07 Trauma, Abuse, and Violence
A practical guide to trauma-informed nursing care, recognizing possible maltreatment, responding to disclosures, and supporting patient safety and choice.
Trauma may result from a single event, repeated events, or circumstances experienced as physically or emotionally harmful or threatening. Its effects vary: a person may show distress, numbness, fear, anger, difficulty concentrating, or no visible reaction.
recognizes possible effects of trauma, responds with awareness, and seeks to avoid retraumatization. It does not require a patient to disclose trauma or prove that it occurred.
In practice, nurses can:
Promote safety: Provide privacy, explain who is present, and ask what would help the patient feel safer.
Build trust: Explain what you are doing and why; be clear about confidentiality and its limits.
Offer choice and control: Ask permission before touching, examining, or asking sensitive questions. Offer choices when possible, and accept a patient’s decision to pause or decline.
Collaborate: Ask what the patient needs and include them in care planning.
Use a culturally responsive approach: Respect the patient’s identity, language, disability-related needs, and cultural context; use a qualified interpreter when needed.
Avoid retraumatization: Do not pressure the patient to recount details, blame them, or make promises you cannot keep.
These practices reflect principles of safety; trustworthiness and transparency; peer support; collaboration and mutuality; empowerment, voice, and choice; and attention to cultural, historical, and gender issues.
Recognizing possible harm
Abuse and violence can affect people of any age or background and may occur at home, in relationships, institutions, workplaces, or the community. Possible concerns include physical or sexual abuse; threats, coercion, stalking, or psychological abuse; neglect or abandonment; and financial or other exploitation.
Possible indicators include injuries with explanations that do not fit, repeated injuries, delayed care, fearfulness around a particular person, unmet basic needs, sudden changes in access to money or belongings, or a caregiver preventing private conversation. These cues warrant careful, respectful assessment; they do not, by themselves, establish that maltreatment occurred. Consider the whole clinical picture, the patient’s account, injuries, health needs, and safety.
When appropriate and safe, speak with the patient alone. Ask direct, nonjudgmental questions, such as, “Do you feel safe where you live?” or “Has anyone hurt, threatened, or controlled you?” Do not ask these questions in front of a person who may be causing harm.
Responding to disclosure or concern
When a patient discloses harm or there is a concern, address urgent medical needs and immediate danger first. Stabilize injuries and assess urgent risks, including threats of further harm or suicide. Follow emergency procedures if the patient is in immediate danger, and do not delay necessary medical care for evidence collection.
The offers a first-line response: Listen with empathy; Inquire about needs and concerns; Validate the person’s experience; Enhance safety; and Support connection to services. Avoid questions that imply blame, such as “Why didn’t you leave?” A nurse might say, “I’m glad you told me,” and “This is not your fault.”
Assess safety privately. Ask whether the person feels safe returning home, whether the person causing harm has access to them, and what they fear may happen next. Work with the patient on practical options. Do not pressure them to leave, report to police, or take another action unless law or an immediate safety emergency requires it.
Explain confidentiality and reporting limits before proceeding when possible, and do not promise absolute secrecy. Reporting duties and permitted disclosures vary by jurisdiction and situation. In the United States, follow state law, facility policy, and supervisory guidance. Child-maltreatment reporting rules commonly include health professionals, while adult-protection reporting requirements vary. Explain what information must be shared, with whom, and why.
Documentation and support
Use . Record the patient’s statements in their own words when relevant, observed findings, assessment, care offered, choices made, referrals, and required notifications. Separate what the patient reports from what you observe, and avoid speculation or conclusions about who caused an injury. Follow policy for body maps and photographs, including consent and secure handling.
With the patient’s agreement, offer connection to social work, advocacy, behavioral health care, shelter or safety-planning resources, or when appropriate. APS serves older adults and adults with disabilities and responds to reports that may involve abuse, neglect, self-neglect, or exploitation. Reporting pathways depend on local rules.
Sexual assault and forensic care
Offer timely medical assessment after sexual assault and explain options for treatment and a . Obtain informed consent for each part of an examination or evidence-collection process; a person may accept some care and decline other parts. Use a trained sexual assault nurse examiner or forensic clinician when available, and follow local protocols for evidence handling, reporting, and referrals. Maintain the person’s informed choice and ongoing control during the examination.
For example, a patient arrives with bruising and says, “My partner gets angry sometimes.” The nurse arranges a private conversation, treats the injuries, listens without pressing for details, and asks, “Do you feel safe going home today?” The nurse explains confidentiality limits, discusses options chosen by the patient, documents observations and statements objectively, and offers a warm referral to an advocate and follow-up care.