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66 LAYING THE FOUNDATION
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UNIT 1
EXAMPLES OF QUESTIONS ASSESSING SETTING:
> ‘What were you doing when the abdominal pain started? Where were you?’
> ‘Has this activity preceded the pain on other occasions?’
> ‘Has the pain occurred before in that setting? How many times?’
Timing
The timing used to describe a primary complaint has three elements: onset,
duration and frequency. Onset refers to the time at which the primary complaint
begins and is usually described as gradual or sudden. Duration depicts the amount
of time for which the primary complaint is present. Continuous and intermittent
are terms that can be used to describe the duration of a primary complaint. When
possible, the duration of the primary complaint should be stated in specic time
increments, such as minutes, hours or days. Frequency describes the number of
times the primary complaint occurs and how often it develops (e.g. number of times
per day, season of year).
EXAMPLES OF QUESTIONS ASSESSING TIMING
> ‘When did the abdominal pain rst start? How long has it lasted? Do you still have it now?’
> ‘Did the pain come on suddenly or gradually?’
> ‘Is the pain continuous or intermittent? If intermittent, how much time elapsed between episodes?’
> ‘When was the last time you experienced this type of abdominal pain? Is the pain different in any
way from the rst time that you experienced it?’
> ‘How often does the pain occur in a week? In a month/year?’
> ‘Have you detected a pattern to the occurrence of the pain? Does it seem to be related to your
bowel movements or food you have eaten?’
Impact on quality of life
The last two pieces of information needed in the history are the meaning or
signicance of the primary complaint to the consumer and the impact that the
primary complaint has on the consumer. For example, the consumer may be
concerned because his or her father started having headaches at his or her age,
andsubsequently had a stroke.
Secondly, the impact that the primary complaint has on the consumer’s
lifestyle should be investigated. For example, consider the elderly consumer who
complains of minor headache but admits to cancelling routine activities because of
the headache. In this case, the condition is presented as mild, but its effects impact
signicantly on this consumer’s life.
EXAMPLES OF QUESTIONS ASSESSING IMPACT ON QUALITY OF LIFE
> ‘What does it mean to you when you have this pain?’
> ‘How do you see the pain affecting your lifestyle?’
Past health history
The past health history (PHH) or past medical history (PMH) provides
information on the consumer’s health status from birth to the present. The consumer
may think you are ignoring the reason for seeking health care. The following
statements can ease the transition.
EXAMPLES OF QUESTIONS ASSESSING PAST HEALTH HISTORY
> ‘I will get back to the reason for your visit today in a few minutes. Now I would like to ask some
questions related to your health in the past.’
> ‘Sometimes the reason for an illness is connected with your past health. Therefore, let’s discuss
your past health.’
THE COMPLETE HEALTH HISTORY INCLUDING DOCUMENTATION 67
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Medical history
The medical history comprises all medical problems that the consumer has
experienced during adulthood and their
well as serious episodic illnesses should be included. Forward or reverse chronology
can be used to describe the medical history as long as the approach is consistent
with the chronological format in the history. If the consumer denies medical
illnesses, rephrase your questions. Some consumers may discount ‘a little high
blood pressure’ as being insignicant, or the fact that they take medication for it as
no longer affecting them.
EXAMPLES OF QUESTIONS ASSESSING MEDICAL HISTORY
> ‘Do you currently receive treatment from a healthcare provider for anything?’ or ‘Have you ever
been diagnosed as having an illness? What was it?’
> ‘When was the illness diagnosed?’
> ‘What is the current treatment for this problem?’
> ‘Do you have any difculty following the prescribed treatment?’
> ‘Have you ever been hospitalised for this illness? Where? When? For what period of time?
Whatwas the treatment?
> ‘Have you ever experienced any complications (sequelae) from this condition? What were they?
How were they treated?’
How did you feel after the treatment?’
sequelae or aftermath. Chronic illnesses as
CHAPTER 3
Surgical history
Record a complete account of each surgical procedure, both major and minor,
including the year performed, hospital, physician and sequelae, if known.
EXAMPLES OF QUESTIONS ASSESSING SURGICAL HISTORY
> ‘Have you ever had surgery? What type?’
> ‘Who was your doctor at the time?’
> ‘When, where and by whom was the surgery performed?’
> ‘Were you hospitalised?’
> ‘Were there any complications? How were they treated?’
> ‘Are you currently receiving any treatment related to this surgery?’
> ‘Have you ever had an adverse effect from anaesthesia?’
CLINICAL REASONING
Allergies versus side effects
Many consumers report that they are allergic to specic medications. When questioned
further on the specic reaction to a medication, consumers frequently report symptoms
such as nausea, headache, diarrhoea and vomiting. While not discounting the consumer’s
experience with this medication, it is vital to keep in mind that these examples are
not drug allergies but adverse reactions to the medication. True drug allergies usually
manifest as urticaria, breathing difculties or anaphylaxis. The sorts of questions you
would need to differentiate between what consumers view as side effects or an allergy
would include:
> What happened when you took this drug?
> Did you have any breathing difculties, rashes, swelling in your face or limbs,
or a change in blood pressure?
> Did your doctor or treating team change your treatment because of this reaction,
oradvise you to never have this treatment in the future because of the reaction?
68 LAYING THE FOUNDATION
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UNIT 1
Allergies
Carefully explore all consumer allergies, which may include medications, topically
applied dressings or tapes, or things that touch the skin (e.g. latex in gloves),
animals, insect bites, foods and environmental allergens. Allergies are usually
written in a conspicuous location in red ink on the consumer’s physical chart in
order to stand out, or a bright sticker is placed on the chart and other visual triggers
are used indicating this consumer has an allergy (e.g. red arm band, medic alert
necklace, bracelet or tattoo). For the electronic medical record, once entered this
usually is made conspicuous on any subsequent screen related to this consumer.
EXAMPLES OF QUESTIONS ASSESSING ALLERGIES
> ‘Are you allergic to any medications? Animals? Foods? Insect bites? Bee stings?’
> ‘Are you allergic to anything in the environment?’
> ‘Are you allergic to anything that you touch?’
> ‘What symptoms do you get when you are exposed to this substance?’
> ‘What treatment do you use? Is it effective?’
> ‘Have you experienced any complications from the allergies? Which ones?’
> ‘Have you ever seen an allergist for this problem? What happened?’
> ‘Do you carry an EpiPen with you? Or have you ever needed adrenaline for anything?’
(for consumers with life-threatening allergies such as bee stings)
Medications
Past and present consumption of medications, both prescription and over-thecounter (OTC), can affect the consumer’s current health status.
CLINICAL REASONING
Natural remedies
Natural remedy products are consumed by more of the population than ever before.
Whether to improve health or combat illness and pain, this branch of complementary
and alternative medicine deserves the nurse’s attention. Glucosamine, ginkgo biloba,
chondroitin, ephedra, black cohosh and St John’s wort are just a few of the many
products that consumers ingest. As these products are considered dietary supplements
in NewZealand and Australia, they are not held to the same level of scrutiny and
accountability as medications. Different brands of the same herbal product can have
varying levels of potency and purity. Because many people consider these products to be
natural, consumers rarely consider the possibility of herbal products interacting adversely
with one another or with prescription medications. For this reason, consumers need to be
asked at every encounter which OTC herbal products are being consumed.
Prescription medication
EXAMPLES OF QUESTIONS ASSESSING PRESCRIPTION MEDICATION
> ‘What prescription medications are you currently taking? Who prescribed them?’
> ‘What prescription medications have you taken in the past? Who prescribed them?’
> ‘What is the dose? How often do you take this medication?’
> ‘How do you take this medication (e.g. pills, liquid, suppository, drops, inhaler, cream, ointment,
patch, injection)?’
> ‘For how long have you been taking this medication?’
> ‘Have you ever experienced any side effects with this medication?’
> ‘Have you ever had an allergic reaction to this medication? What happened?’
> ‘Tell me the purpose of this medication.’
THE COMPLETE HEALTH HISTORY INCLUDING DOCUMENTATION 69
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CLINICAL REASONING
Obtaining an accurate medication history – OTC products
Frequently, consumers discount OTC medications such as aspirin, paracetamol, ibuprofen,
vitamins, enemas, cold remedies and antacids. Ask the consumer whether such products
are used, because they can adversely interact with prescribed medications and with one
another. Also, women frequently overlook birth control pills and men discount medications
used for erectile dysfunction; keep this in mind when interviewing.
The outcome of the medication history may point to a need for consumer education.
Ifcontact is made with the consumer prior to the healthcare visit, ask the consumer to bring
in all medications currently being taken. This will allow you to identify all medications that
are in date and if the consumer’s account of what they take matches with the prescription
on the label. Many consumers keep unused medications past their expiration date. This
presents a potential health hazard because some medications lose their potency after a
period of time and others become toxic.
Over-the-counter medication
EXAMPLES OF QUESTIONS ASSESSING OVER-THE-COUNTER MEDICATION
> ‘Do you currently take any over-the-counter medications? Which ones?’
> ‘Why do you take this medication?’
> ‘Do you take any other remedies? For what purpose?’
> Repeat all but the rst and last questions from the ‘Prescription medication’ section.
> ‘Do you ever take aspirin, paracetamol, ibuprofen, antacids, calcium supplements, nutritional or
herbal supplements, vitamins or laxatives?
pills or cold medications?’ (
> ‘Do you consume any probiotics or diet supplements? Which? How much? How often?’
If yes, repeat all but the rst and last questions of the previous section.)
Do you douche? Administer enemas? Do you take allergy
CHAPTER 3
Communicable diseases
Communicable diseases can have a grave impact on the individual as well as
on society. Some communicable diseases generate enough of a concern to the
community that they are reportable to the public health department. The most
talked about communicable disease at present is human immunodeciency virus
(HIV), the virus responsible for acquired immune deciency syndrome (AIDS).
In recent years, there has also been a major focus on hepatitis C and the growing
number of consumers diagnosed with it. There is substantial value in asking the
consumer about possible exposure to communicable diseases, because pathology
may not manifest itself until many years after exposure.
EXAMPLES OF QUESTIONS ASSESSING COMMUNICABLE DISEASES
> ‘Have you ever been diagnosed with an infectious or communicable disease (e.g. syphilis, chlamydia,
herpes or other sexually transmitted infections), diphtheria, tetanus, pertussis (whooping cough)
ortuberculosis? Which one(s)?’
> ‘What were your symptoms?’
> ‘How were you treated?’
> ‘Did you have any complications? What were they? Were there any permanent consequences?’
> ‘Have you ever had hepatitis?’ (If yes, repeat the second, third and fourth questions.)
> ‘Have you ever been told that you are HIV positive or that you have AIDS?’ (If yes, repeat the second,
third and fourth questions.)
> ‘Do you have any tattoos or body piercings? Where were they done?’ Tattoos or piercings done in
sub-optimal conditions (e.g. many developing countries and unregistered studios/home studios) are
more likely to be a cause of concern or higher index of suspicion for exposure to a communicable
blood-borne disease.
> ‘Have you ever been exposed to someone who had a communicable disease? Which disease(s)?’
70 LAYING THE FOUNDATION
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UNIT 1
Injuries and accidents
A consumer’s injury and accident history can reveal a pattern that is amenable to
health promotion. For example, a teenager who sustains an injury from falling off his
skateboard without a helmet and other protective equipment would be a candidate for
health education. Consider the need to use a domestic and family violence screening
tool. Please have a look at current tools available from government or specialist
support agencies: https://www.justice.qld.gov.au/initiatives/end-domestic-familyviolence/our-progress/enhancing-service-responses/dfv-common-risk-safety-framework
EXAMPLES OF QUESTIONS ASSESSING INJURIES AND ACCIDENTS
> ‘Have you ever been involved in an accident?’ or ‘Have you ever been injured in any way?’
> ‘What occurred? Did you lose consciousness?’
> ‘Did you take any precautionary measures? What were they?’
> ‘Were you hospitalised? For how long?’
> ‘Were there any complications? What were they?’
> ‘Were there any long-term effects from this injury/accident?’
> ‘Have you ever sustained an injury in a car accident? Describe.’
> ‘Have you ever had a broken bone? Stitches? Burns?’
> ‘Have you ever been assaulted? Raped? Shot? Stabbed?’
> ‘Have you ever been bitten by an animal or insect (e.g. white tail spider, snake, tick)?’
Special needs
The awareness of any cognitive, physical (Figure 3.5) or psychosocial disability is
essential to providing individualised health care to a consumer. A consumer with
Down syndrome, a paraplegic and a consumer with intention to harm themselves all
have unique needs. These consumers may receive less than optimal health care if their
particular limitations are not identied and considered when planning treatment.
FIGURE 3.5 Consumers with physical special needs, such as a wheelchair or requiring assistance to mobilise,
need to have this documented in their health history.
EXAMPLES OF QUESTIONS ASSESSING SPECIAL NEEDS
> ‘Do you have any disability, impairment or special need? Can you describe this and how it affects you?’
> ‘What type of limitations does this disability/impairment/special need place on you?’
> ‘What strategies do you use to limit the effect the disability/impairment/special need has on
yourlifestyle?’
> ‘What support systems help you cope with this disability/impairment/special need?’
> ‘Does your disability/impairment/special need place an extra nancial burden on you? How do you
manage that?’
THE COMPLETE HEALTH HISTORY INCLUDING DOCUMENTATION 71
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Blood transfusions
The chance of contracting an infectious disease from a blood transfusion is greatest
in consumers who receive many transfusions, such as haemophiliacs, oncology
consumers and trauma victims. Blood collection agencies and other organisations
are continuously improving their screening tools and history-taking procedures to
protect the nation’s blood supply. Still, the recipient assumes some risk with every
transfusion. Tests are available to screen blood for hepatitis, HIV, and some other
viruses. Unfortunately, no approved diagnostic test is available to screen blood
for malaria and other infectious diseases. You will need to be mindful of cultural
considerations for those who have beliefs that preclude the acceptance of blood
transfusions, as even discussing this topic may cause discomfort for some.
EXAMPLES OF QUESTIONS ASSESSING BLOOD TRANSFUSIONS
> ‘Have you ever received a blood transfusion (whole blood or any of its components)? When?’
> ‘Why did you receive this blood product?’
> ‘What quantity did you receive?’
> ‘Did you experience any reaction to this blood product? What was it?’
Childhood illnesses
Rarely are adults familiar with a complete history of their childhood illnesses. Ask
the consumer about specic childhood diseases by name. Note: although COVID-19
is not considered a childhood illness, ensure that you assess the consumer’s history
with any communicable disease or virus.
CHAPTER 3
EXAMPLES OF QUESTIONS ASSESSING CHILDHOOD ILLNESSES
> ‘Have you ever had any of the following illnesses: varicella (chickenpox), diphtheria, pertussis
(whooping cough), measles, mumps, rubella, polio, rheumatic fever or scarlet fever?’ (This question
is eliminated if previously asked during the communicable diseases section.)
> ‘How old were you when the illness occurred?’
> ‘Was an actual diagnosis made? By whom?’
> ‘Were there any complications? What were they?’
Immunisations
The history of immunisations is closely tied to childhood illnesses. Most
immunisations are received in childhood, though some are targeted to adults,
pandemics, or when planning to travel. The adult consumer may not recall the
exact dates when the immunisations were given, as with childhood illnesses, but
should be generally aware that all the regular immunisations were received. Routine
immunisations are also associated with different groups. Healthcare workers are
frequently given the hepatitis A, B, C, varicella and tuberculosis vaccine, and most
recently the COVID-19 vaccines and their mandated boosters. Every April, the adult
population and other groups who are considered more susceptible are encouraged
to receive the inuenza vaccine. Vaccinating in April ensures protection for the peak
u season in the southern hemisphere. Vulnerable groups include children between
6 months and less than 5 years, adults over age 65, Aboriginal and Torres Strait
Islander peoples aged 6 months and over, those aged 6 months or over with specic
risk (e.g. solid organ transplant recipients, people with HIV or AIDS, people with
asplenia), pregnant women and those who are at high risk through occupational
exposure (e.g. those who work with the public, healthcare workers, childcare
professionals, commercial poultry and pork industry workers etc.) (Australian
Government Department of Health and Aged Care, 2022). In addition, travellers
to underdeveloped areas of the world receive numerous vaccines prior to visiting
specic regions. Immunisation schedules supported by government funding are
available across the life span. Review the latest immunisation schedule for further
information; this is also discussed in detail in Chapter 20, and websites are provided
at the end of this chapter.
72 LAYING THE FOUNDATION
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UNIT 1
Family health history
The family health history records the health status of the consumer, as well as that
of immediate blood relatives. At a minimum, the history needs to contain the age
and health status of the consumer, spouse, children, siblings and the consumer’s
parents. Ideally, if possible, the consumer’s grandparents, aunts and uncles should
be incorporated into the history as well.
The second component of the family health history is the report of occurrences
of familial or genetic diseases. Such information is crucial to the consumer and may
not have been revealed previously because some familial illnesses do not occur in
every generation.
CLINICAL REASONING
Practice tip: Family health history and cultural restraints
In some cultures (e.g. Aboriginal and Torres Strait Islander cultures), it is disrespectful to
speak of the dead. Thus, the consumer may be reluctant to provide detailed information
on the family health history of dead relatives. In these cases, you can ask the consumer
whether there is any history of specic diseases in the family, rather than focusing on any
specic deceased individual. The consumer may be willing to share in which previous
generation and on which side of the family the condition existed. If these approaches are
unsuccessful, explain to the consumer the importance of this information because it may
provide clues to current health conditions.
EXAMPLES OF QUESTIONS ASSESSING FAMILY HEALTH HISTORY
You may want to preface the family health history questions with the following statement:
Different diseases tend to run in families. I would like to ask you about your family and their
‘
health to gain a better understanding of your background.’
You can then continue with questions about the family health history:
> ‘Tell me about who makes up your family: spouse, children, siblings and parents.’ (Be aware and
prepared for consumers who have family issues, and who may become upset talking about their
family and those with whom they are no longer in contact.)
> ‘Do any of these individuals have any medical illnesses or diseases? What are they?’
> ‘Have there been any deaths in your immediate family? What was the cause of death? How old was
this person at the time of death?’ (Be aware that this may be an inappropriate question for some
cultural groups, and for those with recent deaths in the family.)
> ‘Has anyone in your family ever had any of the following illnesses? heart disease, sudden cardiac
death before age 50, hypertension, stroke, tuberculosis, diabetes mellitus, cancer, kidney disease,
blood disorders, sickle cell anaemia, arthritis, epilepsy, migraine headaches, gout, thyroid disease,
liver disease, asthma, allergic disorders, obesity, alcoholism, mental illness (schizophrenia,
depression), intellectual disability, drug addiction, AIDS, HIV infection’
Social history
The social history explores information about the consumer’s lifestyle that
canaffect health. You may have already gleaned some of this information in
discussing family in the previous section. If so, aim to add to rather than repeat
thesame information. Introduce this area of questioning with statements similar
tothefollowing.
EXAMPLE OF QUESTIONS ASSESSING SOCIAL HISTORY
> ‘Now I would like to ask you some questions about your lifestyle. This information is important
because of the effects that different practices can have on your health.’
THE COMPLETE HEALTH HISTORY INCLUDING DOCUMENTATION 73
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CLINICAL REASONING
Practice tip: Family health history for a consumer who was adopted
Consumers who were adopted have varying degrees of information about their biological
parents. Encourage adopted consumers to be frank about their family health history. If the
history of the biological parents is unknown, this is documented.
Likewise, the history of adoptive parents can be equally important. Certain environmental
factors (such as smoking, drug and alcohol use, and sanitation) may inuence the health of
the adopted child into their adult years.
Alcohol use
The intermittent and prolonged use of alcohol can interfere with normal
metabolism and normal body function.
EXAMPLES OF QUESTIONS ASSESSING ALCOHOL USE
> ‘How much alcohol do you drink per week?’
> ‘How often do you drink?’
> ‘What type of alcohol do you prefer (beer, wine, wine coolers, liquor, spirits)?’
> ‘Do you ever consume homemade alcohol or homebrew?’
> ‘What quantity do you usually consume at one time?’
> ‘Has your drinking pattern changed? In what way?’
> ‘When did you rst start to drink?’
> ‘How long have you been drinking the amount that you are currently consuming?’
> ‘At what time of the day do you drink?’
> ‘Have you ever lost consciousness or blacked out after drinking?’
> ‘Have you ever forgotten what happened when you were drinking?’
> ‘Do you drink alone?’
> ‘Do you drive after drinking?’
> ‘Did you ever drink during pregnancy? How much?’ (for women)
> ‘Do you think you have a drinking problem?’
CHAPTER 3
CLINICAL REASONING
Practice tip: The Alcohol Use Disorders Identication Test (AUDIT)
The Alcohol Use Disorders Identication Test (AUDIT) screening tool is easily administered
and can be used to assess a consumer’s likelihood of having an alcohol use disorder.
Thisisthe internationally developed tool that has translations in 40 languages and
signicant research supporting the validation of the tool.
There is a shortened version of this tool called the AUDIT-C (a three-question test) that
may also be used for a very quick assessment.
Have a look at these two tools at the following links:
> AUDIT: https://auditscreen.org/
> AUDIT-C: https://www.hepatitis.va.gov/alcohol/treatment/audit-c.asp#S1X
Tobacco use
Because of the harmful nature of tobacco products, the consumer’s use of tobacco
should be ascertained at each visit. If tobacco is used, it is the role of the nurse to
encourage the consumer to consider the benets of quitting. Many resources are
available to the nurse to assist the consumer in the smoking cessation process.
Seewebsites at end of this chapter.
Some providers quantify tobacco use in the number of packs per day (PPD) for
a specied number of years; for example, 2 PPD × 15 years. Additionally, if your
consumer uses alcohol and other drugs including tobacco, the Alcohol, Smoking
74 LAYING THE FOUNDATION
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UNIT 1
and Substance Involvement Screening Test (ASSIST tool) developed by the World
Health Organization may be best to use, and all these elements can be screened for
at the one time. Visit the following link to review this tool and support materials
published by the World Health Organization: https://www.who.int/publications/i/
item/978924159938-2
EXAMPLES OF QUESTIONS ASSESSING TOBACCO USE
> ‘Do you use or have you ever used tobacco (cigarettes [ltered or nonltered], pipe, cigars)?’
> ‘At what age did you start to use tobacco?’
> ‘What quantity do you use on a daily basis?’
> ‘Has this amount changed? In what way?’
> ‘Have you ever tried to quit? How many times? What method(s) did you use? What was the outcome?’
> ‘How long ago did you quit?’
> ‘Do you think you have a smoking (tobacco) problem?’
> ‘Do you live with someone who smokes?’
CLINICAL REASONING
Practice tip: Dealing with sensitive topics
How do you ask sensitive questions? Alcohol, drug use and sexual practices are some of
the most sensitive areas that are addressed in the health history. Here are some tips for
dealing with these sensitive topics:
> Ask these questions in the later stages of the interview after rapport has been established.
> Use direct eye contact (if culturally appropriate); this demonstrates the importance of the
topic to the consumer and your lack of embarrassment.
> Pose questions in a matter-of-fact tone.
> Adopt a non-judgemental demeanour. Be aware of your facial expression.
> Use the communication technique of normalising when appropriate (e.g. ‘Many high
school students drink alcohol or use drugs or engage in sexual relationships on a
regularbasis. Does this happen at your school? With you?’).
Drug use
The questions about use of drugs in this social history section of the complete
health history are not to be confused with the medication section under the
past health history, which includes the use and abuse of OTC and prescription
medications. The questions in this section refer to the use of illegal substances.
Youmay feel uncomfortable asking the consumer whether there has been drug use;
remind the consumer that the information will be kept condential and that the
withholding of information may delay necessary treatment.
EXAMPLES OF QUESTIONS ASSESSING DRUG USE
> ‘Do you use or have you ever used marijuana, amphetamines, hallucinogens, sedatives, cocaine,
crack, heroin, PCP, other inhalants (e.g. petrol or paint), or other recreational or street drugs?’
> ‘When did you rst start to use drugs?’
> ‘What amount and how often do you use?’
> ‘Has this changed? In what way?’
> ‘In what form do you use the drug (pill, needle, snort, sniff, other)?’
> ‘Describe how you inject the drug.’
> ‘Do you share needles? Do you clean the needles between uses? How?’
> ‘Have you experienced any health problems from the drug use?’
> ‘Have you ever overdosed? What happened?’
> ‘Have you ever been through a drug rehabilitation program? What was the outcome?’
> ‘Do you think you have a drug problem?’
THE COMPLETE HEALTH HISTORY INCLUDING DOCUMENTATION 75
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REFLECTION IN PRACTICE
Responding appropriately to sensitive information
Seventeen-year-old Charli is brought to the emergency department by her mother, who
explains that she heard a loud noise in the bathroom and ran upstairs to nd her daughter
unconscious on the oor, with her limbs shaking and jerking. Charli’s seizure lasted for
approximately 2 minutes. When Charli awoke, she had no memory of the seizure. Charli’s
mother is concerned as there is no history of epilepsy and she has not had a seizure before.
Charli’s mother excuses herself to go and provide some information to the administration
ofcer. While she is out of the room, Charli tells you that she takes MDMA occasionally.
Shethen asks, ‘Do you think that has anything to do with what happened?’
> How would you respond to Charli’s question?
> Do you exhibit any biases when working with people who take street drugs? Do these
biases interfere with your nursing care? If so, what actions do you take to control
yourbias?
> Explore the legal ramications of working with consumers who take illegal drugs in your
city or state. Are there special provisions if the consumer is a minor?
Domestic and intimate partner violence
Domestic and intimate partner violence (IPV) is violence that occurs
between family members. It can include intimidation, emotional abuse, isolation,
minimising, denying and blaming, using children to coerce, threaten or make the
partner feel guilty, sexual abuse, rape, male privilege, economic abuse or coercion
and threats (Services Australia, 2022). The latest research shows that women are
more likely than men to experience family, domestic and sexual violence.
In Australia, 1 in 6 women and 1 in 16 men have experienced physical and/or
sexual violence, 1 in 4 women and 1 in 6 men have experienced emotional abuse,
and 1 in 5 women and 1 in 20 men have been sexually assaulted or threatened by
a current or previous partner (AIHW, 2019). One woman is killed every nine days
and one man is killed every 29 days by their partner (AIHW, 2019). Family violence
among Australian Aboriginal and Torres Strait Islander communities occurs more
frequently than in the general population (AIHW, 2019).
In New Zealand, a survey of women found that intimate partner violence was
1 in 2 for Maˉori women and 1 in 3 for other women. Those aged 15–29 years were
the largest group of people experiencing sexual assault (66%). People who are
gay, lesbian or bisexual were more than twice as likely compared to the general
population to experience sexual or intimate partner violence. The majority of sexual
(94%) or family violence incidents (76%) were not reported to police (New Zealand
Ministry of Justice, 2020; New Zealand Ministry of Justice, 2015).
It is vital to be familiar with your country/state’s legal statutes regarding
mandatory reporting of actual and suspected violence and abuse.
Just as many healthcare providers advocate screening for tobacco and alcohol
use for both men and women at each healthcare encounter, some providers
recommend routine screening for domestic and intimate partner violence at every
healthcare encounter for women. Although men can be the victims of domestic
and intimate partner violence, the majority of victims are women. People may
not disclose violence unless asked about it and, even then, may initially answer
in the negative; however, over 94% of women found it acceptable to be asked
about abuse while pregnant (Special Taskforce on Domestic and Family Violence
in Queensland, 2015), and the rst antenatal visit appears to be the best screening
point for pregnant women (Dahlen, Munoz, Schmied & Thornton, 2018; Campo,
2015). In about half of all cases of women murdered, the perpetrator is a current or
ex-partner, and approximately 3 in 4 of these women had been assaulted previously
by the partner who killed them (Family Violence Death Review Committee, 2017).
CHAPTER 3
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