slide1
Download
Skip this Video
Download Presentation
I’m concerned that your injuries may have been caused by someone hurting you…..

Loading in 2 Seconds...

play fullscreen
1 / 59

I’m concerned that your injuries may have been caused by someone hurting you….. - PowerPoint PPT Presentation


  • 81 Views
  • Uploaded on

More women are injured by domestic violence than the total number of injuries sustained by women from car accidents, muggings and rapes combined. Battering is the most common cause of traumatic injury and death for a woman in the United States today.

loader
I am the owner, or an agent authorized to act on behalf of the owner, of the copyrighted work described.
capcha
Download Presentation

PowerPoint Slideshow about ' I’m concerned that your injuries may have been caused by someone hurting you…..' - dex


An Image/Link below is provided (as is) to download presentation

Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.


- - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - -
Presentation Transcript
slide1

More women are injured by domestic violence than the total number of injuries sustained by women from car accidents, muggings and rapes combined.

Battering is the most common cause of traumatic injury and death for a woman in the United States today

slide5

I’m concerned that your injuriesmay have been caused by someone hurting you..

You do not deserve that.

slide7

There will undoubtedly be times and incidents where you will come into contact with the victims of physical abuse resulting from domestic violence…….

AS FUTURE NURSES……

as future nurses
AS FUTURE NURSES……

AN AMBULANCE OR POLICE OFFICER WILL HAVE BROUGHT THEM INTO YOUR HEALTHCARE FACILITY. PERHAPS THEIR PARTNER HAS BROUGHT THEM.

THEY WILL NEED ALL OF YOUR KNOWLEDGE, SKILL, AND COMPASSION TO DEAL WITH WHAT HAS HAPPENED TO THEM PHYSICALLY, EMOTIONALLY AND MENTALLY.

as future nurses1
AS FUTURE NURSES……

YOU WILL BE READY AND WILLING TO PROVIDE THAT….

BUT ALSO IN YOUR NURSING CAREER YOU WILL MOST ASSUREDLY BE CONFRONTED BY ANOTHER TYPE OF VICTIM.

THIS VICTIM WILL ARRIVE ALONE AND NOT SEEM TO BE IN EXTREME DISTRESS. THEY WILL OFFER AN EXPLANATION FOR THEIR INJURIES THAT MAY NOT FIT WITH WHAT YOU FIND ON EXAMINATION.

as future nurses2
As Future Nurses……

THEY WILL ALSO NEED THE BEST OF YOUR SKILLS AND KNOWLEDGE.

THEY MAY NEED AN EVEN BIGGER DOSE OF COMPASSION. IT HAS TAKEN A LOT OF COURAGE FOR THEM TO SHOW UP AT YOUR FACILITY.

IT WILL REQUIRE COURAGE ON YOUR PART AS WELL, TO FULLFILL YOUR ROLE AS NURSE.

as future nurses3
As Future Nurses……

WE WILL PRESENT SUCH A VICTIM.

WE WILL DISCUSS THE PRESENTING ASPECTS OF THE PATIENT, THE ASSESSMENTS AND FINDINGS, AND FINALLY…..

THE OBLIGATIONS OF THE HEALTHCARE PROVIDER WHO FINDS THEMSELVES WITH SUCH A PATIENT.

the nursing process in cases of suspected abuse
The Nursing Process in Cases of Suspected Abuse

A Clinical Assessment of the Potentially Abused Client

components of the assessment process
Components of the Assessment Process
  • Client presentation and non verbal communication
  • Physical assessment and evaluation
  • Neurological assessment and evaluation
  • Screening interview and Verbal Responses
assessment indicators in cases of suspected abuse
AssessmentIndicators in Cases of Suspected Abuse

Common Abuse type Injuries

  • Multiple Injuries
  • Bruising on the chest, abdomen or genital area
  • Minor lacerations
  • Injuries during pregnancy
  • Ruptured eardrums
  • Patterns of repeated earlier injury
  • Delay in seeking medical attention
assessment indicators in cases of suspected abuse1
Assessment Indicators in Cases of Suspected Abuse

Other indicators of Abuse

Client appears ashamed or evasive

Gives an unconvincing explanation of her injuries

Has recently been separated or divorced

Seems uncomfortable or anxious in the presence of her partner

Is reluctant to follow your advice

Presents with children though little is wrong with them

Presents at a facility outside their home area

initial client presentation
Initial Client Presentation
  • Client presented to the facility at 0915 complaining of injuries to her hands and knees
  • Physical Profile
    • 32 year old Caucasian female
    • Married with one child, age 5
    • Home address approximately 25 miles from facility
    • Well dressed and well groomed
    • Good initial physical condition
initial client presentation1
Initial Client Presentation
  • Client reported falling off her bike while riding home from the library this am.
  • Client stated it was “her fault” and no vehicles or other persons were involved.
physical assessment and evaluation
Physical Assessment and Evaluation

Initial Client Evaluation

  • Bruising on Breast
      • Two bruises noted
        • Left 2.5 cm
        • Right 3.0 cm oblong
          • Both bruises found to have yellow and green margins
  • Palpation of Ribs and Soft tissue
      • No rib fractures noted
      • Extreme tenderness over and around bruised areas
physical assessment and evaluation1
Physical Assessment and Evaluation

Initial Client Evaluation

  • Abdominal Bruising
      • Large 8 cm deep bruise in upper right quadrant
  • Upper thighs
      • Left thigh
        • 7 cm rectangular deep bruise
      • Right Thigh
        • 4 cm egg shape bruise with yellow and green coloration at margin
physical assessment and evaluation2
Physical Assessment and Evaluation

Initial Client Evaluation

  • Bilateral hand and knee abrasions with kitty litter size gravel deeply embedded in wounds
  • Puncture wounds
    • Two 0.2 cm wounds about 0.3 cm deep located on left scapula
      • Each wound has streaks of blue ink radiating in a downward direction
physical assessment and evaluation3
Physical Assessment and Evaluation

Initial Client Evaluation

  • Questions raised by physical assessment
    • Is there trauma to the liver?
    • Is there trauma to the Ribs or underlying structure?
    • Internal Bleeding?
    • Were the puncture wounds due to a pen being used as a weapon?
    • Is there Partner Violence occurring?
neurological assessment and evaluation
Neurological Assessment and Evaluation
  • Assessment of Neuromuscular involvement
    • Evaluation of cranial nerve functions
  • Assessment of Mental Processes and Emotional State
    • Evaluation of the appropriateness of client responses and orientation

Provides Two main functions

neurological assessment and evaluation1
Neurological Assessment and Evaluation
  • Focus of Assessment
    • Client claimed a fall from a bicycle
      • Potential for hidden head or spinal injury
  • Suspected Abuse
    • Potential for hidden deficits
    • Potential for hidden injuries of the scalp and neck
verbal assessment
Verbal Assessment

The Tie that Binds

Connects all parts of the assessment process into a whole

Clarifies, defines and guides the assessment process

verbal assessment1
Verbal Assessment

Listening to what is NOT said

Tone, pitch and volume of voice will give clues to Client’s internal feelings.

Fear

Anxiety

Pain

verbal assessment2
Verbal Assessment

Listening to what is NOT said

  • Pitch and volume
    • Another clue to internal feelings
  • Fear
    • Voice can be very quiet or very loud
  • Anxiety
    • Shaky, vocal quiver, stuttering, stammering or high pitch
  • Pain
    • Difficulty speaking, holding of breath or gasping talk
verbal assessment3
Verbal Assessment

Presentation Phase

Nurse reviews available data

Seeks out and asks for advice from other healthcare team members

Arranges privacy for client communication

Orientation Phase

Sets the tone for the relationship by adopting a warm, empathetic, caring manner

Closely observes client during the interview

Prioritize the client’s problems and goals

verbal assessment4
Verbal Assessment

Working Phase

Encourage client to express feelings about their health or situation

Provide information needed to understand and change behaviors

Identifies Diagnosis, interventions and goals

Take action to meet the goals set with the client

Remind client your time with them is almost up

Evaluate goal achievement with client

Achieve a smooth transition for the client to other healthcare team members

Termination Phase

the nursing response
The Nursing Response

Wound Care Priorities

Client Education and Assistance

Dealing with your OWN feelings

Ethical and Legal Standards and Requirements

wound care priorities
Wound Care Priorities

Bruises on Abdomen, Thigh and Breasts

Older pre-existing injuries

Abrasions with contamination on hands and knees

Puncture wounds on left scapula

dealing with your own feelings
Dealing with your OWN feelings

Acknowledge and address your own feelings

Seek out other healthcare professionals to speak to about your feelings

Understand Cultural and Ethnic Differences and embrace them

Keep a Professional Attitude, remember Empathy NOT Sympathy

dealing with your own feelings1
Dealing with your OWN feelings

Acknowledge and address your own feelings

Shock and disbelief

Anger

“Why did this happen”

Use your Peers and other assets to assist you in dealing with your feelings

Peers

Clergy

Counselors

understand cultural and ethnic differences
Understand Cultural and Ethnic Differences

Differences between cultures

Yours is NOT theirs

Parental/Social Support systems

Are NOT yours

Your view of current society

Is NOT theirs

professional attitude
ProfessionalAttitude

“BE”

NON-JUDGEMENTAL

Use compassion and touch

CARING

about the WHOLE person

They are NOT a collection of symptoms or problems

ADVOCATE

BE a solution for the client

client education and assistance
Client Education and Assistance

I’m concerned that your injuries may have been caused by someone hurting you..

You do not deserve that.

client education and assistance1
Client Education and Assistance

Approaching the Suspected Abuse Victim

  • Using a Framing Question
      • Over the past several years, domestic violence has become more of a health issue than ever before. Because of this I have started asking all my clients about it.
      • I’m concerned that your symptoms may have been caused by someone hurting you.. You do not deserve that.
      • I don’t know if this is a problem for you, but many of the women I see as patients are dealing with abusive relationships. Some are too afraid or uncomfortable to bring it up themselves, so I have started asking about it routinely.
client education and assistance2
Client Education and Assistance

Acknowledge

Abuse does not go away

“You may not be ready to leave him yet”

Advocate for

Client safety

Clients right to make their own decisions

Validate the client

Concern for the CLIENT

“You did nothing to deserve this”

Clarify

“What he does to you is wrong”

“You are not at fault”

client education and assistance3
Client Education and Assistance

Use all phases of the Nursing Relationship

NOW is your time to make a difference in the clients life

Be non-judgmental

The focus is wholly on the client and HER decisions

Be Supportive

Offer options and alternatives

Use the Termination Phase to transition client to specialized team members

client education and assistance4
Client Education and Assistance

Abuse is an interdisciplinary healthcare issue

Immediately assess the safety risk to the client.

Support the client in her decision REGARDLESS of what it is.

Immediately involve the Partner Violence Liaison

Ease client’s transition from your care to the Liaisons care.

If none is available..

Offer to call a Domestic Violence Counselor

Assist client in placing the call

Stay with the client until the counselor arrives, transportation has been arranged, or the client has chosen to leave.

client education and assistance5
Client Education and Assistance

Know who to call

Keep current on your facilities requirements

Become educated as a healthcare provider on the treatment and interventions for the victim of Domestic Violence

Most of all…

Care……..

slide41
It shall be the duty of every licensee who attends or treats a bullet wound……….

or any other injury that the licensee has reason to believe involves a criminal act, including injuries resulting from domestic violence, to report such injury at once to the police of the city, town, or city and county or the sheriff of the county in which the licensee is located.

Any licensee who fails to make a report as required by this section commits a class 2 petty offense……

Colorado State Statute 12-36-135

legal and ethical requirements
Legal and EthicalRequirements

Governing Bodies

Scope of Practice

Facility regulations

JCAHO

American Medical Association

State Law

legal and ethical requirements1
Legal and EthicalRequirements

Information for local assistance

Make available hot line numbers to shelters and domestic abuse assistance programs.

Caution The client to keep the phone number someplace safe and free from detection.

Information for client education

Offer the client web sites that give information concerning domestic abuse and agencies that can help.

Caution the client to clear the history after using the computer so web sites visited are not obvious to another user.

Offer written materials on breaking the circle of violence.

legal and ethical requirements2
Legal and EthicalRequirements

If you believe after examination and the client admits it to you, You must report it

Your examination leads you to believe it is abuse BUT the client denies it…

WHAT CAN YOU DO?

legal and ethical requirements3
Legal and EthicalRequirements

You MUST report it.

You MUST document that you reported it and to whom you reported.

You MUST document in exquisite detail your examination findings.

legal and ethical requirements4
Legal and EthicalRequirements

R. A. D. A. R.

R ….REMEMBER to routinely ask questions about partner violence

A ….ASK directly with specific Questions

D ….DOCUMENT the injuries (including photographs if client allows it)

A ….ASSESS the clients safety

R ….REVEWING options with the client

legal and ethical requirements5
Legal and EthicalRequirements

What is legal is NOT always ethical

KNOW your reporting will help the client

Remember caring for an abused client is an interdisciplinary task and the decision most likely will not be yours alone to make

slide48

More women are injured by domestic violence than the total number of injuries sustained by women from car accidents, muggings and rapes combined.

Battering is the most common cause of traumatic injury leading to death for a woman in the United States today

slide56

Lisa

1959-1995

slide57

I’m concerned that your injuries

may have been caused by someone hurting you..

slide59

QUESTION

QUESTION AGAIN

KEEP QUESTIONING

ad