And abuse often begins or escalates during pregnancy. No single sign usually marks patients as victims. Nurses need to be vigilant for subtle physical and psychological clues. Look for symmetrical bruises on the upper arms, wrists, and neck where a person might physically attempt to stop the victim from walking away. Check for nail marks or a swatch of hair missing from the woman's head, which she might try to hide under a hat or long bangs.
Victims often have bruises in various stages of healing.
Observation is key to recognizing patterns of abuse. Minor injuries often become extreme emergencies to a victim of abuse, while severe trauma may barely raise a concern. A victim may watch a partner for signs of approval before answering questions, or edge toward the opposite side of the stretcher when her partner walks near. A nurse may notice the patient's heart rate accelerate when the abusive partner enters the room and moves closer. None of these observations alone indicate abuse, but their presence warrants further exploration.