse and observing her response. And Establishing a therapeutic and trusting
environment. I think that this pathway of priorities is the most important for the clients wellbeing.
Body
I think that the priority data from the case study is the clients age and the presence of
bruises on the clients arms and neck with the client being unclear to the cause of the bruises. The
clients age is a priority because it means the client is likely still living at home and that they may
need more emotional support as they are at a vulnerable age. The presence of bruises on the
clients arms and neck with the client being unclear to the cause of the bruises is a big priority
because it could be a sign that the client is being abused which effects client safety as well as
social well-being.

Based on the clients presenting scenario, the concept map identifies the risk for physical
abuse from family or partner as a more important psychosocial priority than risk for pregnancy.
I believe this is the most important priority because the clients safety is in this situation, the
most important factor in determining the clinical assessment and treating priorities. If the client
is being physically abused then the client is at risk for further bodily harm or even death. The
article Health consequences of intimate partner violence (Campbell, J. C. 2002) emphasizes
the possible consequences of physical abuse which includes injury, chronic pain,
gastrointestinal, and gynaecological signs including sexually-transmitted diseases, depression,
and post-traumatic stress disorder. This is a more important priority than risk for pregnancy
because if the client is harmed that carries significant risk for the health and wellbeing of a
possible fetus. Addressing risk for physical abuse from family or partner is a priority because it
keeps the client and by extension any fetus safe.
Based on the scenario the concept map is made off of I think that risk for ineffective
relationship with family or partner is a more important complication then risk for low self-esteem
or bruises on arm and neck. I feel this way because when thinking of what complication to
address first if the risk for ineffective relationship with family or partner is managed then further
bruising may be prevented and ineffective relationships as a cause of low self-esteem may be
addressed. Risk for ineffective relationship with family or partner is a priority because it
addressing if effects the clients safety as well as the clients social and mental wellbeing both
immediately and in the long term most effectively.
In the concept map under risk for ineffective relationship with family or partner the
priority nursing interventions include Consulting with a social worker to offer additional
services to protect the client from further possible violence., Providing information on various

organizations that support people suffering from abuse., Administering an intimate partner
violence screening test., Establishing external supports such as friends and family that the
client can rely on., Asking directly if they are suffering from abuse and observing her
response. And Establishing a therapeutic and trusting environment. I think that Consulting
with a social worker to offer additional services to protect the client from further possible
violence. Is a valid priority intervention because the social worker can provide answers to any
questions the client has and the social worker can offer additional services such as alternate
housing options, or community support groups and may be able to offer information about police
or legal services available to protect the client, this intervention has the potential to improve the
clients well-being and knowledge. I think that Providing information on various organizations
that support people suffering from abuse. Is a valid priority because the information the
organisation provide can support the client in improving the clients social and mental well-being
and the organisations can also give information on how to prevent the abuse from occurring
which improves client safety. I think that Administering an intimate partner violence screening
test. Is a valid priority because it can help confirm whether or not the client is being abused and
by whom, this test can be used to involve police or legal protection if needed and to be
documented as relevant information about client safety. The study A qualitative study of
intimate partner violence universal screening by family therapy interns: Implications for practice,
research, training, and supervision enforces the argument that intimate partner violence
screening is important by stating that screening helps provide information for the healthcare
workers that work with the client. I think that Establishing external supports such as friends and
family that the client can rely on. Is a valid priority because social supports can provide
emotional support for the client improving their social well-being and can potentially lead to

offers of alternate places to stay if the clients home environment is unsafe for the client. I think
that Asking directly if they are suffering from abuse and observing her response. Is a valid
priority because it can help confirm whether or not the client is being abused and by whom, this
information can be used to involve police or legal protection if needed. I think that Establishing
a therapeutic and trusting environment is a valid priority because it improves the clients mental
well-being and makes the client more likely to forthcoming with relevant information such as
how she got her bruises and whether or not she is suffering from abuse, these points are
supported in the article Survivor preferences for response to IPV disclosure (Dienemann, J.,
Glass, N., & Hyman, R. 2005) which states that women react very positively to healthcare
providers treating them with respect and concern. Providing the client with a safe environment is
important so she can make sound decisions about her personal health free of fear or distraction.
Conclusion
In conclusion I think that the pathway I have chosen is the most valid and effective
pathway. Out of all the pathways I think it best promotes client safety as well as social and
mental well-being both in sort term and long term. I think that the psychosocial priority risk for
physical abuse from family or partner is the most valid priority because it best promotes client
safety. I think that the priority complication risk for ineffective relationship with family or
partner is the most valid as addressing it best supports the client. I think that the priority nursing
interventions in the nursing pathway under risk for ineffective relationship with family or
partner are valid priorities because they treat the client in various positive ways including
Promoting client safety, improving client social and mental well-being and providing information
to the client.

References
Dienemann, J., Glass, N., & Hyman, R. (2005). Survivor preferences for response to IPV
disclosure. Clinical Nursing Research, 14(3), 215-233.
Campbell, J. C. (2002). Health consequences of intimate partner violence.The Lancet, 359(9314), 13311336.
Todahl, J. L., Linville, D., Chou, L. Y., & MaherCosenza, P. (2008). A qualitative study of intimate partner
violence universal screening by family therapy interns: Implications for practice, research, training, and
supervision.Journal of marital and family therapy, 34(1), 28-43.

17 year old female

Vital signs stable
Past medical history: none
Client comes in regarding pregnancy
testing as client has not menstruated
in 3 months. Client also has bruising
on arm and neck but cannot provide
clear history to cause of the bruises.
Risk for physical abuse from
family or partner. (Psychosocial)
Risk for
ineffective
relationship
with family or
partner.
Consulting with a
social worker to
offer additional
services to
protect the client
from further
possible violence.
Provide
information on
various
organizations that
support people
suffering from
abuse.
Administer an
intimate partner
violence
screening test.
Establish external
supports such as
friends and family
that the client can
rely on.
Ask directly if
they are suffering
from abuse and
observe her
response.
Establish a
therapeutic and
trusting
environment.

Risk for low

self-esteem.

Establish a
therapeutic
and trusting
environment.
Promote client
self-esteem,
ensure client
they are not
the cause of
or are at fault
for any abuse.
Consulting
with a
counsellor to
offer
additional
services to
the client.
Establish
external
supports such
as friends and
family that
the client can
rely on.
Client
education on
equalitycentered
relationship
behaviours.
Assess any
risk for
substance
abuse.

Bruises on
arm and
neck.
Assess for
other nonvisible injuries
with client
consent.
Assess for
pain.
Give pain
medication as
ordered if
client has any
pain.
Assess for
healing or
signs of any
new bruising
on
subsequent
visits.
Consult with
physician to
determine any
need for x-ray.
Advise selfcare at home
such as ice
packs and
pain
medication.
Assess bruises
for size, color
and
tenderness.

Risk for Pregnancy.

(Psychosocial)
Knowledg
e deficit.

Offer the
client a
pregnancy
test.
Educate the
client on
nutrition.
Educate the
client on the
first
trimester.
Provide the
client with
information
on possible
courses of
actions
including
pregnancy
continuation
and
pregnancy
termination.
Consulting
with a social
worker to
offer
additional
services to
the client
regarding
their
education.

Risk for
Ineffective
Child
Bearing
Process
related
to
Assess for
any bruising
to the
abdomen.
Inquire if
sexual
partner is
aware of
possible
pregnancy.
Assess for
risk of
substance
abuse such
as drugs or
alcohol.
Assess what
the clients
home
situation is.
Inquire what
the clients
supports
are.
Consulting
with a social
worker to
offer
additional
services to
the client.

Stress
related to
knowledge
deficit,
young age
and not
Consulting
knowing if
with a social
worker to
offer
additional
services to
the client
related to
stress
management.
Provide
education
and resources
on stress
management.
Provide
information
on nutrition
to optimize
well-being.
Establish
external
supports such
as friends and
family that
the client can
rely on.
Encourage
actions such
as exercise to
reduce stress
and assess
clients level
of stress
before and