LU 1.5 Violence, Rape, Abuse, Suicide & Homicide

What is domestic violence ?

• it is the commission of one or more of the following acts :

• i) willingly place the victim in fear of physical injury

• ii) causing physical injury to the victim

• iii) detain the victim against his/her will

• done by a person by himself or a third party against his/her spouse, former spouse, child or any other member of the family

What is the immediate protection against domestic violence ?

• Emergency Protection Order (EPO)

• it allows social welfare officers to grant victims immediate

• it prohibits the abuser from harming the victim or inciting third parties to harass and harm the victim

What are the nursing management for domestic violence survivors at ETD ?

• they should be triaged according to the severity of the injuries sustained

• critical or semi critical survivors shall be triaged to the red or yellow zones respectively

• non critical survivors shall be immediately ushered to a designated OSCC facility

• Secondary triaging of vital signs shall be performed in OSCC facility for non critical survivors

What are the assessment done for domestic violence ?

• obtain the objective data

• check for contusions, abrasions, lacerations, hematomas, fracture

• the abuser may be present and overprotective, not allowing the victim to answer questions

What are the nursing diagnosis and interventions for domestic violence ?

• nursing dx : ineffective family coping, spiritual distress, disturbance in self concept, grieving, fear

• interventions :

• i) manage any injuries that may present

• ii) maintain an awareness of the potential for abuse

• iii) contact the police with the patient’s consent

• iv) obtain a social service referral

• v) provide emotional support

What is rape and how is it consider rape ?

• when he has sexual intercourse with a woman under the following circumstances :

• 1) against her will

• 2) without her consent

• 3) with her consent but obtained by putting her in fear of death or hurt to her or any other person

• 4) with her consent through deception

• 5) with or without consent, when is under sixteen years of age

What are the assessment done for rape victims ?

• check for physical injury

• check of emotional response (controlled or hysterical)

What are the presentation of rape victims to the hospital ?

• walk in through triage with or without police report

• brought by parents/ guardian/ teacher

• pregnant

• brought in semi-critical or critical condition

• referred from level C hospital or health clinics

What are the nursing management for suspected rape ?

• documentation of pertinent history

• careful physical examination

• start treatment of physical injuries

• psychological support

• collection of forensic evidence

• evaluation for risk of pregnancy and prevention

• follow up care of the victim

What are the important points for nursing management in rape cases ?

• history and physical injures are documented using standard terminology

• history, general physical and pelvic examination are performed methodically

• primary goal is to attend the patient’s medical needs first

• gathering of evidence occurs simultaneously with physical examination

What are the nursing diagnosis and interventions for rape cases ?

• nursing dx : rape trauma syndrome (fear, anger, self blame), nightmares, anxiety

• interventions :

• 1) give emotional support in nonjudgmental manner

• 2) maintain confidentiality

• 3) listen to client, encourage expression of feelings

• 4) document physical findings

• 5) provide referral to rape counselor & follow up care

What is abuse ?

a pattern of behavior used by one person to gain and maintain power and control over another

What are the type of abuse ?

• physical

• sexual

• psychological

• economic

• spiritual

• emotional

• verbal

What are the symptoms of physical abuse and sexual abuse?

• physical abuse : pattern of bruises, burns, unexplained dislocations, aggressive behavior, unusual fear of parent

• sexual abuse : itching of genitals, bruised genitals, stain on underwear, unusual sexual behavior

What are the possible findings of abuse in

• child

• spouse

• elderly

• child : signs of neglect (hunger, poor hygiene,fatigue), signs of emotional abuse (thumb sucking, learning disorders)

• spouse : headache, injury to the face, head, body, depression, insomnia

• elderly : malnutrition, poor hygiene, bruises

What are the nursing diagnosis and interventions for abuse cases ?

• nursing dx : situational low self esteem, fear, pain

• interventions :

• 1) provide nursing care specific to physical or emotional symptoms

• 2) conduct interview in private with child & parents separated

• 3) inform parents of requirement to report suspected abuse

• 4) do not probe for information or try to prove abuse

• 5) be supportive & nonjudgmental

• 6) provide referrals for assistance & therapy

What is suicide ?

• self inflicted death with evidence that the person intended to die

What are the suicide warning signs / symptoms ?

• negative view of self

• isolation

• substance abuse

• self harm

• making suicide threats

• drastic mood changes

What are the nursing managements step for suicide in ETD ?

• STEP 1: Identify risk factors and protective factors

• STEP 2: Conduct suicide inquiry

• STEP 3: Determine risk level/intervention(Code blue, yellow or red)

• STEP 4: Documentation

• STEP 5: Regular monitoring & reassessment

What are the recommend interventions for suicide attempt cases according to colour code

• blue (low risk)

• yellow (moderate risk)

• red (high risk)

• code blue : allow family member to monitor while waiting for psy intervention, refer to psychiatry

• code yellow : body & belonging search to remove items that could be used for self-harm, refer to psychiatry

• code red : body & belonging search to remove items that could be used for self-harm, urgent referral & rapid evaluation by psychiatry

What are the nursing diagnosis and interventions for suicide attempt cases ?

• nursing dx : risk for self harm injury, loneliness, hopelessness

• interventions :

• 1) use crisis intervention to determine suicide potential

• 2) discovers areas of depression & conflict

• 3) find out about the patient’s support system

• 4) treat the consequences of the suicide attempt

What is the suicide risk assessment ?

• SAD PERSON scale

• history taking (from patients and significant others)

What are the nurses’ roles principles in homicide ?

• coordinating cases to be reviewed by the rightful personnel such as police

• advocating family needs and responses toward the event

• facilitating in the process of assessments and investigating

• never handle the case alone

What is OSCC (One Stop Crisis Centre) ?

• an integrated and comprehensive multiagency service center

• for the management of survivors of domestic violence, sexual assault, child abuse and neglect

What are the level of network for the management of OSCC survivors ?

• first level : initial hospital management

• second level : follow up

• third level : rehabilitative programs with various agencies and legal proceedings

What are the roles of OSCC ?

• to provide multidisciplinary care of the survivors

• to identify and manage survivors

• to provide treatment and multilevel crisis intervention to survivors

• to ensure the delivery of optimal care and evidence management for the survivors

What are the department involved in OSCC ?

• Obstetrics andGynecology Department

• Pediatric Department

• Surgical Department

• Forensic Department

• Psychiatric Department

What are the principles of documentation for domestic violence, rape, abuse, suicide & homicide ?

• Let the survivor tell her story and write every detail as soon as possible.

• Do not write down after the survivor has narrated her story FULLY by memory but write down as the history is being taken.

• Include the name of the assailant, and use statements, such as “survivor states” or “survivor reports”.

• Introduce yourself.

• Date and time of the examination and the name of staff present during the interview and examination to be noted.

• Reassure the survivor that she is in control of the pace, timing and components of the examination.

• Limit the number of people allowed in the room during the examination to the minimum necessary.

What are history to be taken in all these cases ?

• events preceding the assault

• place of assault

• details of the assault

• sexual history

• medical history

• site and mechanism of injury

What are the nursing perspectives when caring with these clients ?

• Don’t talk down or belittle based on your judgments of their situation

• Don’t assume

• Follow through and be reliable

• Be patient and even-toned

• Give the patient information and options for medical treatment

• Ask permission before touching the patient