Exam 2
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