Assessing For Violence PDF

Chapter 10 Assessing for Violence  Learning Objectives 1. Describe how to prepare a physically and emotionally safe environment in which to interview and assess a client who has experienced domestic violence. 2. Use the domestic violent screening tools to identify vict...

Chapter 10 Assessing for Violence  Learning Objectives 1. Describe how to prepare a physically and emotionally safe environment in which to interview and assess a client who has experienced domestic violence. 2. Use the domestic violent screening tools to identify victims of violence across the lifespan. 3. Teach clients who are at risk for violence to develop a safety plan. 4. Correctly use injury maps to document physical findings in clients. 5. Analyze data from the client interview and physical assessment of a client at risk for domestic violence or suspected to have suffered from abuse to formulate valid clinical judgements.  Family Violence Intimate partner violence, child abuse, elder abuse, and human trafficking are serious health problems that you must recognize the signs of and assess for in every patient. In the U.S. 1 in 4 women and 1 in 10 men are victims of intimate partner violence. On average 19,000 calls are made daily to intimate partner violence hotlines. Approximately 1 in 7 children experience abuse or neglect, with 5 children dying every day as a result. L Elder abuse impacts 1 in 10 people older than 60 years of age. As a result of these statistics the Joint Commission has set standards that all health care settings have policies and procedures to assess, document, and make referrals for family violence (intimate partner violence, child abuse, elder abuse).  Types of Violence Intimate partner violence In the U.S., approximately 10 million people are physically abused by intimate partners annually (average of 20 people every minute). Intimate partner is any partner (boyfriend, girlfriend, spouse, dating partner, sexual partner) iii with whom the person has a close relationship that may include emotional connectedness and physical/sexual contact. everyone Includes current or former partners  Types of Violence Intimate partner violence- 4 main categories Physical violence use of tone death disability injury Sexual violence sexual act without consent Stalking repeated and unwanted attention fear aggressoruses nonverbal or verbal Psychological aggression (emotional abuse) cues to harm  Types of Violence Child abuse and neglect 656,000 children are victims of child abuse and/or neglect annually. Most common maltreatment is neglect, followed by physical abuse. Child abuse and neglect defined at both federal and state level. Child Abuse and Prevention Treatment Act sets federal definition- recently amended to include sex and human trafficking, as well as to enhance protection of infants affected by withdrawal symptoms and Fetal Alcohol Spectrum Disorder.  Types of Violence Child abuse and neglect- 4 main categories Neglect failure to providechild's 4 basic needs Physical abuse shakingharm Sexual abuse inappropriatetouching pomographic images Emotional abuse developmental or self esteem injuries children act younger than they are  Types of Violence Child abuse and neglect Every state has a definition of child abuse and neglect that may expand upon the federal definition. Some states include parental substance use. Important you know the definition as a mandated reporter. As a mandated reporter, you are required by law to report any known or suspected child abuse or neglect. Not mandatedreportersfor intimate partnerneglect  Types of Violence Elder abuse and neglect Often underreported, estimates that only 1 in 24 cases actually reported. In nearly 60% of cases, perpetrator is a family member, most commonly an adult child or spouse. Includes both intentional acts and failure to act by a caregiver or trusted person  Types of Violence Elder abuse and neglect- 5 main categories Physical abuse intentionallyhurting them Sexual abuse or abusive sexual contact sexually Psychological or emotional abuse verbal andnonverbalbehaviors Neglect failure of caregivers to prevent harm Financial abuse or exploitation lack of financial resourcesneeds  Types of Violence Elder abuse and neglect Almost every state has some form of mandatory reporting of elder abuse. As a mandated reporter, you only need suspicion that elder abuse or neglect may be occurring  Human Trafficking “involves compelling or coercing a person to provide labor or Signs include: services, or to engage in commercial sex acts.” Delayed medical care Inconsistent stories Bruises or other signs of physical abuse 40 million people worldwide are victims Withdrawn, quiet, depressed, anxious Disproportionately affects women and girls 71% Resistance to accept assistance or hostility 25% of all victims are children (Stop the Traffik, 2021). Self-mutilation Hesitant to answer questions or answers seem rehearsed Vulnerable groups include: unhoused persons, runaway youth, Has companion who refuses to leave or let person speak sexual and gender minorities, undocumented migrants, and Unaware of location/time/date victims of previous violence. Malnourished Poor hygiene, inappropriately dressed Unexplained absences from work or school Tattoo branding Hypersexualization or unusually high number of sexual partners in doctor's visits  Abuse, exploitation and neglect occur more often, and with more frequency in people with IDD than in the general population Perpetrators often known to the victim Abuse, In those with limited communication, can be difficult to obtain a history on what may be exploitation causing injuries Abuse can present as unexplained changes in and Neglect physical health (i.e. malnutrition), or mental health (i.e.: Anxiety or depression), as well as in the IDD changes in behavior (i.e.: withdrawal, disruptive behavior, inappropriate Patient attachments, sexualized behavior). Neglect can present as a recurring pattern of inadequate care (i.e.: Missed appointments, nonengagement, nonadherent).  Behaviors that may indicate abuse in IDD clients with limited communication: New onset of urinary or fecal incontinence sexual assault Withdrawal Abuse, Excessive masturbation Refusal to allow bathing or aggression during bathing exploitation Self restraint (wrapping oneself inside their shirt, wrapping a blanket or throw tightly around themselves Sexual aggression towards others and Neglect Verbal or physical aggression when approached by a caregiver or others – especially if the person shares characteristics of the abuser in the IDD Suicidal behavior/attempts Night terrors Patient Always consider all causes of injury and thoroughly evaluate for any preventable causes Apply trauma informed principles in conducting your assessment  Suspicious behaviors in caregivers who may be abusing IDD individual: Refusal to follow directions or complete necessary personal tasks Displaying controlling attitudes and behaviors Showing up late or not at all Abuse, Using threats or menacing looks as a form of intimidation Using vehicle, money, or other resources without consent exploitation Socially isolating the person with disabilities and Neglect Devalues the person with disabilities Frequently switches healthcare providers in the IDD Speaks for the person with disabilities Abusing or harming pets or service animals Patient Frequently makes attempts to be alone with a person for no apparent reason Displays unwelcoming or uncooperative attitude during home visits These signs/symptoms do not guarantee abuse or neglect is occurring, but a higher level of suspicions is warranted Abuse, exploitation and Neglect in the IDD Patient Assess for risk factors (ie: residential living) and for possible indicators of abuse, exploitation and neglect. Report suspected abuse, exploitation or neglect to the appropriate authorities. Refer all victims of abuse, exploitation or neglect to appropriate local resources and services for support, especially those with expertise in working with the IDD population.  Nursing Assessment of Family Violence Screening According to latest guidelines published by U.S. Preventive Services Task Force (USPSTF), all women of child-bearing age (14-46) should be screened for IPV regardless of whether they have signs of abuse or neglect. Early detection is key in preventing long-term negative health outcomes associated with IPV. Interview victim separately from potential perpetrator when possible. Listen for cues of abuse, such as explanations that don’t match injury, inability to keep story straight, and frequently seeking care for suspicious injuries.  Nursing Assessment of Family Violence Intimate Partner Violence Normalize the questions by asking every patient about IPV. Know the IPV screening tool used in your facility Some hospitals ask a single question “Do you feel safe at home?” Others may use a standardized tool (HITS, E-HITS, HARK, PVS, WAST)  Nursing Assessment of Family Violence Elder Abuse and Neglect USPSTF does not recommend a specific screening for elder abuse; however, several other agencies recommend routine screening. Elder Abuse Suspicion Index has been validated in primary care and can be used with cognitively intact patients.  Nursing Assessment of Family Violence Child Abuse and Neglect Monitor for signs of abuse and neglect during clinic or hospital visits. If child verbal, a history should be obtained away from the caregivers through open-ended questions or spontaneous statements. Keep questions short and use age-appropriate language and familiar words. Children older than 11 can generally be expected to provide a history at the level of most adults. Medical history important part of screening- ask questions related to hospitalization, recent injuries, and delay in seeking care. Don’t offer any rewards for answering questions.  Nursing Assessment of Family Violence Collecting subjective data: Interview techniques Create a safe and confidential environment Establish a trusting rapport Actively listen Use simple direct questions with a relaxed and calm approach. Do not screen if there are any safety concerns for you or the client Prior to screening, discuss any legal, mandatory reporting requirements or other limits to confidentiality Remember when asking questions to allow the client to answer completely, do NOT interrupt Convey a concerned and nonjudgmental attitude Show empathy and compassion  Danger Assessment Begins with a calendar so that people can see for themselves how frequent and severe the violence has become over the past year. Calendar is followed by a series of 20 yes/no items. The more “yes” answers there are, the more serious the danger of the person’s situation. Danger Assessment Any childrenlivingwith you Any children with him risk of danger  Assessing a Safety Plan Ask the client, Do you: Have a packed bag ready? Tell your neighbors about your abuse and ask them to call the police when they hear a disturbance? Have a code word to use with your kids, family, and friends? Know where you are going to go if you ever have to leave? Remove weapons from the home?  Assessing a Safety Plan Have the following gathered: Cash, Social Security cards/numbers for you and your children, birth certificates for you and your children Driver’s license, rent and utility receipts, bank account numbers Insurance policies and numbers, marriage license, jewelry Important phone numbers, copy of protection order  Documentation Documentation of abuse must include: Detailed, nonbiased progress notes Use of injury maps Photographic documentation as appropriate Use verbatim documentation of reported perpetrator threats Use exact terms an abused patient uses to describe sexual organs or sexually assaultive behavior Slide 7-26 Photographic Documentation Digital photographic documentation in the medical record can be invaluable. Written consent needs to be obtained prior to taking photo. If patient is unconscious or cognitively impaired, taking photos without consent is generally viewed as ethically sound