Violence and Abuse
Sexual Violence: Impact: Physical Health: Reasons for Problems
Recurrent problems are result of failing to treat underlying issues Body responds as though in constant state of trauma Pelvic exams are avoided, leading to increased risk for STD's, unplanned pregnancy, and cervical cancer
Intimate Partner Violence: SAFEHOME Services
Shelter Housing program Support groups Counseling Economic advocacy Healthcare advocacy Outreach advocacy (including Latina Outreach, SAFE/TANF) Legal advocacy Johnson County court services Education and prevention Miami County services
Intimate Partner Violence: Characteristics of IPV: Cycle of Violence
Three distinct phases: - Tension-building phase - Acute battering phase - Honeymoon phase Begins with tension-building arguments, progresses to violence, and settles into a making-up/calm period Increases in frequency and severity as it is repeated, growing more dangerous Honeymoon phase shortens and eventually disappears and abuser no longer feels need to apologize Being forced to walk on eggshells to avoid angering partner, causes chronic tension in women that leads to poor general health
Intimate Partner Violence: Violence Against Pregnant Women: Prenatal Care
Twice as likely to miss 3 or more prenatal care appointments Twice as likely to wait until 3rd trimester to initiate prenatal care
Intimate Partner Violence: Nursing Management: Assessment: Isolating Client: How to Get the Patient Alone
Use HIPPA Order tests Need to answer a billing question Broken BP cuff, need equipment in a different room Have partner get some ice chips Triage into a small room
Intimate Partner Violence: Power and Control
Using coercion and threats Using intimidation Using emotional abuse Using isolation Denying, minimizing, and blaming Using children Using privilege Using economic abuse
Intimate Partner Violence: Nursing Management: Assessment: Ask Direct Questions
"We are concerned about the violence that is impacting the health of many of out patients, so we routinely ask the following questions:" - "Is your partner or someone close to you threatening you, or otherwise making you feel afraid?" - "Have you ever been hit, kicked, punched, strangled, or otherwise hurt by your partner or spouse?" - "Are you safe at home?"
Sexual Violence: Biggest Barrier to Reporting
*Fear of not being believed* Intervention: start out by believing the victim and verbalizing this belief
Sexual Violence: Rape Recovery: Four Phases of Rape Recovery
Acute phase (disorganization) - shock, fear, disbelief, anger, shame, guilt - feelings of uncleanliness - insomnia, nightmares - sobbing Outward adjustment phase (denial) - appears outwardly composed - returns to work or school - refuses to discuss assault and denies need for counseling Reorganization - denial and suppression do not work - attempts to make life adjustments by moving or changing jobs - uses emotional distancing to cope Integration and recovery - begins to feel safe and starts to trust others - may become an advocate for other rape victims
Intimate Partner Violence: Direct Health Impact from Domestic Violence
Acute trauma and death Chronic pain Headaches Fatigue Depression Anxiety Suicidal ideation/attempt Alcohol and drug abuse STD's Pregnancy complications Chronic abdominal pan Chronic somatic complaints Increased risk of stroke, heart disease, asthma Linked to arthritis, migraines, ulcers
Sexual Violence: Trauma-Informed Response: Role of Sexual Assault Victim Advocate
Assess safety Provide emotional support Increase comfort level Explain medical and legal process Offer resources and referrals Answer questions Problem solve Listen Normalize Offer follow-up services
Sexual Violence: Nursing Management: Protecting Yourself Against Date Rape Drugs
Avoid parties where alcohol is being served Never leave a drink of any kind unattended Don't accept a drink from someone else Accept drinks from a bartender or in a closed container only If a drink is left unattended, pour it out, don't drink it Don't drink anything that tastes or smells strange Don't drink from a punch bowl or a keg If you think someone drugged you, call 911
Intimate Partner Violence: Violence Against Pregnant Women: Reason for Violence
Battering more likely to begin or escalate in pregnancy because the attention is off the abuser, leading to battering to exert power and control
Intimate Partner Violence: Characteristics of IPV: Generation-to-Generation Continuum of Violence
Children exposed to IPV more likely to become victims or perpetrators in adulthood When parent is abused, children are usually abused as well Exposure connected to developmental difficulties, problem behavior, and physical and mental health effects
Intimate Partner Violence: Myths and Facts About Intimate Partner Violence: Why Women Stay
Concern for children Promises of change Isolation No place to go Traditional value system Hope Fear Emotional paralysis Guilt/Shame Low self-esteem Economic dependence Keeping the family together
Intimate Partner Violence: Characteristics of IPV
Generation-to-generation continuum of violence Cycle of violence
Intimate Partner Violence
IPV is actual or threatened physical or sexual violence or psychological abuse Common terms to describe IPV are *domestic violence (DV), intimate partner violence (IPV), family violence, and abuse* Nurse may be first to identify signs of IPV
Sexual Violence: Impact
Immediate and long-term psychological consequences Physical health Mental health
Intimate Partner Violence: Nursing Management: Assessment: Screening: How Should Domestic Violence Screening Occur
Interview patient alone Use gender neutral terms Use trained non-familial translators Be non-judgmental Make eye contact Disclose limits of confidentiality
Intimate Partner Violence: Violence Against Pregnant Women: Effects
More likely to experience depression and/or PTSD More likely to experience complications: - *preterm labor* - *low birth weight* - placental abruption - uterine rupture - hemorrhaging - fetal injuries (e.g., bone fractures, brain trauma) - *miscarriage or neonatal death*
Intimate Partner Violence: Incidence
Mostly women - 1 in 3 women - 1 in 4 men (stats vary) Most common between 18-24 years
Intimate Partner Violence: Nursing Management: Assessment: Ask Direct Questions: If Patient Says "No" But You Suspect Abuse
Offer hotline number and let them know about Safe Place hospitals Just asking the questions lets the patient know you care and there are resources to help them
Sexual Violence: Characteristics
Often not an IPV situation Instead of being a pattern, this is often an isolated incident
Sexual Violence
Sexual assault is any sexual activity without consent - forced kissing - unwanted touching - pressured oral sex When asking about sexual assault, use a broad definition
Sexual Violence: Statistics
Sexual assault occurs every 2 minutes in US 1 in 4 women and 1 in 10 men will experience sexual assault in their lifetime Only about 20% of victims report Approximately 90% of victims know perpetrator
Sexual Violence: Important Points
Sexual violence has been called a "tragedy of youth" because more than half of all rapes occur before age 18 Childhood sexual abuse is a trauma that can affect every aspect of the victim's life Many rape survivors seek treatment in ER if no rape crisis center is available - many ER doctors and nurses have little training in how to treat rape survivors or in collecting evidence - if they have to wait for hours in public waiting rooms, survivors may leave hospital and never receive treatment or supply evidence needed to arrest and convict assailants
Sexual Violence: Rape Recovery
Survivors typically go through four phases of recovery following rape A significant proportion of women who are raped also experience symptoms of PTSD
Intimate Partner Violence: Myths and Facts About Intimate Partner Violence: Why Women Stay: When They Leave
Woman will leave abuser 7 times total before leaving for good
Intimate Partner Violence: Nursing Management: Assessment: Screening: When to Suspect Domestic Violence
*Frequent medical visits for somatic complaints* (pain, fatigue) *Delay in seeking medical care* *Inconsistency between history and injury* *Partner behavior demonstrates controlling behaviors* - "Hovering Partner" - insisting on being present - monopolizing discussion *Client behavior demonstrates possibly controlling partner* - avoiding eye contact - jittery, anxious, nervous - checking phone a lot - concerned about partner's reaction to taking longer than expected *Missing prenatal care appointments* *Progressive isolation from support systems*
Intimate Partner Violence: Violence Against Pregnant Women
*Risk of violence increase in pregnancy* May be first time abuse is experienced Violence is more likely in unplanned pregnancies More likely to experience pregnancy complications Findings from National Violent Death Reporting System: - 45% pregnancy-associated homicides involved IPV - 54% of pregnancy-associated suicides involved IPV
Intimate Partner Violence: Nursing Management: Assessment: Ask Direct Questions: SAVE Model
*Screen all clients* by asking: - Within the last year, have you been physically hurt by someone? - Do you feel you are in control of your life? - Within the last year, has anyone forced you to engage in sexual activities? - Can you talk about your abuse with me now? - In general, how would you describe your present relationship? *Ask direct questions in a nonjudgmental way*: - Begin by normalizing topic - Make continuous eye contact - Stay calm; avoid emotional reactions - Never blame woman - Do not dismiss or minimize . - Wait for each answer patiently - Do not use formal, technical, or medical language - Avoid using leading questions - Use a nonthreatening, accepting approach *Validate the client* by telling her: - You believe her story - You do not blame her for what happened - It is brave to tell you this - Help is available - Talking with you is a hopeful sign and a first big step *Evaluate, educate, and refer the client* by asking her: - What type of violence was it? - Is she now in any danger? - How is she feeling now? - Does she know that there are consequences to violence? - Is she aware of community resources available to help her?
Sexual Violence: Impact: Physical Health
13 times more likely to have two or more major alcohol problems 26 times more likely to have two or more major drug abuse problems More likely to experience: - wide-spread, chronic pain - GI disorders - migraines - unplanned pregnancies - STD's - cervical cancer - eating disorders
Intimate Partner Violence: Definition
A pattern of abusive behaviors used by one individual to maintain power and control over a partner in the context of an intimate of family relationship Abuse may be *physical, emotional, sexual, financial* It is a *cycle/pattern* Distinguished as abuse when *one person has power and control over the other*
Intimate Partner Violence: Myths and Facts About Intimate Partner Violence
Battering of women occurs only in lower socioeconomic classes. - Violence occurs in all socioeconomic classes. Substance abuse causes the violence. - Violence is a learned behavior and can be changed. - Presence of drugs and alcohol can make a bad problem worse. Men have the right to discipline their partners. Battering is not a crime - In the past, our patriarchal legal system afforded men the right to physically chastise their wives and children; we no longer live under that system. - Women and children are no longer considered the property of men, and violence against them is a crime in every state. Violence occurs to only a small percentage of women. - One in four women will be victims of violence. Intimate partner violence is typically a one time, isolated occurrence. - Battering is a pattern of coercion and control that one person exerts over another. - It is repeated using a number of tactics, including intimidation, threats, physical injury, economic deprivation, isolation, and sexual abuse. - The various forms of abuse utilized by batterers help to maintain power and control over their victims. Women can easily choose to leave an abusive relationship. - Women stay in the abusive relationship because they feel they have no options. Only men with mental health problems commit violence against women. - Abusers often seem normal and do not appear to suffer from personality disorders or other forms of mental illness. Pregnant women are protected from abuse by their partners. - One in five women is physically abused during pregnancy. - The effects of violence on infant outcomes can include preterm delivery, fetal distress, low birth weight, and child abuse. Women provoke their partners to abuse them. - Women may be willing to blame themselves for someone else's bad behavior, but nobody deserves to be beaten. Violent tendencies have gone on for generations and are accepted. - The police, justice system, and society are beginning to make IPV socially unacceptable. IPV is only a heterosexual issue. - There is as much IPV in the LGBT population with the added psychological abuse of "outing." - Outing is when one partner threatens to disclose the others sexual preference in an effort to maintain power and control.
Intimate Partner Violence: Nursing Management: Interventions
Communicate successfully - Listen - Communicate belief - Validate decision to disclose - Emphasize unacceptability of violence Enable to gain control - Offer step-by-step explanations of procedures - Allow to actively participate in care - Allow control over all health care decisions - Allow to take lead Improve health of community - Primary prevention: education - Secondary prevention: prevent progression in early stages - Tertiary prevention: rehabilitation Educate about community resources Provide emotional support Offer a safety plan
Intimate Partner Violence: Nursing Management: Assessment: Assess Immediate Safety
Danger Assessment Tool helps women and HCPs assess potential for homicidal behavior in an abusive relationship Risk factors for abuse-related murders: - Increased frequency or severity of abuse - Presence of firearms - Sexual abuse - Substance abuse - Precipitated by arguments and conflicts - Generally violent behavior outside home - Control issues (e.g., daily chores, friends, job, money) - Physical abuse during pregnancy - Suicide threats or attempts (victim or abuser) - Child abuse
Intimate Partner Violence: Intimate Partner Relationships
Dating partners Married partners Same sex partners Living together Have a child in common Roommates Adult child/parent Siblings Caregiver
Intimate Partner Violence: Nursing Management: Diagnosis
Deficient knowledge related to understanding the cycle of violence and availability of resources Anxiety related to threat to self-concept, situational crisis of abuse Situational low self-esteem related to negative family interactions Powerlessness related to lifestyle of helplessness Compromised individual and family coping related to abusive patterns
Intimate Partner Violence: Types of Abuse
Emotional abuse: - promising, swearing, or threatening to hit - forcing to perform degrading or humiliating acts - threatening to harm children, pets, or close friends - humiliating by name-calling and insults - threatening to leave her and the children - isolation from family and friends - destroying valued possessions - controlling every move Physical abuse: - hitting or grabbing so hard it leaves marks - throwing things - slapping, spitting at, biting, burning, pushing, choking, or shoving - kicking or punching, or slamming against things - attacking with a knife, gun, rope, or electrical cord - controlling access to health care for injury Financial abuse: - preventing from getting job - sabotaging current job - controlling how all money is spent - failing to contribute financially Sexual abuse: - forcing to have vaginal, oral, or anal intercourse - biting breasts or genitals - shoving objects into vagina or anus - forcing to do something sexual that she finds degrading or humiliating - forcing to perform sexual acts on other people or animals
Intimate Partner Violence: Nursing Management: Assessment: Ask Direct Questions: Patient Barriers for Disclosure
Fear for safety Abuser threats and control Feels ashamed and humiliated Feels they deserve the abuse Feels protective of partner Minimizes, denies, or normalized abuse Language, culture, and religion Immigration status Sexual orientation Perceptions of health care system
Intimate Partner Violence: Characteristics of IPV: Cycle of Violence: Tension-Building Phase
First and usually longest phase when tension escalates Woman might sense partner's growing anger and blame herself Woman takes responsibility for keeping situation from exploding, and, in her mind, any resulting violence will be her fault for failing to do so
Sexual Violence: Consent
Free and enthusiastic yes - Free: no consequences to answer - Enthusiastic: truly wanting to - Yes: clear verbal and non-verbal aggreance Consent must be obtained on an ongoing basis for each act because people can change their mind
Intimate Partner Violence: Important Points
Frequently fear of harm to unborn child will motivate pregnant woman to escape abusive relationship Although safety is important, it is most important to regain sense of control (lack of control is what prevents woman from escaping)
Sexual Violence: Impact: Physical Health: Reasons for Problems: Interventions
Give choices for each step of exam Accommodate gender preferences for examinee Explain everything you're going to do Use blind-swab pap smear instead of speculum
Intimate Partner Violence: Nursing Management: Assessment: Ask Direct Questions: If Patient Says "Yes"
Give following therapeutic messages: - you are not alone, help is available - you're not first or only person to experience this - you do not deserve to be hurt no matter what - I am concerned about you and am here to help - you deserve to be a safe and healthy relationship Offer option of SAFEHOME healthcare advocate: - free and confidential - do not force to call police or go to shelter - serve victims regardless of language or documentation status - offers resources and options If patient does not want SAFEHOME advocate: - give brochures, power/control wheel, and safety plan if safe - hide hotline number - encourage safety planning - talk about SAFE place program
Intimate Partner Violence: Nursing Management: Assessment: Documentation
Include: - Patient's responses to questions, using direct quotes - Who was involved (e.g., DV agency, police) - What marks are on his/her body; photographs Your charts can be used in court of law
Sexual Violence: Characteristics of Assailants: Risk Factors for IPV in Men
Individual Factors - Young age - Heavy drinking - Personality disorders - Depression - Low academic achievement - Witnessing violence as a child - Low income and/or unemployment - Experiencing violence as a child - Desire for power and control in all relationships - Anger and hostility - Taking aggression out on others while growing up Relationship Factors - Martial conflict - Economic stress - Dysfunctional family - Marital instability - Male dominance in family - Cohabitation - Having outside sexual partners Community Factors - Weak sanctions against IPV - Poverty - Low social capital Societal Factors - Traditional gender norms - Social norms supportive of violence
Intimate Partner Violence: Nursing Management: Assessment: Isolating Client
Interview patient alone to avoid triggering abusive episode Ensure safety by taking victim to an area away from abuser to ask questions
Intimate Partner Violence: Nursing Management: Assessment: Ask Direct Questions: Healthcare Staff Barriers to Screening
Lack of education, awareness, or skills Fear of not knowing what to do, what to say, or who to tell Avoiding "Pandora's Box" Do not want to offend patient Personal biases, attitudes, and exposure Insufficient support from hospital Time constraints
Intimate Partner Violence: Myths and Facts About Intimate Partner Violence: Common Myth
Myth: Victims can leave an abusive relationship if they really want. Reality: Leaving increases risk of being killed by batterer. - 93% known murderer - 64% were wives, common-law wives, ex-wives, or girlfriend of offender - *lethality assessment and acknowledgment is essential*
Sexual Violence: Characteristics of Assailants
No typical profile - > 50% under age 25 - Majority married with normal sex lives Trouble dealing with stresses of daily life causes anger and feelings of powerlessness Characteristics: - Become jealous easily - Do not view women as equals - Frequently are hot tempered - Have a need to be reassured of their manhood - Do not handle stress in their lives well
Intimate Partner Violence: Nursing Management
Nurse may be first person they turn to HCP may be only place they go outside of abuser's control Medical visits provide opportunity for early detection, education, referrals, and prevention
Intimate Partner Violence: Power and Control: First Tactic
Often starts with isolation so woman has no support system
Intimate Partner Violence: Nursing Management: Assessment: Screening: Common Injury Presentations
Oral and dental injuries Grab mark Defensive posturing injuries Injuries during pregnancy STIs or PID Strangulation injuries Pattern injuries Pelvic or genital injuries Multiple injuries in various stages of healing
Intimate Partner Violence: Characteristics of IPV: Cycle of Violence: Female Victim and Male Abuser Example
Phase 1—Tension building: - Verbal or minor battery occurs - Almost any subject, such as housekeeping or money, may trigger buildup of tension - There is a breakdown of communication - Victim attempts to calm abuser - Victim feels like "walking on egg shells" around abuser Phase 2—Acute battering: - Uncontrollable discharge of tension - Violence is rarely triggered by victim's behavior, and she is battered no matter what her response - Start of battering episode is unpredictable and beyond victim's control Phase 3—Reconciliation (honeymoon)/calm phase: - First, abuser is ashamed of his behavior and tries to minimize abuse and blame it on partner - Batterer becomes loving, kind, and apologetic and expresses guilt then works on making victim feel responsible - This loving behavior strengthens bond between partners and convinces victim, once again, leaving relationship is not necessary
Sexual Violence: Nursing Management
Providing supportive care - Take to secure, isolated area when asking about assault - Provide change of clothes, access to shower and toiletries, and private waiting area Collecting and documenting evidence - Instruct to bring everything worn during assault - Instruct not to shower or bathe - Use SANE nurse to conduct exam Assessing for STIs - Pelvic exam to collect vaginal secretions - Be aware exam is emotionally stressful Preventing pregnancy - Offer pregnancy prevention with emergency contraceptive pill Assessing for PTSD - Assess for presence of intrusive thoughts (nightmares, flashbacks, recurring thoughts) - Assess for presence of avoidance reactions (avoiding trauma-related stimuli, social withdrawal, emotional numbing) - Assess for presence of physical symptoms (insomnia, irritability and angry outburts, heart palpitations and sweating, muscle aches and pains)
Intimate Partner Violence: Nursing Management: Interventions: ABCDES of Caring for an Abused Woman
Reassure her she is not *alone* Express *belief* that violence is not acceptable in any situation and that it is not her fault Maintain *confidentiality* by interviewing her in private *Documentation* should include the following: - Clear quoted statement about abuse in woman's own words - Accurate descriptions of injuries and history of them - Information on first, worst, and most recent incident. - Photos of injuries (with consent) *Education* about cycle of violence and that it will escalate: - Educate about abuse and its health effects - Help her understand that she is not alone - Offer appropriate community support and referrals - Display posters and brochures to foster awareness of public health problem *Safety* is most important aspect of intervention, to ensure that woman has resources and plan of action to carry out when she decides to leave
Intimate Partner Violence: Nursing Management: Assessment: Ask Direct Questions: If Patient Says "Yes": Safety Planning
Recognize steps already being taken to ensure safety Identify support system - code words, check ins Know safe places to go - ER, police station Pack a "go" bag - include necessary documents, important items, clothing Plan for safety in the home - Escape route during incidents, available phones - Security systems Secure finances Inform work and schools of existing protection orders
Intimate Partner Violence: Nursing Management: Assessment: Screening
Routinely screen ALL patients *age 14 and older* for domestic violence - Screen parent if younger Know your hospital's policy on domestic violence
Intimate Partner Violence: Other Community Resources
SAFEHOME Rose Brooks New House Hope House Safe Haven Joyce Williams KCAVP
Intimate Partner Violence: Nursing Management: Assessment
Screen for abuse during every health care visit Isolate client immediately from family Ask direct questions about abuse Assess immediate safety Document and report your findings
Intimate Partner Violence: Characteristics of IPV: Cycle of Violence: Acute Battering Phase
Second phase is explosion of violence Batterer loses control and victim may be assaulted or murdered Afterward, victims consider themselves lucky that abuse was not worse, no matter how severe their injuries Victims often deny seriousness of injuries and refuse to seek treatment
Sexual Violence: Types
Sexual abuse - forced sexual contact of any kind (vaginal, oral, or anal) without consent Incest - sexual activity between persons so closely related that marriage between them is legally or culturally prohibited Rape - legal term denoting penile penetration of vagina, mouth, or rectum without consent Statutory rape - sexual activity between an adult and a person under the age of 18 Acquaintance rape - someone is forced to have sex by a person he or she knows (e.g., coworker, teacher, husband's friend, boss) Date rape - assault that occurs within a dating relationship or marriage - form of acquaintance rape
Sexual Violence: Who is Responsible
Sexual assault is *never* victim's fault
Sexual Violence: Trauma-Informed Response
Start by believing the victim and verbalizing this belief Give victim control back by offering choices to opt in and out of any examination and testing Explain why you need to ask certain questions that might seem intrusive Ensure victim understands what you are saying/asking Remember effects of trauma: explain everything you are doing and why Have a sexual assault victim advocate present to support victim
Intimate Partner Violence: Nursing Management: Interventions: Emotional Support
Strengthen sense of control over life: - Teach coping strategies - Assist with ADLs - Allow her to make decisions - Educate about PTSD Encourage establishment of realistic goals: - Teaching problem-solving skills - Encouraging social activities Provide support and allow to grieve losses: - Listening to and clarifying reactions - Discussing shock, disbelief, anger, depression, and acceptance Explain to the woman that: - Abuse is never OK - She is not alone and help is available - Abuse is a crime and she is a victim - Alcohol, drugs, money problems, depression, or jealousy does not cause violence, but can give abuser an excuse - The actions of the abuser are not her fault - Her history of abuse is believed - Making a decision to leave an abusive relationship is hard and takes time
Sexual Violence: Rape Recovery: Symptoms of PTSD
Symptoms usually begin within 3 months of incident and must last more than a month Intrusion: - nightmares - flashbacks - recurrent thoughts Avoidance: - avoiding trauma-related stimuli - social withdrawal - emotional numbing Hyperarousal: - increased emotional arousal - exaggerated startle response - irritability
Intimate Partner Violence: Characteristics of IPV: Cycle of Violence: Honeymoon Phase
Third phase is a period of calm, loving, contrite behavior from batterer He may be genuinely sorry for pain he caused He attempts to make up for brutal behavior and believes he can control himself Victim wants to believe partner can change and feels responsible for causing incident
Intimate Partner Violence: Abuse Profiles
Victim/Survivor: - Anyone can be a victim - May be no outward signs of abuse - Rarely describe themselves as abused - Many were abused as children Abuser: - Anyone can be an abuser - May be pillars in community and non-violent in public - Desire control and power - May be learned behaviors or what they feel is their privilege
Sexual Violence: Impact: Mental Health
Victims experience higher rates of depression, anxiety, PTSD, and suicidality - 13% of rape victims attempt suicide and 30% actively consider it - 30% of rape victims develop PTSD - 30% experience major depressive episode (compared to 10% in general population)
Key Concepts
Violence against women is a major public health and social problem because it violates a woman's very being and causes numerous mental and physical health sequelae Every woman has the potential to become a victim of violence Abuse may be mental, physical, or sexual in nature or a combination of all of these The cycle of violence includes three phases: tension building, acute battering, and honeymoon Many women experience PTSD after being sexually assaulted which can inhibit a survivor from adapting or coping in a healthy manner Pregnancy can precipitate violence toward the woman or escalate it FGC is practiced worldwide and nurses in the United States need to become knowledgeable about it and place no judgment on this cultural practice Human trafficking is a violation against human rights, and nurses who suspect it should report it to stop the cycle of abuse against young children and women The nurse's role in dealing with survivors of violence is to establish rapport; open up lines of communication; apply the nursing process to assess and screen all clients in all settings; and implement and intervene as appropriate
Intimate Partner Violence: Nursing Management: Interventions: Safety Plan for Leaving an Abusive Relationship
When leaving an abusive relationship, take the following items: - Driver's license or photo ID - Social Security number or green card/work permit - Birth certificates for you and your children - Phone numbers for social services or women's shelter - The deed or lease to your home or apartment - Any court papers or orders - A change of clothing for you and your children - Pay stubs, checkbook, credit cards, and cash - Health insurance cards If you need to leave a domestic violence situation immediately, turn to authorities for assistance in gathering this material Develop a "game plan" for leaving and rehearse it Don't use phone cards, they leave a trail to follow
Sexual Violence: Impact: Immediate and Long-Term Psychological Consequences
Withdrawal Distrust of others Relationship problems PTSD Substance abuse Depression Attempted or completed suicide Unhealthy diet-related behaviors including anorexia, bulimia, and obesity
