OB exam 3 ---> Women's Health: IPV, Human Trafficking, Substance Use, and LGBQTIA Nursing Care and Community Resources

Registered nurses work with women to promote wellness by

1. Using multiple modalities of care

2. by working with the interdisplinary Health care team

3. by providing care to the community, working with individuals and families in the community

4. by advocating for health polices

What nurses do for women's healthcare

- Nurses' role in women's health care includes assessment, indetification and knowing how to intervene

1. nurses must provide safe and cultrually sound care

2. must be able to identify red flags

3. must work with interdisplinary team and identify barriers

Definition of violence against women

- defined as any gender based violence that is likely to cause physical, mental or sexual harm and suffering to a women inclduing coercian and depriving in both public and private

- most common type of violence against women is IPV

Walker theory of violence

- the most common theory

- goes from alot of tension, to acute battering, to acting loving

Feminist prescriptive of IPV

- believes that IPV occurs due to power dyanmics

- the man will withold things from the women that she needs to scare or force her into staying

- take away money, house, children, resources so women is stuck and has to rely on man

Theory of learned helplessness of IPV

- IPV will result in escape skills being replaced with coping skills

Social-ecological perspective of IPV

- there are dynamic relationships between individuals and groups with their enviroemnt

social perspective (of why IPV occurs)

- IPV is based on social structure and how ones family dyanmic is previved in society

biological factors (of why IPV occurs)

- IPV is based on neurobiological and hormal changes

IPV in pregnancy

- 303,000 women experince IPV when they are pregnant a year

- women who are pregnant are at risk of IPV from before conception to a year after delivery

- becoming pregnant can make the abuse worse or create a sense of protection

Consequences of IPV when a woman is pregnant

higher risk of spontaneous abortion, preterm birth, low birth weight and neonatal death

Proper environment to ask women about IPV

- always ensure to ask the partner to leave the room--> suggest they go get ice

ask women if she feels safe at home if shes in a healthy relationship

ABCDES of IPV

1. alone

2. belif--> listen no matter what you think, document properly

3. confidentiality

4. documentation

5. education

6. safety --> number one priority is the safety of the mother and fetus

proper documentation of abuse

- This is very important to ensure that a woman is able to have evidence if she goes to court and wants to press charges

1. Write clearly and take pictures of bruises if possible

2. Use direct quotes from women as much as possible --> the client states

3. Avoid using terms like alleged and summarizing the patient's story

- do not make a diagnosis IPV yet, because that would be false

4. always document the woman's demeanor and the time of day

resources for IPV

- domestic violence hotline

- Safe houses are confidential

- https:// women aware. security

- Esses County Family Justice Center

Sexual violence definition of indicence

a broad term used to describe a wide range of sexual victimization including sexual assault, harrasment, rape, molestation, and statutory rape

1. 1 out of every 5 women will experince rape in their lifetime

2. 1 out of everu 3 women will be sexualy harassed In their life time

3 phases of rape trama

1. acute phase: disorganization

- right after it happens

- will be dishelved and confused

2. outward adjustment phase

- few days after, everything may seem fine

-carrying on with life, but dealing with rape trama internally

3. long term phase: reorganization

- working through the trama

Assessment of sexual assault victim

- always done by a sexual assault examiner nurse

- will follow specfic protocol and will maintain patients dignity

- will focus on evidence collection and documentation

Human trafficking and nursing

nurses must be able to identify victims of human trafficking, know the signs

- nurses are mandated reported so we must always report

- 75% of human trafficking victims are women and 1/ 4 are children

Human trafficking overview

- Human trafficking is a 32 billion dollar business in the USA, and there are thought to be 40 .3 million victims worldwide

- Nurses are mandated reporters, so it is critical we know the signs. Being a partner who answers all questions, the patient wont look you in the eyes, no documentation, bruises, and untreated STDs

Interventions for human trafficking

- As nurses, we are mandated reports so we must do that properly

- want to provide women with resources, if the partner won't leave room, get reactive

- give her hotline number in a Chapstick, remember sometimes leaving is more dangerous, be mindful

Perinatal substance abuse

defined as a chemical dependence to a substance that is chronic, relapsing, and progressive

-5.4% of women reported using illicit drugs in pregancy

- more use in the 1st and 2nd trimester then the 3rd

- universal screening is recommended

Tobacco and pregnancy

- miscarriage

-preterm birth/ IUGR

- placenta previa or abruption

alcohol and pregnancy

- misscariage

- birth defects

- fetal alcohol syndrome

- use librium or valium to help with withdrawl

weed and pregnancy

- IUGR

opoids and pregnancy

- IUGR/ preterm birth

- placenta abruption

- neonatal abstinence syndrome

- use Subutex, Suboxone, and methadone to deal with withdrawal of opoids

cocaine and pregnancy

- has severe vasoconstrictive effects that can cause a placental abruption

- no medication to help with withdrawls, only psychotherapy

- very high risk of relapse

finnegan neonatal abstinence screening

- used to see if a baby is going through withdrawal and how severe it is

- will look forward for a high pitched cry, yawning, sneezing and associated symptoms

- if the score is 8 or higher we keep retaking it

- can give baby morphine and then retake score to see if they are improving

when a mother is using drugs during pregancy

- find out what substances they are using

- dont use bias language be non judgmental

- help paint he big picture, stoping is the best thing you can do for you and your baby

neonatal absteince syndrome

- occurs after birth when a baby is constantly exposed to a substance in utero, and the supply is suddenly stopped upon birth, so the baby will experience withdrawal

- will see the effects of the CNS, GI, autonomic, and respiratory systems

- symptoms will not occurs untill 24-96 hours after birth, can take up to 7 days

signs and symptoms of NAS

- will take 24-96 hours to occur

1. CNS--> irritability, tremors, high-pitched cry, seizures

2. GI--> poor feeding, vomit, and constant need to suck

3. autonomic --> fever, sweating, yawning and sneezing

4. respitroy --> nasal congestion and tachpnea

cisgender vs transgender vs genderqueer

1. cisgender --> when a person's gender identity aligns with their birth sex

2. transgender --> when a person's gender identity does not align with their birth sex

3. gender queer --> when a persons gender identity is not just male and not just female

MSM, FSF, FTM and MTF

1. MSM--> male sex with male

2. FSF--> female sex with female

3. FTM--> female to male

4. MTF--> male to female

important questions to ask regarding sex and gender

1. What gender do you identify with? What are your pronouns

2. What name or nickname would you go by

3. What is your sexual orientation

sexual orientation

- refers to whom a person is sexually and emotionally attracted to

1. heterosexual --> attracted to the opposite gender than oneself

2. gay--> when a person is attarcted to the same gender as their own, typically used to refer to men atrracted to men

3. lesbian--> a women who is attracted to women

4. bisexual--> when a person is attracted to their own gender and other genders

sexual identity

- a person's internal feeling of being male, female, both or another gender

1. transgender male--> female at birth, now identfies as a male

2. transgender female --> male at birth and now identifies as a female

3. genderqueer or fluid --> a person whos gender changes or times or who identifes as both male and female

LGBTQ+ youth are...

- 2-3 times more likely to commit suicide

- are more likely to be bullied or homeless

- are at a higher risk of STDs and HIV

gay men are at....

are at an increased risk of HIV and STDs espeially in commuties of color

LGBTQ+ people...

- are more likely to smoke, drink, use drugs, and have depression or anxiety

- are lesss likley to get preventive screneing for cancer

- more likley to have behavioral issues

transgender people are...

at a greater risk of HIV, STD, vicitmization and suicide

elderly LGBTQ+ people

- are at a greater risk of isolation, lack family support, and have decreased social resources

- Some elderly people have reported facing discrimination in elderly care places

barriers for healthcare for the LGBTQ+

1. limited acesess

- many LGBTQ+ individuals do not have proper insurnace because they were kicked out of their home when they were young or because the services they need are not covered

2. bad expericnes

- many LGBTQ+ people have bad experinces with HCP so they do not seek care as much as they need

3. limited knowledge

- many HCP have limited knowledge about LGBTQ+ and do not provide proper care

- its okay to not know eveyrhting but must be kind, acccepting and none judemental