Exam 2

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human papillomavirus infection HPV

HPV vaccine STD

Hanging strangulation

Hanging occurs when a person is suspended with a ligature around his or her neck, which constricts due to the gravitational pull of the person's own body weight

nursing roles

ADPIE

communicable disease history

1900- communicable diseases were leading causes of death in US 2000: Improved sanitation, hygiene, vaccines, and antibiotics reduced mortality related to communicable diseases HIV, TB and diarrheal diseases are tope 15 causes of mortality Chronic diseases have replaced communicable diseases as leading causes of death in US

Elder Abuse

"Intentional or neglectful acts by a caregiver or any other person that causes harm or a serious risk of harm to a vulnerable adult" Physical abuse Neglect Emotional or psychological abuse Verbal abuse and threats Financial abuse and exploitation Sexual abuse Abandonment

Virginia Lynch

"It is important to emphasize that the forensic nurse does not serve as a criminal investigator; this function remains outside the boundaries of nursing practice. Forensic nurses do not compete with, replace, or supplant other practitioners - rather, they fill voids by performing select forensic tasks in cooperation with other health and justice professionals."

oldest old

85-100 approximately 40%

Role of the Forensic Nurse

"The application of nursing science to public or legal proceedings, and the application of forensic health care in the scientific investigation of trauma and/or death related to abuse, violence, criminal activity, liability, and accidents. (IAFN) Forensic Psychiatric Nurses Death Investigators Forensic Legal Nurse Consultants Sexual Assault Nurse Examiner (SANE)/Forensic Nurse Examiner (FNE): Pediatrics, Gerontology Interpersonal Violence

ligature strangulation

(any type of cord-like object) strangulation occurs when the pressure applied around the neck is with a ligature only

globally emerging communicable diseases

-Ebola hemorrhagic fever -Legionnaires' disease (legionellosis) -Hantavirus -E. coli O157:H7 -Lyme's disease -Dengue fever

Universal Imperatives of Care

-mortality (1st priority) -morbidity -daily functioning -decision making -cost -access

sources of data

-routinely collected data (census data, vital records) -data collected for other purposes (medical records) -original data collected for specific epidemiologic studies

Forensic Nurses - History and Program Development

18th Century: Practicing aspects of forensic nursing originates Before the French Revolution (circa 1789), nurses testified in court about sexual assault and pregnancy 1970's: Concerns over treatment of SA victims presenting in the ED 1976: First Sexual Assault Nurse Examiner (SANE) program in Tennessee 1991: Recognized as a specialty by the America Academy of Forensic Science 1992: International Association of Forensic Nurses was founded Mid-1990's: SANE programs began to develop rapidly 1995: American Nurses Association granted forensic nursing specialty status 1997: Publication of Standards and Scope of Forensic Nursing Practice 2004: National Protocol for Sexual Assault Medical Forensic Examination released by the U.S. DOJ, Office of Violence Against Women. 2013 - updated, 2nd Edition released 2016 the first National Protocol for Sexual Abuse Medical Forensic Examinations Pediatrics

role of CHN in preventing disasters

3 levels

principles of triage

4 priorities

young-old

65-75

old-old

75-85

2 types of SANE certifications

A (Adult) P (Peds)

Carter Center

A leader in the eradication and elimination of diseases, the Center fights six preventable diseases - Guinea worm, river blindness, trachoma, schistosomiasis, lymphatic filariasis, and malaria in Hispaniola • The Center uses health education along with simple, low-cost methods • The Center also strives to improve access to mental health care

Photography

ALS Documentation: o area that luminated •Photos Documentation: o patient identifier o pictures of patient, including a face shot to provide additional identification of patient o any damage to clothing items or any items worn by patient o take photos in a systematic order (head to toe, front to back) o photographs for each injury (distance demonstrates anatomical location, close shot without measuring device, close shot with measuring device)

global impact

According to World Health Organization (WHO), three diseases are responsible for half of all infectious diseases each year (approximately 5 million) HIV/AIDS TB Malaria

anthrax

Acute bacterial disease that affects mainly the skin (cutaneous) or respiratory tract (inhalation) Case Fatality: 5% to 20% for cutaneous; 100% for inhalation

disease reporting in GA

All physicians, laboratories and other health care professionals are required by law to report conditions listed under the Notifiable Disease Reporting Requirements Both laboratory and clinical diagnoses are reportable within specified time intervals Most diseases are reportable within 7 days Diseases that need to be reported immediately are done through a telephone call to the public health district

Common Health Problems of Older Adults

Alzheimer's disease Arthritis Vision and hearing loss Heart disease Hypertension Diabetes

Waterborne Diseases

An outbreak occurs if two or more persons experience a similar illness after consuming contaminated water Examples Hepatitis A Cholera Yemen Typhoid fever (can be from food also) The Doctors Bacillary dysentery

Physical Assessment

Assess medical stability / medical condition - ABCs First!!!! Evidence collection/Forensics on stable patients Perform head to toe assessment for identification of injury Injuries suspicious of abuse Oral and dental injuries Central body pattern injuries Defensive posturing injuries Bilateral or multiple injuries Injuries during pregnancy Strangulation injuries Patterned injuries Pelvic/genital injuries Multiple injuries in various stages of healing

Nursing Process for Communicable Disease Control

Assessment - Case identification, case finding, comprehensive, no assumptions, community's need for surveillance or new or improved control programs Planning - Assisting with immunizations, symptom relief, controlling disease if present, limiting exposure, collaboration Implementation - Service delivery, supervision of staff, agency functions, primary prevention education for future infections, record keeping and reporting Evaluation - What was the outcome? Did you get what you expected?

Providing Prevention and Care for Communicable Diseases

At all levels of prevention, the nurse functions in following roles: Counselor Educator Advocate Case manager Primary care provider

Healthy People 2020 4 goals

Attain high-quality, longer lives free of preventable disease, disability, injury, and premature death. Achieve health equity, eliminate disparities, and improve the health of all groups. Create social and physical environments that promote good health for all. Promote quality of life, healthy development, and healthy behaviors across all ages.

private settings nurse center models

Bethesda Community Clinic

Emerging Infectious Diseases

Diseases in which the incidence has increased in the past several decades or has the potential to increase in the future Ebola virus MRSA HIV/AIDS SARS Hantavirus (pulmonary syndrome)

Re-Emerging Infectious Diseases

Diseases that once were a major health problem globally or in a particular country and then declined, but are becoming significant health problems again Tuberculosis Malaria Syphilis Whooping cough

Which of the following reflects the goal of service programs for healthy older adults? −A. Provision of necessary care −B. Comprehensiveness of services −C. Maintenance of functional independence −D. Ensured access to care

C. Maintenance of functional independence Rationale: The goal of services for healthy older adults focuses on maintaining the adults' functional independence. Comprehensiveness and accessibility are criteria for effect service delivery. Provision of care reflects the activity of a service.

CHN in an Aging America

Case management for resources and referrals Development of creative living arrangements and services Encouragement of healthy lifestyle changes to avoid disease and disability Education about immunizations and safety measures including fall prevention

Home Health Nursing Case Management

Case manager for each client Responsible for coordination of other professionals and paraprofessionals involved in the client's care Case conferencing with team members (Medicare mandate—every 60 days) Supervising paraprofessionals Knowledge of reimbursement for services

Vector-borne diseases

illnesses for which infectious agent is transmitted by a carrier (vector) lyme disease (tick) Rocky Mountain spotted fever (ticks) Malaria (mosquitos) Zika Virus (mosquitos) Prevention and control vector borne diseases Prevent exposure Use repellents Vector control

herd immunity

immunity of the group, basis for increasing immunization coverage

Criteria for Effective Health Services

Comprehensiveness Adequate financial support Adult day care programs Access to high-quality health care services Health education (including preparation for retirement) In-home services Recreation and activity programs Specialized transportation services Coordination Accessibility Promotion of quality programs

The Medical Forensic Examination

Consent History Physical Assessment Injury Identification Evidence Collection Medication Administration Documentation

Endemic

Consistent presence of a disease in a specific geographic region

Palliative care

Consists of comfort and symptom management Does not provide a cure As any care, primarily intended to relieve the burden of physical and emotional suffering that often accompanies the illnesses associated with aging

CJCC Purpose

Created by the Georgia General Assembly in 1981 as an Executive Branch agency, the Criminal Justice Coordinating Council (CJCC) represents the culmination of many efforts to establish a statewide body that would build consensus and unity among the State's diverse and interdependent, criminal justice system components. CJCC is legislatively charged with eleven areas of criminal justice coordination. Among those responsibilities is to serve as the statewide clearinghouse for criminal justice information and research; develop criminal justice legislative and executive policy proposals; and serve in an advisory capacity to the Governor on issues impacting the criminal justice system.

active immunization

immunization, antibodies develop

Disability

impairments, activity limitations, or participation restrictions

Medicare Criteria and Reimbursement home health

Criteria: Service type and frequency reasonable & necessary Client homebound Plan of care on Medicare forms Client in need of skilled service (observation, assessment, teaching, performing selected procedures) Service intermittent and part-time Episode of care: 60 days Admission: assessment using Outcome and Assessment Information Set (OASIS) Medicare documentation: OASIS, Medicare Plan of Care

older adult nationally

inc life expectancy females>males

measurement of relative risk ratio:

incidence rate in exposed group/incidence rate in unexposed group

specificity

indicates how accurately the test identifies those without the condition or trait; true negatives

general nursing

individual-based grounded in a relationship of caring focuses on individual good (patient) restoration of health and function manage resources at hand take care of clients who come to them commitment to individual patient

Types of Partner/ Spousal Violence

Dating violence •Spousal abuse, intimate partner violence, or domestic abuse •Physical, sexual, emotional, economic or psychological •Pattern of abusive behaviors in any relationship where one partner gains or maintains power and control over another intimate partner •Violence in pregnancy •Prenatal visits are an important opportunity to identify victims of violence

Scope of Practice home health

Direct care: refers to the actual physical aspects of nursing care - anything requiring physical contact and face-to-face interaction: Performing a physical assessment on the client Changing a dressing on a wound Giving medication by injection Inserting an indwelling catheter Providing intravenous therapy Teaching clients/family how to perform a task Indirect care: activities a nurse does on behalf of client to improve or coordinate care: Consulting with other nurses and health providers in a multidisciplinary approach to care Organizing and participating in client care team conferences Advocating for clients with the health care system and insurers Supervising home health aides Obtaining results of diagnostic tests Documenting care

subclinical stage

individuals are exposed but asymptomatic, incubation and induction periods

Primary Prevention communicable diseases

Education Use of mass media Targeting meaningful health messages to aggregates Immunization Vaccine preventable diseases and schedule Assessing immunization status of community (possible barriers); planning and implementing immunization programs Adult immunizations

Health Needs of Older Adults (cont.) Secondary prevention

Education on preventive measures and positive health behaviors (routine screenings; see Table 24.1)

Pandemic

Epidemic that is world wide

Strangulation - Physics

Exact anatomic location of applied force Duration of applied force Quantity of applied force (Pounds of Pressure) Surface area of applied force (manual vs. ligature) Documentation! Documentation!! Documentation!!!

entrepreneurial health care system

industrialized countries based on a country's political economy operate from an individualistic perspective

Sexually Transmitted Infections

Factors associated with risk for STIs Younger than 25 years Member of minority group Residing in an urban setting Being impoverished Substance use Unsafe sex practices Women have higher risks of complications from STI (PID, sterility, cancer) Can be transmitted to neonate

Families With a Family Member who is Disabled or Chronically Ill

Family and advocacy Impact on the family: obstacles, such as assistive devices and technology and financing, respite care, entitlements, loss of work, caregiver health, and mental health status Universal design: ensuring access

intensity of disaster

level of destruction and devastation it caused

Health Needs of Older Adults (cont.) tertiary prevention

Follow-up and rehabilitation Health issues: Alzheimer's disease, arthritis, cancer, depression, diabetes, cardiovascular disease, osteoporosis

pluralistic health care systems

Found in most developing countries -Traditional healing systems -Lay practices -Household remedies -Transitional health workers -Practitioners of Western medicine late 1970s: adoption of primary health care approach

international council of nursing ICN

Founded in 1899, ICN is a federation of more than 130 national nurses associations (NNAs) • World's first and widest reaching international organization for health professionals • ICN works to ensure quality nursing care for all • Latest initiative: The Girl Child Education Fund (GCEF) supports the primary and secondary schooling of girls under the age of 18 in developing countries whose nurse parent or parents have died

Getting the History

Frequent ED visits Delay in seeking care/passing other hospitals to reach yours Chronic/exaggerated pain Vague symptoms Depression Eating disorders Suicide attempts Chronic substance misuse - alcohol or drug addiction Stress related symptoms (fatigue, anxiety, headache, difficulty concentrating) PTSD symptoms (hyper-vigilance, exaggerated startle reflex, difficulty sleeping) Known hx of abuse in household Spontaneous abortion, multiple pregnancy, (which can also be close together) Reproductive coercion, birth control sabotage

Healthy People 2020 Goals

Goal is to prevent unintentional injuries and and violence and reduce their consequences •Factors that affect violence include •Individual behavior •Physical environment •Access to services •Social environment •Societal level factors

Services for Healthy Older Adults

Goal: maintenance of functional independence Living arrangements and care options Day care and home care services Arrangements based on level of care ▪Skilled nursing facilities ▪Long-term care services ▪Intermediate care; assisted living ▪Personal care homes ▪Continuing care retirement communities Respite care services Hospice and palliative care

priority 1 triage

life threatening, will likely survive if stabilized

Health Needs of Older Adults Primary prevention

Health education; follow-through of sound personal health practices; recommended immunizations (see Immunization Schedule in D2L) Nutrition, oral health, exercise, safety needs Economic security needs Psychosocial needs: coping with multiple losses, maintaining independence, social interaction, companionship, and purpose Spirituality, advance directives, hospice, palliative care, and preparing for death

Roles of the Parish Nurse

Health educator Health counselor Advocate Referral agent Developer of support groups Coordinator of volunteers Integrator of faith and health

Faith Community Nurse Activities

Health ministries: activities and programs in faith communities organized around health and healing to promote wholeness in health across the life span; services may include: Visiting the homebound Providing meals for families in crisis Participating in prayer Volunteering in community AIDS care groups Serving "healthy heart" church suppers Holding regular grief support groups

Functions of School Nursing Practice

Health services for individuals with chronic conditions Prevent and promote health Health education and promotion Promotion of healthful school environment

examples of nursing positions that use epidemiology

nurse epidemiologist, school nurses, communicable disease nurse, environmental risk communicators, hospital infections control nurse all nursing documentation on patient charts and records is an important source of data for epidemiologic reviews

Community Health Nurse's Role communicable diseases

Help with Investigating reportable communicable disease using systematic approach Review information Clarify disease is suspect or lab confirmed Review case definition Review disease information Use specific questionnaires when available

Home Hospice

Hospice movement to humanize end-of-life experience and provide carative, palliative care (relief of suffering without curing underlying disease) Four major changes in end-of-life care: Caraitive treatment should attend to body, mind, and spirit. Death must not be a taboo topic. Medical technology should be used with discretion. Clients have a right to truthful discussion and involvement in treatment decisions

ageism common misconceptions about older adults

Inability to live independently Chronologic age as a determinant of oldness Most with diminished intellectual capacity or senility All content and serene Inability to be productive Resistant to change No social security on retirement

Sexual Abuse

Includes acts of sexual assault or sexual exploitation (intrafamilial versus incest)

Home Care

Includes disease prevention, health promotion, and episodic illness Is an approach to care provided in people's homes because theory or research suggests this is the optimum location for certain health and nursing services

Healthcare Associated Infections

Infections acquired during hospitalization or any health care setting May involve patients, health care workers, visitors Also called nosocomial infections, hospital acquired infections UTI, surgical infections, and pneumonia most common Bacteria: staph (blood), ecoli (UTI), enterococci(blood, UTI, wound), pseudomonas (all) Universal Precautions

Physical Abuse

Intentional harm to a child by another person that results in pain, physical injury, or death

IAFN

International Association of Forensic Nurses

Forensic Issues In Our Community

Intimate Partner Violence (IPV) •Sexual Assault •Child Abuse: sexual, physical, and neglect •Elder Abuse: sexual, physical, neglect, and dependent adult abuse

Family Caregiving

It is essential to work with the family in the provision of care to an individual client Family is defined by the individual and includes any caregiver or significant person who assists the client in need of care at home Family caregiving includes assisting clients to meet their basic needs providing direct care such as personal hygiene, meal preparation, medication administration, and necessary treatments

Characteristics of Healthy Older Adults

Lifetime of healthy habits Strong social support system Positive emotional outlook Affected by personality traits, life experiences, current physical health, and current societal supports

community health nursing opportunities

Major responsibility for managing health services in health centers, clinics, schools, workplaces, and community settings • Settings ranging in population density and complexity from remote areas to major cities - Large and small organizations - Global Health Council: career opportunities, career seminars - Campus Office of Global Affairs: opportunities overseas

Shaken Baby Syndrome

Medical symptoms include bilateral retinal hemorrhage, subdural or subarachnoid hematomas, and the absence of other external signs of abuse Other symptoms can include breathing difficulties, seizures, dilated pupils, lethargy, and unconsciousness

Hospice Services and Reimbursement

Medicare hospice benefit: terminal prognosis (6 months or less), sign up for comfort-focused hospice benefit, acknowledgment of terminal prognosis; choosing comfort care instead of life-extending care Hospice coordinates care in all settings Four payment levels Routine home care with intermittent visits Continuous home care when the patient's condition is acute and death is near Inpatient hospital care for symptom relief Respite care in a nursing home to relieve family members

Manual strangulation

occurs when pressure is applied to the neck with hands, arms, or legs MOST COMMON

parasitic disease

More prevalent in tropical climates and countries with inadequate prevention and control methods Intestinal parasitic infections Parasitic opportunistic infections

Vertical transmission

Mother to child

Hospice

Multidisciplinary approach to end-of-life care and needs Option for people with a "projected" life expectancy of 6 months or less

unstable patient

NO SANE examination

Role of the CHN pts w/ disabilities

Need for broad and holistic practice Creativity, tenacity, honesty, and knowledge Involvement in wide-ranging, multiple roles at different levels

Working in the Client's Home

Nurse is a guest Establish trust Client safety is priority

home health

Nurses have provided care in the home for more than a century in the United States Home care gives clients and families a chance to receive health care in their usual environment

Working in the Client's home

Nurses practice autonomously with little structure in the home setting Competence and creativity are essential The home environment lacks many resources typically found in institutions Essential that nurses Have good organizational skills Be able to adapt to different settings Demonstrate interpersonal skills for working with the diverse needs of people in their homes

Epidemic

Occurrence of a disease in excess of normal expectancy

Injury in Sexual Assault

Of the cases that presented with injury anywhere on the body in 2015, 44.78% of those cases included genital injuries. Of the total number of cases seen in 2015, 57.76% presented with injuries. 116 Total Number of Cases Seen in 2015 Common Bodily Injuries (excluding genitals): •Scratches •Bruises •Abrasions •Bites •Tears/Lacerations/Cuts

Expert Witness

Offer informed opinions that may inform the judge or jury in the details of sexual assault forensics

HIV, Hepatitis and Sexually Transmitted Diseases

Often acquired through behaviors that can be avoided or changed Nursing actions should focus on disease prevention Vaccine administration, early detection, or teaching clients about abstinence or safer sex Infected individuals can transmit to others

Munchausen Syndrome by Proxy

Parent or caretaker attempts to bring medical attention to self by injuring or inducing illness in their child

Private Settings Faith Community Nursing

Parish nurses work in close relationships with individuals, families, and faith communities to establish programs and services that significantly affect health, healing, and wholeness Address universal health problems Also known as Health Ministry and Congregational Nursing

Developmental crises

Periods of disruption that occur at transition points during normal growth and development

Child neglect

Physical, emotional, medical, or educational are withheld or unavailable

air pollution

one of most hazardous sources of chemical contamination adverse effects including costs to property, productivity, and quality of life difficulty establishing cause and effect

Strangulation - Pathophysiology

Pressure around the neck can result in the closure of blood vessels and/or air passages. Injury and death from strangulation occur from one or more mechanisms. •The first mechanism is venous obstruction, whereby occlusion of the jugular veins results in congestion of the blood vessels and increased venous and intracranial pressure. •The second mechanism is carotid artery obstruction, which stops blood flow and impedes oxygen delivery to the brain. •The third mechanism is pressure on the carotid sinus that can cause acute bradycardia and/or cardiac arrest.

stages of disaster management

Prevention Preparedness Response Recovery

responsibilities of school nurse

Promote Health Identifies health-related barriers to learning Care of children with special needs Screenings Medication administration Staff training

Strangulation

one of the most potentially lethal forms of intimate partner abuse, and is seen in sexual assault a form of asphyxia characterized by closure of the blood vessels and air passages of the neck as a result of external pressure on the neck

interdependency

one planet of interdependent nations each unique

Emotional Abuse

Psychological mistreatment or neglect

Toluidine Blue Dye

Purpose: In the genital assessment of sexual assault patients the TBD can be used to identify lacerations/abrasions not seen by the naked eye and sometimes even with the use of a colposcope How it Helps: The Toluidine solutions dyes nucleated squamous cells in the deeper layer of the epidermis exposed by lacerations. Dye uptake is interpreted as positive for injury. It does not highlight episiotomy scars. Fossa navicularis and posterior fourchette lacerations. Fossa redness and several lacerations from penile vaginal penetration. •Lacerations with Toluidine Blue dye uptake

Private Settings Occupational Health Nursing

Purpose: to ensure healthy and productive workforce Roles: Consultant Educator Role Model

Hospice Nursing Practice

RN as central to hospice interdisciplinary team Case manager; frequent visits Collaboration with hospice team Competencies similar to home health nurses with addition of added expertise in relieving physical and emotional suffering of terminally ill people and families

scope of disaster

Range of its effect, either geographically or in terms of the number of victims

infant death

only infants born alive included in infant mortality rate infant= birth to 1 year fetal deaths not added

campus office of global affairs

opportunities overseas

web of causality

Recognizes the complex interrelationships of many factors interacting, sometimes in subtle ways, to increase or decrease the risk for disease relationships are sometimes mutual, with lines of causality going in both directions

SANE

Registered nurse who has completed specialized training and a preceptorship which enables them to provide comprehensive care to the sexual assault patient which entails documentation of the assault, perform necessary medical exams, testing and treatment, collect crucial, time sensitive evidence, maintains chain of custody for all evidence, and provides expert testimony in court.

hospice focus

emphasis on quality of life and comfort focus is on health of whole family plan of care is guided by patient choice nurse is case manager until death client chooses how to live last days intermittent visits increase as death become imminent nurses are experts in symptom control sedatives and opioids are expertly adjusted to eliminate suffering end-of-life disease course is managed to avoid crises goal is for symptoms at end of life to be managed at home if possible spiritual care is focus of whole team survivors have bereavement support

water pollution

effects: cause of disease, contamination of streams, lakes, and wells, contamination of fish, upset of ecosystem nurse's role: examining household or city drinking water, identifying increased incidences of water-related diseases; promoting safe healthy water

Georgia Law: Medical Provider Reports of Abuse

Reports by physicians and other personnel of nonaccidental injuries to patients; immunity from liability -Any physician, nurse or personnel employed by a medical facility whose employment duties involve the care and treatment of patients therein having cause to believe that a patient has had physical injury or injuries inflicted upon him other than by accidental means shall report or cause reports to be made in accordance with this Code section -An oral report shall be made immediately by telephone or otherwise and shall be followed by a report in writing, if requested -They shall then notify the local law enforcement agency having primary jurisdiction in the area in which the medical facility is located of the contents of the report -Any person making a report pursuant to this section shall be immune from any civil liability that might otherwise be incurred or imposed, providing such participation pursuant to this Code section shall be in good faith

preventing STDs

Requires diverse and multidisciplinary interventions Parents, families, schools, religious organizations, health departments, community agencies, and media Educational programs provide adolescents with the knowledge and skills to: Refrain from early onset of sexual intercourse Make informed decisions related to sexual behavior and health Increase the use of contraceptive measures

UN Convention on the Rights of Persons With Disabilities

Respect for inherent dignity and individual autonomy Nondiscrimination Full and effective participation and inclusion in society Respect for difference and acceptance of persons with disabilities as part of human diversity and humanity Equality of opportunity Accessibility Equality between men and women Respect for evolving capacities of children with disabilities and the right of children with disabilities to preserve their identities

Corrections Nursing functions

Restore and maintain health of inmates Track and screen for communicable diseases Assist in setting up resources for continuing care after release Educate and promote health lifestyles Assist in assessing medical conditions

Other Abusive Situations

•Internet Crimes •Pedophiles pass themselves offas minor •Child Abduction •Family members or intimate partners most common offenders •Crimes Against Children by Babysitters •School Violence •Includes bullying, slapping, punching, and weapon use

Vaccine-Preventable Diseases

Routine recommended childhood immunizations include: Hepatitis A & B, diphtheria, pertussis, measles, mumps, rubella, rotavirus, polio, Haemophilus influenzae, meningococcal conjugage, varicella (chickenpox), influenza (seasonal), and human papillomavirus

Courtroom Testimony

SANEs serve as Expert Witnesses and Fact Witnesses

gonorrhea

STD 2nd most reportable notifiable disease increasing- inc transmission or inc reporting men have symptoms: drainage from penis women often asymptomatic antimicrobial resistance: cephalosporin with azithromycin or doxycycline can be transmitted to neonates during delivery: ophthalmic prophylaxis

chlamydia

STD most commonly reported STD silent with serious complications specific screening recommendations by CDC

syphilis

STD primary- chancre secondary- rash, fever, sore throat latent- tertiary syphilis associate with neuro changes) PCN

Infectious disease of concern in U.S.

Sexually transmitted diseases (including HIV) Mosquito borne illnesses (zika and dengue) Whooping Cough Hepatitis (A, B, and C) Tuberculosis Influenza and pneumonia (vaccinations) Measles

Strangulation Assessment

Signs and Symptoms Ligature marks redness, abrasions, bruising Petechial hemorrhages (face, eyes, inside mouth) Redness to eyes Loss of memory Loss of consciousness Headache Coughing Voice changes Difficulty breathing Difficulty/pain with swallowing Neck pain/Sore throat N/V Loss of bodily functions Nursing Assessment Inspection of the neck, behind the ears, inside the mouth Inspect the jaw, scalp, eyelids, chest, shoulder, back Palpate for tenderness Auscultate the lungs

frail elderly

over 85 need assistance w/ ADLs

United Nations

overall umbrella agency

Fact Witness

Testimony on what you have witnessed without an opinion

direct victims of disaster

people who experienced the event' dead and the survivors displaced persons- those forced to leave to escape effects of disaster, usually temporary refugees- people who are forced to leave their homeland due to war or persecution

active immunity

long term

how nurses use epidemiology

look at health and at disease causation and investigate how to both prevent and treat illness involved in surveillance and monitoring of disease trends

home health focus

emphasis on rehab and physiological stabilization focus on health of client nurse is case manager until home health discharge priority is given to correcting physiologic imbalances intermittent visits decrease in frequency as pt stabilizes symptom control is domain of physician sedatives/opioids used hesitantly to reduce suffering end-of-life problems tend to be seen as medical crises client is brought to hospital for unmanaged symptoms spiritual needs met by clergy no bereavement support is provided

strangulation stats

The documentation of the interrelationship between strangulation, intimate partner violence and sexual assault demonstrates 47-68% of women who reported domestic violence also reported one or more strangulation events (Stapczyski, 2010; Smith, Mills, & Taliaferro, 2001). Nonfatal strangulation is a strong predictor of future violence and a significant risk factor for homicide or attempted homicide (Glass, Laughon, Campbell, Wolf, Block, Hanson, Sharps, & Taliaferro, 2008). Strangulation Study Findings: Study of 300 strangulation cases in San Diego: 50% had no visible injuries. 35% insignificant to minor visible injuries. 15% significant injuries. 89% history of DV 50% child witness Reluctance to seek medical attention

Sexual Assault Response Team (SART)

The purpose of the SART is to ensure services and support are available to patients of sexual assault Members Include: •Sexual Assault Nurse Examiner (SANE) •Law Enforcement •Crisis Center Advocates •District Attorney's Office •Court Advocates •Georgia Bureau of Investigation (GBI) Victi m Law Enforce ment SANE Advoca te Crime Lab DA's Office

population

complex and include concerns, values, beliefs, physical symptoms and health history issues focusing on 3 eras of health conditions and universal imperatives of care

priority 4 triage

the dead, the dying, or those with injuries that will likely cause death even with treatment

international governmental organizations with national governments

USAID US agency for international development American international health alliance world bank

casualties in disaster

number of humans injured or killed by or as result of an incident multiple-casualty >2 but <100 mass casualty >100

smallpox

Variola virus transmitted person to person Risks associated with smallpox vaccination Routine immunization not recommended Ring Vaccination Strategy

Control and Elimination of TB

WHO Characterizes TB burden into 3 classifications: Multidrug- resistant tuberculosis Clients with HIV and tuberculosis TB case management Screening tests Skin testing with purified protein derivative (PPD) Two step testing Interferon gamma release assays (IGRA) Blood test For people who will not return for reading or BCG vaccine Positive tests: Followed up by chest radiography for persons with a positive skin reaction and pulmonary symptoms

susceptibility stage

the disease is not present and individuals have not been exposed

Home Health Care

Who is eligible for home health care? Patient must be considered homebound Requires extreme effort to leave the house (oxygen, walker or wheelchair, requires help) Payers include: Medicare, Medicaid, private insurance, private pay, charity No age requirement

Documentation of Bruises

Why we should not "age" bruises in our documentation..... Factors that can influence the appearance, size, and colors of a bruise: force of the impact location of the bruise available space for blood to collect vascularity of the area fragility of the blood vessels weight of the patient Factors that can influence the healing of a bruise: Age Malnutrition Diabetes Alcoholism impaired blood clotting immunosuppression

epidemiologic triangle

host, agent, environment changes in 1 of the elements of the triangle can influence the occurrence of disease by increasing or decreasing person's risk for disease interaction between these 3 factors leads to or prevents disease

factors that contribute to disaster

host, agent, environmental

agent

a factor that causes or contributes to a health problem or condition

immunity

a host's ability to resist a particular infectious disease-causing agent

screening

a key component of many secondary prevention interventions involves testing of groups of individuals who are at risk for a specific condition but do not have symptoms

rate adjustment

a method used to adjust for differences in populations (ex: age)

host factors in disaster

age, general health, mobility, psychological , socioeconomic

reliability

how precise is the measurement the measurement's consistency or repeatability

private settings

nurse center models faith community nursing occupational health nursing

Functioning

all body functions, activities, and participation

environment

all the external factors surrounding the host that might influence vulnerability or resistance

level of disaster

amount of resources required for relief and recovery

precautionary principle

an action, material, or chemical should not be used if there is no scientific data to indicate it is safe

zoonosis

an infection transmitted from a vertebrate animal to a human ex: rabies

epidemiology history

ancient times- Hippocrates 1st person to use ideas middle ages 1348 plague; black death 19th century louis pasteur- germ theory/pasteurization joseph lister- antiseptic surgery Robert Koch- pure culture and identified organisms that cause TB, anthrax, and cholera disease John snow- "father of epidemiology" water pump cholera outbreak map in London Florence nightingale- 1820-1910 environmental conditions 20th century- focus shifted from looking for single agents (like cause of cholera) to determining multifactorial etiology (CV disease contributing factors) development of genetic and molecular techniques new infectious diseases public health preparedness for bioterrorism

World Health Organization WHO

and UNICEF focuses on health issues

disaster

any human-made or natural event that causes destruction and devastation that cannot be alleviated without assistance; internal disasters are events that occur within a health care agency, whereas external disasters are events that occur outside the health care agency does not require death or injury categorized by causation, casualties, scope and intensity

core functions of public health

assessment, policy development, assurance

global health council

career opportunities, career seminars

global response to communicable diseases WHO's 3-pronged approach

case-finding surveillance and control elimination and eradication

WHO 3-prong approach to communicable diseases

case-finding surveillance and control elimination- certain geographical region eradication- global elimination

effects of disaster

casualties- both dead and injured physical devastation- may compromise key social systems financial devastation- cost of disasters continue to increase psychological morbidity- can be both short and long term

elite-old

centenarians

controlled global trends

childhood immunizations >78% smallpox eradicated relapsing fever, plague reduced leprosy close to elimination

epidemiologists studying populations at risk:

collection of people among whom a health problem has the possibility of developing because certain influencing factors are present or absent or because there are modifiable risk factors

Daily-adjusted life year DALY

combination of years of life lost due to premature mortality and years of life with a disability adjusted for the severity of the disability

era of infectious diseases

communicable diseases 5 of 10 leading causes of death major preventative measure of immunization management of childhood illness, polio endgame, oral rehydration therapy eradication, elimination, and control of communicable diseases

herd immunity

community immunity

Steps of epidemiology

define the outcome (health outcome can be a disease, or it can refer to injuries, accidents, or even wellness) describe the distribution (the who, where, and when of a disease, event, or injury) search for factors that explain the pattern or risk for occurrence (ask what influences the occurrence of the disease or injury or why and how events occurred)

global health procedures/interventions

dependent on context in which working, population, health status, an health conditions dependent on how nursing is practiced in the county necessary to know mission of agency and kinds of services/resources they provide criteria for support- sustainability, absorptive capacity, transferability

public health nurses often "sentinels of surveillance"

detect unusual illness patterns respond to environmental emergencies in work and community settings

Multiple crises

different kinds of crises can overlap in an actual experience, compounding the stress felt by involved persons

horizontal transmission

direct- direct contact or droplet indirect- transmitted by fomites (insects, water, good, inanimate objects)

providers of care

district-level providers community health workers (local, respected, responsible persons approved by committee to serve village people in health matters) village midwife community health nurse

bruises

do NOT age

preventing disaster secondary level

earliest possible detection and treatment

primary health care

education concerning prevailing health problems and methods of preventing/controlling them promotion of food supply and proper nutrition adequate supply of safe water and basic sanitation maternal and child health, including family planning immunization against major infectious diseases appropriate treatment of common diseases and injuries provision of essential drugs

public health nursing

education- entry level BSN functions- Health of populations; community needs and priorities Caring relationships (individuals, families, communities, and systems) Grounded in cultural sensitivity All aspects of health; strategies to promote health motivated by epidemiologic evidence Individual and collaborative, strategies to achieve results

current operational health care systems worldwide

entrepreneurial welfare oriented comprehensive socialist

3 eras of health conditions global community health

era of infectious diseases era of chronic long-term health conditions era of social health conditions

analytic epidemiology

examines the how and why of observed patterns of health and disease cohort studies- retrospective and prospective case-control studies cross-sectional studies- prevalence studies ecological studies- bridges descriptive and analytic epidemiology

vaccines

example of primary prevention communicable disease

type of disaster

examples: school shooting, hurricane, fire

older adults population

expected to be 20% by 2030 Globally Number of adults over age 65 expected to reach 1.4 billion by 2050 Those over age 80 years growing faster than any other group

safety in home, worksite, and community

exposure to toxic chemicals, radiation, noise pollution, biologic pollutants, injury hazards, psychological hazards nurse's role- monitoring, preventative measures for injuries, safety education, promotion of first aid/CPR, noise education, active lobbying for crime prevention, reduction of workplace stressors, development of educational and support programs

upstream focus

focus of the root causes of disease and socioeconomic factors rather than its effects example: promoting improved heart health, sidewalks/parks

WHO collaborating centers

focus on specific areas of expertise and carry out work of member countries in these areas

UN Educational, Scientific, and Cultural Organization (UNESCO)

focuses on educational issues

ILO (International Labour Organization)

focuses on working conditions

era of social health conditions

global burden of disease questions related to value on a life disability- adjusted life year DALY

ethical issues communicable diseases

health care access- COST enforced compliance- direct observation therapy DOT confidentiality, privacy, & discrimination- partner notification

socialist health care system

health care viewed as a social entitlement emphasized prevention and prioritized special groups centralized planning for health care

WHO goals

health for all primary health care

World Health Assembly WHA

highest governing body with WHO 139 member countries

expert witness

informed opinions based off the assault, can give your opinion

Unhealthy or contaminated food

inherently harmful foods, contaminated food or foods with toxic additives food irradiation/cold pasteurization for global food safety nurse's role- education about proper food storage, cooking, and handling

priority 2 triage

injuries not immediately life threatening, but could become so

natural immunity

innate resistance to an infectious agent

characteristics of a crisis

internal or external force disrupts system Precipitated by a specific identifiable event that becomes too much for usual problem-solving skills •System attempts to restore balance via coping •Possibly not an event per se, but a person's perception of the event are normal in that all people feel overwhelmed occasionally •Resolution can be either positive (adaptive) or negative (maladaptive)

tertiary prevention

intervention aimed at disability limitation and rehabilitation from disease, injury, or disability

secondary prevention

intervention that seeks to detect disease early in its progression, before clinical signs and symptoms become apparent, in order to make an early diagnosis and begin treatment

primary prevention

intervention that seeks to promote health and prevent occurrence of disease, injury, or disability

experimental studies

investigator initiates treatment or intervention to influence the risk or course of disease previously discussed study designs were observational studies clinical trials randomization to groups masking or "blinding" treatment community trials

screening test

is NOT a diagnostic test

National Protocol

is not the law or the protocol set in stone for how forensic nursing practice

Universal Design

is the design of products and environments to be usable by all people, to the greatest extent possible, without the need for adaptation or specialized design." The specific provisions include the following: Public use and common use portions of the dwellings are readily accessible to and usable by persons with handicaps. All doors within such dwellings that are designed to allow passage into and within the premises are sufficiently wide to allow passage by persons in wheelchairs. All premises within such dwellings contain features of adaptive design

validity

is the measurement really measuring what we think it is

tertiary prevention communicable diseases

isolation and quarantine control transmission by health care workers safe handling and control of infectious wastes

control and elimination of TB continued

isoniazid (INH) for those exposed and infected but no evidence of active disease responds well to long term treatment first line drugs- greatest activity against active bacteria second line drugs directly observed treatment- DOT

preventing disaster primary level

keep disaster from happening by taking actions to eliminate its occurrence

2 phases of TB

latent: can persist for many years active: symptoms evident such as cough, fatigue, loss of appetite, weight loss, night sweats chest x-ray shows infiltrates

vaccine

made from a live or inactivated form of the organism

scope of disaster

magnitude of area affected; includes major disasters and presidentially declared disasters

community health nursing opportunities

major responsibility for managing health services in health centers, clinics, schools, workplaces, and community settings settings range in population density and complexity from remote access to major cities

uncontrolled global trends

malaria, cholera, tuberculosis, yellow fever

3 forms of strangulation

manual hanging ligature

validity

measured by sensitivity and specificity

sustainability long-term

meet the needs of the present without harming the ability of future generations to meet their needs limit waste/ecological footprint conserve resources by balancing present and future needs food and fuel limitations of the natural environment

priority 3 triage

minor injuries without immediate complications

purpose of epidemiology

monitor health of public identify determinants of health and disease in communities investigate and evaluate interventions to prevent disease and maintain health

child neglect

most common

effective screening programs

must include referrals for diagnostic evaluation for those who screen positive to determine whether they have the disease and need treatment

causation of disaster

natural or man-made

agent factors in disaster

natural or technologic element that causes the disaster

risk factors

negative influences

herpes simplex 2 virus- genital herpes

no cure but can control symptoms STD

Prevention stage disaster management

no disaster expected or anticipated assess community for readiness identify community risk factors and develop and implement programs to prevent disasters from occurring

descriptive epidemiology

person (race, sex, age, education, occupation, income, marital status) place (examine geographical patterns) time (secular trends, point epidemic, cyclical time patterns-seasonal fluctuation, calendar events, nonsimultaneous, event-related clusters)

preparedness stage disaster

personal, professional, community not all disasters can be prevented preparedness can improve the response phase

Virginia Lynch

pioneer nurse in forensic nursing

detrimental environmental factors decrease our QOL

pollutants air, water, food, soil

3 P's framework of global community health nursing

population (focus on community), provider (healthcare team), procedure (interventions implemented to improve population health)

public health nursing characteristics

population-based grounded in social justice focuses on greater good health promotion/disease prevention utilize/organize community resources seek out clients in need commitment to community as a whole

risk

probability that a disease or unfavorable health condition will develop directly influenced by biology, environment, lifestyle, and system of healthcare

intoxication

production of toxins from bacteria example: botulism commonly occurs when cooked food is left out or by food preparer toxins are difficult to identify

measures of morbidity and mortality

proportion rate risk incidence prevalence attack rate case fatality rate

public settings

public health nursing school based nursing correctional nursing

sensitivity

quantifies how accurately the test identifies those with the condition or trait; true positives

preventing disaster tertiary level

reducing the amount and degree of disability or damage resulting from the disaster

comprehensive health care system

related to welfare-oriented systems eliminates financial complexities of previous 2 systems- welfare and entrepreneurial

causality

relationship between a cause and its effect

indirect victims of disaster

relatives or friends of direct victims

recovery stage disaster

repair, rebuild, or relocate damaged homes and businesses and restore health and economic vitality to community address ongoing physical and mental health needs- prolonged or delayed stress responses are common reactions, be aware of signs evaluate community response and identify gaps in response

reporting communicable diseases

reportable diseases are reported to State Health Department and then to CDC each state has disease report form national notifiable disease list any outbreak & unusual disease

response stage disaster

rescue, triage, on-site stabilization, transportation of victims, and treatment at local hospitals response should be simple, clear, and flexible effects of disaster are particularly disruptive to children goal- save lives and prevent further injury or damage and minimize effects of disaster

acquired immunity

resistance acquired through exposure

food Infection

results from bacterial, viral, or parasitic infection of food examples: shigella, ecoli, salmonella accompanied by immune response with antibodies

resolution stage

return to health or death

Mistreatment of Elders

•Includes neglect, physical, sexual, emotional or financial abuse •Primary risk factors •Invisibility •Vulnerability •Prevention •Specialized training for caregivers and health care workers •Mandatory reporting

secondary prevention communicable diseases

screening case and contact investigation, partner notification

passive immunity

short term temporary protection

clinical stage

signs and symptoms develop

basic methods in epidemiology

sources of data, rate adjustment, comparison groups

tuberculosis

spread by droplets poor nutrition, health status, and chronic disease can contribute to developing active disease communicability depends on length of exposure as well as proximity incubation is 10-12 weeks

Hepatitis B virus

spread through blood and bodily fluids; can survive at room temperature for at least 1 week 3 doses of vaccine

Hepatitis C

spread through blood or bodily fluids most common chronic blood-borne infection in US can be asymptomatic leading cause of chronic liver disease, liver cancer, and liver transplants in US prevention: testing for people born between 1945-1965, IV drug abuser, organ transplant or blood donations before 1992, HIV/AIDS, liver disease, born to HCV+ moms NO VACCINE there is a cure

ecology

study of interactions and relationships between living organisms and their environments

epidemiology

study of the distribution and factors that determine health-related states or events in a population information is used to control health problems

welfare oriented health care system

supports cost of health care for all- National Health Insurance about half of health care expenses are covered many physicians and dentists in private practice

multilateral agency

supports development efforts of governments and organizations in countries throughout the world collaboration with other agencies such as UNESCO and UNICEF

natural history of a disease or health condition

susceptibility, subclinical, clinical, resolution

host

susceptible human or animal who harbors and nourishes a disease-causing agent

airborne

suspended in air or cling to inanimate objects

bruise & bite mark

think DNA

environment factors in disaster

those that could potentially contribute to or mitigate a disaster

vectors

through bite of insect or animal

comparison groups

to decide whether the rate of disease is the result of a suspected risk factor, compare the exposed group with a group of comparable unexposed persons

passive immunity

transfer of immunity from one person to another

Hepatitis A virus

transmitted through fecal-oral route; sources include water, food, or sexual contact inactivated vaccine administered in 2 doses

disaster clarification

type, level, scope

Global Burden of Disease GBD

what does morbidity and mortality cost the family, community, government, and/or private industry? 98% of deaths in children under 15 occur in developing (resource poor) countries 83% of deaths between 15 and 19 are in developing (resource poor) countries

fact witness

what we saw in labs, can only state facts

Era of Chronic, Long-Term Health Conditions

with decrease in infectious disease, increased life expectancy leads to degenerative disease epidemiologic transition: replacement of infectious disease morbidity and mortality with that of chronic disease

Reporting Abuse and Neglect in GA

•A report of child abuse should be made when a person has "reasonable cause to" believe that a child under the age of 18 has been abused by a parent or caretaker. •"Reasonable cause" means a suspicion founded upon circumstances sufficiently strong to warrant a reasonable person to believe that something is true. •The Department of Family and Children Services has the responsibility for evaluating the report and determining whether an investigation is warranted. •A report of suspected child abuse is a request for an investigation. It is not an accusation and a reporter does not have to be absolutely certain of their suspicion. •At a minimum, the report should contain the names and addresses of the child and the child's parents or caretakers, if known, the child's age, the nature and extent of the child's injuries, including any evidence of previous injuries, and any other information that the reporting person believes might be helpful in establishing the cause of the injuries and the identity of the perpetrator.

Situational crises

•A stressful, disruptive event arising from external circumstances that occur suddenly; often without warning, to a person, group, aggregate, or community

Medication

•Antiemetic-Reglan •Pregnancy prevention - Plan B •STD prophylaxis - Azithromycin, Rocephin, Flagyl •STD medication to treat Gonorrhea, Chlamydia ,Trichomoniasis, Bacterial Vaginosis, Chancroid (follow-up with PCP 7-10 days after completion of medication for exams and cultures for Gonorrhea and Chlamydia) •It is recommended that patients follow-up with PCP to complete additional laboratory studies for other possible STDs (HIV, Syphilis) and receive immunization for Hepatitis B

Role of the CHN in Caring for Families in Crisis

•Assessment •Nature of the crisis, clients' response to it, immediate problem, clients' perceptions, available support, and coping abilities •Formation of nursing diagnoses •Planning •Factors affecting clients, clients' general health status, age, past experiences, sociocultural and religious influences and actual assets and liabilities •Implementation •Demonstrate acceptance, confronting crisis, finding facts, expressing feelings, not offering false reassurance, encouraging no blame, seeking out coping mechanisms, encouraging acceptance of help •Evaluation of Resolution •Are clients using effective coping skills and exhibiting appropriate behavior? • Are resources adequate? • Is diagnosed problem solved? • Have desired results been accomplished? •Evaluation of Crisis Resolution •Are clients using effective coping skills and exhibiting appropriate behavior? • Are resources adequate? • Is diagnosed problem solved? • Have desired results been accomplished? •Plan for the future (anticipatory planning) so future crises can be prevented or managed

Partner/Spousal Violence

•Batterer characteristics •Influenced by personal characteristics •Relationship, community, and societal factors contribute to the risk of battering •Victim characteristics •More likely to be female •Also influenced by relationship, community, and societal factors •Effects of violence on children •Children exposed to family violence are more at risk for abuse and violence later in life (victim or perpetrator)

Injury Identification: Central Clearing

•Blunt force trauma injury and central clearing •Bruises, abrasions, lacerations •Appearance of a bruise suggesting causation: The shape of a contusion may provide clues about the striking object •Central clearing: the blood under the area of impact is forced up and out around the linear object, resulting in blood vessel rupture outside the are of impact.

Role of the Statewide SANE Coordinator

•Coordinate, support, and enhance existing and developing SANE programs in the state of Georgia •Building infrastructure and alliances with appropriate non-profit and state agencies •Promote consistent, professional and victim-oriented medical and forensic response and treatment of sexual assault victims

Secondary Prevention

•Early Diagnosis •Recognize signs and symptoms of crisis; signs and symptoms of abuse

Crisis Intervention Methods

•Generic approach includes four key elements •Use of adaptive behavior and coping strategies •Support of the individual/family •Preparation for the practical and emotional future •Anticipatory guidance •Allows nurse to intervene with groups who are experience a similar crisis •Offers a broad base of support •Individual approach •Used for those who do not respond to generic approach or need special therapy •Treatment directed toward immediate state of disequilibrium, identifying causes, and developing coping mechanisms •Inclusion of family members or significant others •Requires specialized training

History of Family Violence

•Global history •Children and women often considered property •U.S. History - children born to help with chores •Children's Bureau - 1960's support mandatory reporting for child abuse •Multiple acts from 1974 to 2003 were reformed and consolidate to form the Keeping Children and Families Safe Act

Protecting the Evidence

•Gloves: Change between body areas to avoid cross contamination •Careful attention to labeling of swabs; package swabs when dry •Do not talk over swabs •Maintain Chain of Custody •There is some order to evidence collection but you do not have to be completely rigid with the process •Patient's history: where, what, how •Alternate light source •Double swap technique

Primary Prevention crisis

•Health Promotion and Education •Anticipatory guidance •Reinforce positive coping strategies, social problem-solving skills, and assertiveness skills •Social support and other resources •Disease prevention •Reduce factors and hazards that increase vulnerability

Evidence Collection

•It involves collection of DNA from the victim's body •Blood and urine is taken from the victim •Cotton swabs are used to collect samples from the mouth, vagina, cervix, and anus. (depending on type of assault) •The SA kit is analyzed by the GBI

Dispelling the Myth

•Men are NOT sexually assaulted •Only young females are sexually assaulted •Most rapes involve a weapon •Sexual assault is usually between strangers •Its not rape if its my spouse/significant other •Sexual assault can be identified by the injuries a patient sustains

Becoming a SANE

•Must be a registered with a minimum of 1-2 years experience as: ER Labor and Delivery Medical-Surgical Or advance practice nurse or physicians assistant • Availability to be on call 24/7 • Critical thinking skills • Excellent Communication/Documentation Skills • Victim Centered • Work independently • Ability to be unbiased • 40 hour didactic training course • Preceptorship: 6 months

Chart Documentation

•Patient's Hx - use quotations, don't omit something because you think it could be used against the patient, include name/info of the offender and any witnesses the patient discloses, don't "sanitize" •Correct use of terminology •Objectivity - we are non-biased medical providers •Accuracy - your documentation may end up in court •Body diagrams with injury documentation including: o location - anterior, posterior, inferior, superior, medial, lateral, proximal, distal o measurement o color o did it occur with abuse/assault, prior to or after, how did it happen, when? Pain?

Injury Identification: Patterned vs. Pattern of Injury

•Patterned injuries present identifiable markings that allow provider to discern (with reasonable certainty) that they were caused by a specific or unknown object and/or by a specific mechanism of injury." (Hammer, Moynihan, Pagliaro, 2006) •Patterns of Injury refer to a distribution or compilation of various injuries that may tell the story of what happened to the person •Case History: 14 year old - Large multi-colored red/black ecchymosis to left outer thigh. History of being kicked and hit by her father 72 hours previously.

child abuse GA mandatory reporters

•Physicians licensed to practice medicine •Hospital or medical personnel •Interns or residents •Licensed psychologists or persons in internship to be licensed •Registered professional nurses •Licensed practical nurses •Professional counselors/therapists •Child counseling personnel •Law enforcement •Dentists •Marriage and family therapists •School administrators •School teachers •Visiting teachers •School guidance counselors •School social workers •School psychologists •Child welfare personnel •Child service organization personnel •Social workers •Podiatrists

Tertiary Prevention

•Rehabilitation •Promote adaptation to a changed level of wellness •Promote interdependence •Reinforce newly learned behaviors, lifestyle changes, coping strategies •Explore application of learned behaviors to new situations •Identify and use additional resources •Continue primary prevention to avert future crises

Other Forms of Family Violence

•Suicide •Taking action to cause one's own death •Warning Signs •Homicide •Any non-war-related action taken to cause the death of another •Rape •Act of aggression motivated by the desire to dominate, control and degrade •Combination of domination and sexuality •Creates physical and psychological harm

Cycle of Domestic Violence

•Tension Building •Acute Battering •Violence occurs •Loving Reconciliation •Can be immediately or days later •Increasing Spiral of Violence •Frequency and severity


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