EDAPT: Interpersonal Violence

Rape trauma syndrome is defined by two phases—expressed response and controlled response. Match the clinical manifestation with the correct response. Select only one answer for each row.

*Expressed response:* Fear Crying Anxiety *Controlled response:* Calm Masked feelings Subdued affect

The nurse is caring for three 12-year-old children. For each child's nursing diagnosis, identify if that child has been abused or neglected, and what nursing action the nurse should take.​

*Imbalanced nutrition related to inadequate caretaking* Neglect Look for physical signs of poor dietary intake. *Acute pain related to physical injuries* Abuse Ask the client to rate pain on a scale from 1 to 10. *Low self-esteem related to social isolation* Neglect Form a trusting relationship with the client and praise the client for making progress.

As a nurse, you are planning trauma-informed, client-centered care for Amaya, who wishes to report sexual assault to law enforcement. Which nursing actions would need to be done immediately, are urgent, or routine? Drag the action items to the appropriate drop zone.

*Immediate:* • Assess and treat signs of physical injury. • Obtain Informed consent for medical-forensic examination​. *Urgent:* • Assess crisis intervention and psychological trauma.​ *Routine:* • Contact law enforcement as the client wishes to report sexual assault.​ • Medical treatment for sexually transmitted infections (STI) and pregnancy prophylaxis.​

What findings does the nurse include or not include within the plan of care? Select only one answer for each row.

*Include:* • Body diagram with size, color, shape, area, and types of injuries • The client's history of events, using verbatim statements *Not Include:* • Obtaining a history from the grandparents • Physical evidence of sexual abuse

Risk factors can be seen within various forms of interpersonal violence. Research suggests known vulnerability of individuals, or specific population-groups, that are higher risk of interpersonal violence. Identify if the risk of experiencing interpersonal violence increases or decreases based on the situations listed below.

*Increased Risk:* Living in foster care Drug addiction Lesbian, gay, bisexual, transgender, queer and intersex (LGBTQI) Individuals with disabilities Immigrants or refugees History of abuse *Decreased Risk:* Stable home life Male College educated

For each potential nursing intervention, click to specify whether the intervention is indicated or nonindicated.​ Select only one answer for each row.

*Indicated:* • Address any medical issues. ​ • Inquire about any safety issues.​ • Document the client's history and assessment in the medical record.​ • Ensure that safety planning is included in the discharge planning process.​ *Nonindicated:* • Report to law enforcement.​ • Collect blood and urine samples for reported sexual assault.​

Identify if the examples are a form of physical abuse, sexual abuse, emotional abuse, or neglect​. Drag the items to the corresponding box.

*Physical Abuse:* Fractures Head trauma *Sexual Abuse​:* Exhibitionism Molestation *Emotional Abuse:* Humiliation​ Threatening behavior *Neglect:* Failure to provide preventative care Lack of supervision

Identify possible indicators of child abuse and neglect in their respective categories. ​Drag and drop the items to the corresponding boxes.

*Physical Abuse:* • Unexplained injuries (burns, bite marks, bruises, broken bones or black eyes) • Patterns of injury (different stages of healing)​ *Sexual Abuse​:* • Becomes pregnant or contracts a sexually transmitted infection (STI)​ • Difficulty walking or sitting *Emotional Abuse:* • Inappropriate adult-like behavior (parenting other children)​ • Overly compliant, passive, or aggressive​ *Neglect:* • Clothing not appropriate for weather​ • Lacks medical care or preventative care (immunizations, dental, eye)​

Identify if the listed effects are physical or psychological effects of workplace violence.​

*Physical Effects​:* Weight loss or gain​ Gastrointestinal problems Insomnia Chronic pain​ Chronic fatigue​ Physical injuries Headaches​ *Psychological Effects​:* Substance abuse​ Suicidal ideation​ Reduced self-esteem & self-confidence​ Depression Feelings of powerlessness​ Post-traumatic stress disorder (PTSD) Anxiety Stress

Identify the form of abuse with its identifying characteristics.

*Physical* is a nonaccidental physical injury to a child caused by a parent, caregiver, or any other person responsible for a child and can include punching, beating, kicking, biting, shaking, throwing, stabbing, choking, and hitting (with a hand, stick, strap, or other objects).​ *Sexual* is the employment, use, persuasion, inducement, enticement, or coercion of any child to engage in, or assist any other person to engage in, any sexually explicit conduct or simulation of such conduct.​ *Neglect* is the failure of a parent or other caregivers to provide for the child's basic physical, medical, educational, or emotional needs. *Emotional* is a pattern of behavior that impairs a child's psychological development or sense of self-worth. This may include constant criticism, threats, or rejection, as well as withholding love, support, or guidance.​

Which nursing diagnosis would be prioritized for Amaya? For each diagnosis below, indicate if it is a priority or not. Select only one answer for each row.

*Priority:* • Fear related to decreased control of the environment and personal safety. *Not Priority:* • Impaired self-esteem related to poor coping mechanisms. • Powerlessness related to feelings of helplessness from the assault​. • Risk of insomnia related to fear and anxiety.

Nursing policies are developed based upon nursing's Code of Ethics, which support professionalism and accountability. Important components of nursing's Code of Ethics that apply to horizontal/lateral violence in the workplace include?​ Match the answer with its correct statement.

*Respect for human dignity* - Nurses value others in every professional interaction​. *Relationships with colleagues and others* - Nurses uphold caring and professional associations​. *Collaboration* - Nurses require shared planning for provision of safe and quality patient care.​ *Accountability for nursing decisions and actions* - Nurses are held responsible for moral principles, including fidelity, loyalty, and respect for dignity.

From the drop-down options next to each statement, identify if the statement could involve sex trafficking , labor trafficking, or both?​

*Sex trafficking:* • The recruitment of a person for the purposes of a commercial sex act. *Labor trafficking:* • Children who work in sweatshops 12 hours per day for minimal pay. • Fraud, or coercion for the purposes of subjection to involuntary servitude and debt bondage. *Both:* • Acts of force, coercion, and abuse that are a means of power and control over an individual. • Migrant workers whose legal documents have been stolen. • Men who are taken from their homes against their will and subservient to their traffickers. • Individuals who are often threatened or coerced by their traffickers to remain silent and therefore do not seek help.

Which age-appropriate questions can the nurse ask Phillip? Select all that apply​.

"How often does it happen?" "Tell me about what happened to you."​ "In what ways are you hurt?" "When was the last time it happened?"

Which follow-up statement(s) verbalized by Phillip would indicate that nursing actions were effective? ​Select all that apply.​

"I will take my medication in the morning with breakfast and at bedtime as prescribed by the doctor."​ "I understand that I may need to talk with a police officer at the child protection agency."

Amaya further states, "Why would I wake up and not remember what happened? This is all my fault."​ As the primary nurse, you suspect it was a drug-facilitated rape. How would you respond to Amaya?

"It was not your fault. Using drugs or alcohol is never an excuse for assault."

Which of the following assessment cues are most concerning to the nurse at this time? Select all that apply.

"It's all my fault." Hesitant to speak to health care providers "Am I in trouble?" Flat affect, limited eye contact

What would be appropriate questions for the nurse to ask a client who has experienced intimate partner violence (IPV) to help determine the coping mechanisms? ​Select all that apply​.

"What has helped in the past?" "What can I do to help you in this difficult situation?" "What are you thinking and feeling?"

José is in the nurse manager's office. He decided it was time to discuss the interaction. As José was trying to explain the situation, the nurse manager quickly interrupted the conversation and responded, "Sam can be hard on new people and her bark is worse than her bite." The nurse manager followed up with, "Don't worry about this, no one got hurt." José felt awful leaving the office as no one validated his safety concerns and Samantha's inappropriate behaviors.​ What is the most therapeutic statement that should have been made by the nurse manager?

"What would you like to talk about? Tell me more about what happened?"

Which of the following questions are appropriate for health care providers to ask as part of screening for human trafficking?​ Select all that apply.

"Where do you live, eat and sleep?​" "Were you threatened if you tried to leave?​" "Have you ever been physically or sexually abused?​" "Has your family been threatened?​" "Have you ever been forced to do something you didn't want to do?​"

Identify a reason from the choices below to match its example of why women may stay in an abusive relationship.​ Note that not all reasons have their own examples.

*Distorted thoughts* - "I didn't know what my boyfriend did to me was rape."​ *Children* - "I stayed for 20 years while I was being abused. I wanted my son to have a father."​ *Fear* - "I was afraid of him...I knew he'd make leaving him an ugly drawn-out nightmare."​ *Damaged self-worth* - "I felt I had done something wrong, and I deserved it."​ *Isolation* - "My husband said I can either have friends or I can have him."​

In both "Patient Information" and "Nurses' Notes" tabs, select all the information that raises an index of suspicion regarding human trafficking. ​

Severe abdominal pain Refused to see a doctor Does not have health insurance No eye contact Pain 8 out of 10

Which of the following are the forms of human trafficking?​ Select all that apply.

Sex trade​ Forced labor​ Domestic servitude​

A 9-year-old boy suddenly refuses to go to school and when he does attend, discloses to the school counselor that he is having trouble walking and sitting, and has started to wet the bed at night. What should the school nurse consider when assessing this child's symptoms?​

Sexual abuse

The nurse takes action by implementing trauma-informed care. The nurse determines which of the following nursing actions are considered trauma-informed? Select all that apply.

Speak with Julianna privately and create an environment where she feels safe.​ Consult with multidisciplinary providers, such as social workers, to help provide additional support and further treatment recommendations. Julianna has the right to accept or decline any medical care or treatment​. Ask Julianna how she feels and actively listen.​ Ensure Julianna understands confidentiality policies, including mandatory reporting laws. ​

Strategies identified by nurses to combat lateral violence include?

Strengthening collegial relationships​

According to the CDC (2021), the last published total lifetime economic burden associated with child abuse and neglect in the United States was approximately $428 billion dollars. Which other public health problems have a similar economic burden?​

Stroke and diabetes mellitus type 2 (DM2)

Which of the following was the first comprehensive federal law to address human trafficking, providing a three-tiered approach of prevention, protection, and prosecution of traffickers? ​

The Trafficking Victims Protection Reauthorization Act​

Most often, who are the perpetrators of child abuse?

The child's parents

The nurse begins to analyze cues related to the patient's history and observations of acute injuries. Which of the following clinical findings does the nurse suspect?

The injuries are consistent with acts of force caused by another person.​

Which of the following nursing actions are trauma-informed care practices? Select all that apply.

The nurse provides informed consent throughout the head-to-toe assessment.​ The nurse allows for client privacy in a safe environment.​ The nurse actively listens to the client.​

The Action Means Purpose Model can be used to describe the elements of human trafficking. Cases that are considered human trafficking involve these three elements.​ Match the elements to their definitions.

*The purpose* - For exploitation, which includes the prostitution of others, sexual exploitation, forced labor, slavery or similar practices, as well as removal of organs. *The action* - Recruitment, transportation, transfer, harboring, or receipt of persons. *The means* - Threat or use of force, coercion, abduction, fraud, deception, abuse of power or vulnerability, or giving payments or benefits to a person in control of the victim.

The nurse and physician suspect possible child abuse. Read the nurses' note, select relevant data in the clinical situation that requires immediate attention.​

Black eye Deformity to his left wrist and radius Father is reluctant to leave his son's side "You don't have to keep asking my kid about his accident" He has trouble thinking every day Last thing he needs is more questions. He's in a class for retarded kids. More tense than worried

Which of the following statements are clear, concise and objective - deemed "best practice" as it relates to documenting a patient history related to interpersonal violence?​

The patient states, "He kept hitting me in the face with his fist and I yelled for help. Stop kicking me in my stomach. Our kids were crying and screaming for daddy to stop. If I yelled again he said he would kill me and pointed a gun to my face."​

What actions are most appropriate in providing post-sexual assault nursing care? Select all that apply

Document the client's history.​ Identify and document physical findings. Assess the level of anxiety. ​ Assess psychological trauma​.

Human trafficking __________ require physical restraint, bodily harm, or physical __________.

Does not Force

Which findings are possible indicators of human trafficking as described in the client's EHR?​

Evidence of controlling or dominating relationships Inability to speak for oneself Lack of control of one's own money/finances Repeated visits to a provider for the same diagnosis

The __________ response pattern is when the client communicates feelings of fear, anger, anxiety, through behaviors such as crying, sobbing, and appears restless. The __________ response pattern is when a client may appear to be calm, composed, or subdued affect; feelings are masked or hidden. ​

Expressed Controlled

Review Phillip's father's statements in the nurses' notes. In analyzing common risk factors for victimization, which clinical finding might the nurse view as a possible indicator that the father may be an abuser?​

His description of his son's learning disability​

Nurse Sue frequently uses sarcasm around other nurses and speaks in a condescending manner. She often rolls her eyes, gossips about co-workers, and does not consider the input of others. Her behaviors can be described as an act of what?​

Horizontal violence​

Horizontal/lateral violence is characterized by behaviors such as? Select all that apply.​

Ignoring or avoiding a person​ Undermining personal values and beliefs​ Passive-aggressive behavior​ Refusing to help or support others​ Making snide, belittling, or sarcastic comments​

The Global Status Report on Violence Prevention (WHO, 2002) defines interpersonal violence as "the __________ use of __________ force or power, threatened or actual, against oneself, another person, or against a group or community, that either results in or has a __________ likelihood of resulting in injury, death, psychological harm, maldevelopment, or deprivation."

Intentional Physical High

What type of violence describes physical violence, sexual violence, stalking, or psychological harm by a current or former partner or spouse and does not require sexual intimacy?

Intimate partner violence

Horizontal/lateral violence can be caused by?​ Select all that apply.

Job insecurity​ Workplace stress ​ Conflicts with co-workers​

Which follow-up statement(s) verbalized by Julianna would indicate that trauma-informed nursing actions were effective? Select all that apply.

Julianna states, "I understand that I will need to talk with a social worker at the child protection agency." Julianna states, "If I am feeling suicidal, I will immediately tell someone, like my counselor or another adult I can talk to."​

Which of the following are reasons that clients often do not self-identify as victims of human trafficking? Select all that apply.

Lack of understanding of the health care system​ Shame Self-blame​ Concerns of deportation​

Which of the following acts of horizontal violence must be reported to the nurse manager immediately?​

Withholding information

Violence can be population-specific. In which of the following populations is violence most prevalent?​

Women and children​

Non-verbal acts of sighing and eye-rolling, and condescending statements, to include withholding information from co-workers are forms of?​

Workplace violence​ Vertical violence Horizontal violence Lateral violence

It is estimated that __________ of the workplace incidents that occur are never reported, as many as 80% of nurses have experienced some form of workplace violence, with a __________ percentage having witnessed events of horizontal violence on the job.

More than half Higher

Human traffickers have __________ specific, identifiable profile. There is __________ evidence that traffickers are more likely to be of a particular race, nationality, gender, or sexual orientation. They may be family members, friends, partners, acquaintances, or strangers. It is an __________ issue of __________ and __________, regardless of profile.​

No No Overarching Power Control

Hierarchical power imbalance in health care organizations can reside within which of the following interactions? ​Select all that apply.

Nurse to unlicensed assistive personnel (UAP)​ Expert nurse to novice nurse​ Physician to nurse​ Nurse to client​ Manager to employee​

Which of the following acts are considered as sexual behavior towards a minor?​ Select all that apply.

Pornography Molestation​ Pedophilia Incest

A priority nursing diagnosis for this client is __________ as evidenced by controlling or dominating relationships, lack of control of one's own money/finances, repeated visits to a provider for the same diagnosis, and inability to speak for oneself.​

Powerlessness

In which client population does intimate partner violence (IPV) often increase?​

Pregnant women

What is the priority nursing action for a client who has self-identified as a victim of human trafficking?​

Providing medical care​

Child abuse and neglect is an important, __________ health concern affecting children, families, and communities. Abuse affects __________ races, religions, economic classes, ages, and educational backgrounds. ​

Public All

Which action(s) taken by health care organizations aim to help reduce horizontal violence? Select all that apply.​

Publicize zero-tolerance policies for workplace violence. How to report via institutional policy and procedures. Utilizing empathetic, therapeutic communication techniques when collaborating with others. Organizing continuing education in assertiveness training for employees.

Phillip discloses, "I don't have a bicycle. I didn't fall off anything else either." He agrees to tell the nurse what happened, "as long as you keep it a secret." What should the nurse do?​

Report the suspected abuse to social services.​

Which adverse health effects can be long-term consequences of intimate partner violence (IPV) and/or sexual assault (SA)? Select all that apply.​

Reproductive problems Chronic pain​ Self-harm Inability to trust

Which of the following clients are considered vulnerable, and at a higher risk for human trafficking?​ Select all that apply.

Runaway and homeless youth​ Undocumented immigrants​ Individuals with low incomes​ Racial and ethnic minorities​ Individuals in communities exposed to intergenerational trauma​

Which parts of the situation are concerning related to horizontal/lateral violence?

Samantha said, "are you kidding me, it's basic knowledge." Samantha sighed and rolled eyes. Samantha stated "Don't tell him, let'em figure it out on his own." José overheard Samantha saying, "Why is Jose' working on this unit?" to another nurse.

Jose' feels powerless and is very upset. He contemplates next steps. What would be the most appropriate action for Jose' to take at this time?

Discussing the incident with the nurse manager​

The nurse is concerned that Jenna is being trafficked. Order the following provider interventions based on priority.​

1. Address any life-threatening medical issues. 2. Inquire about any safety issues. 3. Ensure that any information regarding the client's history and assessment findings are accurately described and documented in their medical record. 4. Provide the adult client with options for services, reporting, and resources. 5. Ensure that safety planning is included in the discharge planning process.

Match the characteristics of the power and control wheel to the proper categories.​

1. Stalking 2. Blocking the door or exit 3. Making you feel bad about yourself 4. Making you account for where you were 5. Saying it's just fighting, not abuse 6. Telling you that you have no parental rights 7. Saying they know what is best for you 8. Not working and requiring you to provide support

Label each component of the power and control wheel, using the drop-down options, to properly match the descriptions.

1. Using children 2. Using intimidation 3. Denying, minimizing, and blaming 4. Using economic abuse 5. Using coercion and threats 6. Using privilege 7. Using emotional abuse 8. Using isolation

Strategies to address horizontal/lateral violence include? Select all that apply.​

Developing policies ​ Annual competencies​ Team building activities​ Communication training ​ Publicizing how to report​

There __________ interpersonal violence category/categories, __________. Family/partner includes __________. Community includes __________. Physical, sexual, psychological, and neglect can occur under __________ categories.

Are two Both family/partner and community Child, partner, elder Acquaintance, stranger Both

What information should be obtained during Amaya's medical exam? Select all that apply.

Assessing for physical injury and documenting findings Collecting evidence Documenting the history of the event​

A 16-year-old teenage girl and her mother present at the pediatrician's office. The teenager reports a painful, red, rash in her genital area. A diagnosis of genital herpes is made. Which of the following actions by the nurse would be most appropriate?​

Accompany the teenager to a private room to obtain a sexual history.

José was frustrated and decided to talk to Samantha about the incident. He discussed statements made, non-verbal behaviors, and that information was being withheld as needed for discharge planning. During their conversation, Samantha was preoccupied with charting, made no eye contact, and did not ask any questions. Nurse Samantha then looks up and says, "Are you done? You are making such a big deal about this."​ Which types of therapeutic communication could Jose use to address the lateral vioence he is experiencing form Samantha?

Active listening​ Focusing Accepting Seeking clarification​

What is the priority action of the nurse?

Address safety concerns regarding suicidal ideation.

Rape is a violent act of __________, power, and means of __________, most commonly by __________ over __________, though men can be victims, too.​

Aggression Control Men Women

Which social determinants of health have a direct relationship with intimate partner violence (IPV)?

Alcohol or substance use​ Unemployment Poverty Economic and gender inequality

Which client assessment finding(s) would indicate that the interventions were effective?​ Select all that apply​.

Amaya has adopted a safety plan to address immediate safety needs​. Amaya verbalizes that she is not experiencing fear and panic anxiety​.

Which of the following are common injury sites on clients who have experienced intimate partner violence (IPV) and sexual assault (SA)?​ Select that all apply.

Chest Back of head Neck Abdomen

Interpersonal violence effects which of the following groups of people? Select all that apply.

Children Women Elders Men Adults

Which of the following clinical manifestations are somatic symptoms experienced by individuals who have experienced interpersonal violence?​ Select all that apply.

Constipation Headaches Chronic pain​ Shortness of breath​

Interpersonal violence can result in which of the following adverse health outcomes? Select all that apply.

Death Psychological trauma Physiological effects Physical injury

Review the client's electronic health record (EHR). Select the findings in the Nurses' Notes which indicate effective outcome(s).

Denies any suicidal ideation Provided referral options