You are FY2 in GP surgery

Personal Details:

Name: Mrs Khan

Age: 28

Medical Record:

Past medical history: 12 weeks pregnant.

Notes:

A 28-year-old woman who is 12 weeks pregnant presented with a complaint of vaginal bleeding. On examination by the nurse, there was no bleeding, but multiple bruises were noted on her body. She appears anxious and withdrawn. The nurse is concerned about her.

Task:

1. Talk to the patient sensitively.

2. Discuss the management plan.

Opening Sentence: (Quietly, looking at the floor) “The nurse said my baby is okay. I just want to go home now.”

Open History (to give freely): (After being gently prompted about the bruises) “My husband… he has a temper. He gets stressed from work and drinks a bit too much. He kicked me this morning. I was so scared about the baby, that’s why I lied about the bleeding. He’s not a bad person; he’s just stressed. He’s always sorry afterwards.”

Cues to give: “Please don’t call the police. It will just make things worse. I have nowhere else to go. I depend on him for everything.”

ICE (Ideas, Concerns, Expectations):

Ideas: “I think if he just stopped drinking, it would be okay.”

Concerns: “What if he finds out I told you? Where would I go? I’m worried about my baby.”

Expectation: “I just want to go home and pretend this didn’t happen.”

How to Act: You are frightened, ashamed, and feel trapped. You are protective of your husband and make excuses for his behaviour. You are very reluctant to accept help.

More History (only if asked): The abuse has been happening for a while, but it has gotten worse since you became pregnant. Your family lives in another town. You have no friends nearby.

Social History: Unemployed, financially dependent on husband.

Creating a Safe Environment:

I want to assure you that everything you say to me is confidential.

Gentle, Direct Questioning:

I have to ask all women this, especially when they are pregnant. Is everything okay at home?

Is there anyone you are afraid of?

Did someone do this to you?

Risk Assessment (after disclosure):

Thank you for telling me. That must have been so hard. How long has this been happening?

Has he ever threatened you?

Are there any weapons in the house?

Are you safe to go home today? What do you think will happen if you go home?

ICE (Ideas, Concerns, Expectations):

What are you most afraid of right now?

What would you like to happen? In an ideal world, what would be the outcome you want?

Explain the situation:

Thank you for being so brave and telling me what is happening. I want you to know that you are in a safe place here, and everything you tell me is confidential. My priority is you and your baby’s safety. What is happening to you is not your fault. No amount of stress or alcohol is an excuse for violence. You do not deserve to be treated this way.”

Addressing and answering the patient’s ICE:

I hear that you don’t want to involve the police, and I will respect that for now. However, I am very worried about you. The violence often gets worse during pregnancy, and going back home now means you could be putting yourself and your baby at risk.

Next Steps:

We have a specialist domestic violence support worker. I would like you to speak with them. They are not a police officer and their job is only to support people in your situation. They can talk to you about your options in a way I can’t. They can arrange for you to go to a refuge, which is a secret and safe house for women and children fleeing violence. You would be safe there, and they would support you.

Safety plan:

In case you go back home today. I think we should make sure that you have a safe plan in place. A safety plan is about thinking about what you would do the next time you feel unsafe. It involves things like having a bag packed with essentials, knowing a safe place to go (like a friend’s house or a refuge), and having the number for a domestic violence helpline stored in your phone. The support worker can help you with all of this.

Confidentiality:

I will not tell your husband what you have told me, and he has no access to your record. No one would know anything about our conversation without your consent.

Please, let us help you. Let me introduce you to the support worker.”

The management is a safeguarding pathway. 1. State that it’s unsafe for her to return home without a safety plan. 2. Make an immediate referral to the domestic violence advisor (IDVA). 3. If she is not accepting a referral, state the legal duty to make a safeguarding referral to social services due to the risk to the unborn child. 4. Offer practical and emotional support.

What is scenario testing? This is a highly challenging safeguarding station. It tests the candidate’s ability to handle a disclosure of domestic violence with sensitivity and to follow a correct and safe safeguarding procedure. The candidate must balance respecting the patient’s autonomy with their professional duty to protect the patient and her unborn child from significant harm.