Domestic & Family Violence Assessments

Elder Abuse and Neglect Defined

- Almost every state has some form of mandatory reporting of abused elderly and other vulnerable patients * Nurses are mandatory reporters of abuse. You only need to suspect that elder abuse or neglect may have occurred in order to call the authorities. You do not need proof.

Photographic Documentation

- Patterned, punch-like abrasion to the mid-forehead from an assailant wearing a ring with a stone - Sutured laceration to the left eyebrow - Sutured partial-avulsion injury to the nose - Punch-like contusion to the left eye involving the sclera. - Manual strangulation-related abrasion to the neck. - Patterned, defensive posture-like bruises to the right forearm

American Medical Association (AMA) Definitions of Elder Abuse and Neglect

- Physical abuse: violent acts that result or could result in injury, pain, impairment, or disease Physical neglect: failure of family or caregiver to provide basic goods and services such as food, shelter, health care, & medications - Psychological abuse: behaviors that result in mental anguish - Psychological neglect: failure to provide basic social stimulation - Financial abuse: intentional misuse of elderly person's financial & material resources - Financial neglect: failure to use elderly person's assets to provide needed services

Routine Screening for Intimate Partner Violence (IPV)

- Routine, universal screening for IPV means the following * Ask every woman at every health care encounter if she has been abused by a husband, boyfriend, or other intimate partner or ex-partner - How to Assess for Intimate Partner Violence - Questions - Procedure "Because domestic violence has such serious health care consequences, we are asking all of our female patients the questions that follow."

Health Effects of Violence: Child Abuse

- There are many long-term physical & psychological effects of child maltreatment - Child maltreatment can have long-term effects on child's development & adult life - Risk factors that may contribute to child mal-treatment * Immediate consequences seen from bruises, fractures, to severe injuries such as shaken baby syndrome. * Suspicion or proof of injury must be reported to the authority b the nurse/healthcare provider. * You will get more in Pedi. Must document anything on the body of the child/elder that you may suspect as the result of abuse.

Health Effects of Violence: Women

- Violent experiences have significant effects on women's health - Health care system can be an extremely important early point of contact * Injuries serious enough to require medical attention are major indicators for what is happening... * Abused women have significantly more chronic health problems: neurological, gastrointestinal, gynecological, and chronic pain. They visit the ER frequently with vague complaints. * Forced sex can lead to chronic pelvic pain, sexually transmitted diseases, & urinary tract infections. * Abuse women have more depression, PTSD, & substance abuse problems. * If pregnant, may lead to low birth weight babies & possible abuse of that child in the future.

Assessing for Risk of Homicide

Danger assessment (DA) * Used by nurses throughout healthcare. Includes a calendar so women can see how frequent and severe violence has become over the last year. * The more Yes answers, the more serious danger the woman's situation. - When She* Says No but There Are Other IPV Indicators * If she/he says no but physical indications say differently, be suspect - When There Are Other IPV Indicators * STI's, pelvic pain, complaints of sexual dysfunction * Chronic irritable bowel syndrome, back pain, depression, symptoms of PTSD, problems sleeping, panic attacks, or nerves

The nurse is assessing a patient who admits to being physically abused by her spouse. The patient says, "I wish I would have agreed with my husband, because then I wouldn't have been hit." What is the nurse's best response?

A. "Changing your reaction to your spouse will likely change his actions against you." B. "Try not to blame yourself. You will know better for next time." C. "Your husband has to want to change. Let's focus on you for now." D. "It is not your fault that your husband lost control. Changing your actions will not prevent him from abusing you again." - The correct answer is 4. It is important for the nurse to reassure the patient that it was not his or her fault. Abuser have problems with self control that cause them to strike their victims. - Answer 1 is incorrect because this answer implies that it is the victim's fault. - Answer 2 is incorrect because this option implies that the victim is at fault. - Answer 3 is correct; however, this is not the best option because this option offers little reassurance to the patient.

Which tool will assist the nurse in assessing a patient's risk for homicide?

A. Harassment in Abusive Relationships: A Self-Report Scale (HARASS) B. Danger Assessment (DA) C. The Abuse Assessment Screen (AAS) D. Intimate Partner Violence (IPV) screening tool - The correct Answer is 2. The DA is designed to assess risk of homicide. - Answer 1 is incorrect because HARASS is a screening and self-assessment tool. - Answer 3 is incorrect because the AAS is an appropriate tool for initial assessment of domestic abuse. - Answer 4 is incorrect because the IPV is an initial assessment tool.

Adolescent Violence Defined

- CDC definition for adolescent dating violence + Physical, sexual, or psychological/emotional violence within a dating relationship that includes stalking + Abuse may occur in person or electronically + May occur with present or former partner

Child Abuse & Neglect Defined

- Child abuse & neglect defined at both federal & state level - The Child Abuse & Prevention Treatment Act (CAPTA) dictates minimum standards that must be incorporated into state statutes - Most state statutes incorporate the following definitions: + Neglect + Physical abuse + Sexual abuse + Emotional abuse

Documentation Requirements

- Documentation of IPV, child abuse, & elder abuse must include the following: + Detailed, nonbiased progress notes + Use of injury maps + Photographic documentation in health record + Other aspects of abuse history, including reports of past abusive incidents, can be paraphrased with use of partial direct quotations + Written documentation of histories of IPV & elder abuse needs to be verbatim but within reason + Critical to document exceptionally poignant statements made by victim that identify perpetrator and severe threats of harm made by perpetrator

Culture and Genetics

- Domestic violence (DV) occurs cross-culturally * May be more difficult to determine in other cultural groups * Lifetime prevalence of DV occurs significantly higher among racial and ethnic minorities - IVP Factors among Ethnic & Racial Minorities: * Death rates are higher among refugee & immigrant women. * Societal stressors - poverty, racism, discrimination, lack of knowledge * Legal regulations - fear of legal action being taken * Lack of access - inability to access health care & limited mental health resources * Cultural values & gender roles - privacy & shame

Health Effects of Violence: Elder Abuse

- Health effects of elder abuse * Complications with bleeding, circulatory problems, serious infections that can lead to death, cardiac problems, & sexually transmitted diseases. * Elder abuse is usually coupled w/ neglect. * Neglect is criminal in nature

Physical Examination: IPV or Elder Abuse

- Important components of physical examination of known survivor of IPV or elder abuse include the following: + Complete head-to-toe visual examination, especially if patient is receiving health services for reported abuse + Health evaluations for known or suspected elder abuse & neglect should include baseline laboratory tests, including a complete blood count (CBC) with platelet level, basic blood chemistries, serum liver function tests, a coagulation panel, & urinalysis * Ecchymoses are not directly related to blunt force trauma that results in bruising, & not all open wounds should be called lacerations (only those related to splitting of tissue from blunt force impact or tearing of tissue should be).

Child Abuse State Statutes Defined

- Neglect: failure to provide for a child's basic physical, educational, medical, & emotional needs. - Physical abuse: physical injury due to punching, beating, kicking, biting, burning, shaking, or otherwise harming a child; even if parent or caretaker did not intend harm, such acts are considered abuse when done purposefully. - Sexual abuse: includes fondling child's genitals, incest, penetration, rape, sodomy, indecent exposure, & exploitation through prostitution or production of pornographic materials - Emotional abuse: any pattern of behavior that harms child's emotional development or sense of self-worth; includes frequent belittling, rejection, threats, & withholding of love & support

Assessment of Elder/Vulnerable Person Abuse and Neglect

Assessment of abuse/neglect in cognitively challenged persons is complicated Physical findings inconsistent with the history provided by the patient, family or caregiveer are red flags of possible abuse/neglect

Elder Abuse Screen

Has anyone ever: - Touched you inappropriately? - Made you do things you didn't want to do? - Taken things that were yours w/o asking? - Physically hurt, scolded, or threatened you? - Failed to help you take care of yourself? - Have you signed documents you didn't understand? - Are you afraid of someone at home? - Are you alone a lot? * "Because domestic violence has such serious health care consequences, we are asking all of our female patients the questions that follow."

Intimate Partner Violence Defined

Intimate partner violence defined by the Centers for Disease Control and Prevention (CDC) * Physical or sexual violence, use of physical force, or threat of such violence * Psychological or emotional abuse or coercive tactics after prior physical violence between persons who are spouses, or nonmarital partners or former spouses or nonmarital partners

History of Traumatic Injuries

May have an impact on current health condition