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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.

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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


I’m concerned that your injuries number of injuries sustained by women from car accidents, muggings and rapes combined.may have been caused by someone hurting you…..


I’m concerned that your injuries number of injuries sustained by women from car accidents, muggings and rapes combined.may have been caused by someone hurting you..

You do not deserve that.


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…… will come into contact with the victims of physical abuse resulting from domestic violence…….

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…… will come into contact with the victims of physical abuse resulting from domestic violence…….

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…… will come into contact with the victims of physical abuse resulting from domestic violence…….

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…… will come into contact with the victims of physical abuse resulting from domestic violence…….

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 will come into contact with the victims of physical abuse resulting from domestic violence…….

A Clinical Assessment of the Potentially Abused Client


Components of the assessment process
Components of the Assessment will come into contact with the victims of physical abuse resulting from domestic violence…….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
Assessment will come into contact with the victims of physical abuse resulting from domestic violence…….Indicators 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 will come into contact with the victims of physical abuse resulting from domestic violence…….

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 will come into contact with the victims of physical abuse resulting from domestic violence…….

  • 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 will come into contact with the victims of physical abuse resulting from domestic violence…….

  • 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 will come into contact with the victims of physical abuse resulting from domestic violence…….

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 will come into contact with the victims of physical abuse resulting from domestic violence…….

    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 will come into contact with the victims of physical abuse resulting from domestic violence…….

    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 will come into contact with the victims of physical abuse resulting from domestic violence…….

    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 will come into contact with the victims of physical abuse resulting from domestic violence…….

    • 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 will come into contact with the victims of physical abuse resulting from domestic violence…….

    • 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 will come into contact with the victims of physical abuse resulting from domestic violence…….

    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 will come into contact with the victims of physical abuse resulting from domestic violence…….

    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 will come into contact with the victims of physical abuse resulting from domestic violence…….

    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 will come into contact with the victims of physical abuse resulting from domestic violence…….

    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 will come into contact with the victims of physical abuse resulting from domestic violence…….

    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 will come into contact with the victims of physical abuse resulting from domestic violence…….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 will come into contact with the victims of physical abuse resulting from domestic violence…….

    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 will come into contact with the victims of physical abuse resulting from domestic violence…….

    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 will come into contact with the victims of physical abuse resulting from domestic violence…….

    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 will come into contact with the victims of physical abuse resulting from domestic violence…….

    Differences between cultures

    Yours is NOT theirs

    Parental/Social Support systems

    Are NOT yours

    Your view of current society

    Is NOT theirs


    Professional attitude
    Professional will come into contact with the victims of physical abuse resulting from domestic violence…….Attitude

    “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 will come into contact with the victims of physical abuse resulting from domestic violence…….

    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 will come into contact with the victims of physical abuse resulting from domestic violence…….

    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 will come into contact with the victims of physical abuse resulting from domestic violence…….

    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 will come into contact with the victims of physical abuse resulting from domestic violence…….

    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 will come into contact with the victims of physical abuse resulting from domestic violence…….

    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 will come into contact with the victims of physical abuse resulting from domestic violence…….

    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……..


    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 Ethical a bullet wound………. Requirements

    Governing Bodies

    Scope of Practice

    Facility regulations

    JCAHO

    American Medical Association

    State Law


    Legal and ethical requirements1
    Legal and Ethical a bullet wound………. Requirements

    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 Ethical a bullet wound………. Requirements

    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 Ethical a bullet wound………. Requirements

    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 Ethical a bullet wound………. Requirements

    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 Ethical a bullet wound………. Requirements

    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


    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


    Lisa number of injuries sustained by women from car accidents, muggings and rapes combined.

    1959-1995


    I’m concerned that your injuries number of injuries sustained by women from car accidents, muggings and rapes combined.

    may have been caused by someone hurting you..


    You do not deserve that. number of injuries sustained by women from car accidents, muggings and rapes combined.


    QUESTION number of injuries sustained by women from car accidents, muggings and rapes combined.

    QUESTION AGAIN

    KEEP QUESTIONING


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