ATI Ch 25, Family And Community Violence Flashcards
1
Q
What are the key phases in the Cycle of Violence?
A
Tension-building phase, Acute battering phase, Honeymoon phase
These phases illustrate the predictable pattern of spouse or partner violence.
2
Q
What occurs during the Tension-building phase?
A
Minor episodes of anger, verbal abuse, minor physical violence, tension increases
Both partners attempt to reduce tension, but the perpetrator may turn to substances.
3
Q
What characterizes the Acute battering phase?
A
Serious abuse occurs, victim may provoke perpetrator, shortest and most violent stage
The vulnerable person may try to cover up injuries or seek help.
4
Q
Describe the Honeymoon phase.
A
Situation defuses, perpetrator becomes loving, promises to change, victim hopes for change
This phase follows the violent episode and leads back to the cycle.
5
Q
What happens during the periods of escalation and de-escalation?
A
Shorter intervals between phases, increased emotions like fear or anger
Without intervention, the cycle of violence intensifies.
6
Q
True or False: The vulnerable person often accepts blame during the Tension-building phase.
A
True
This acceptance of blame contributes to the cycle of violence.
7
Q
Fill in the blank: Repeated episodes of violence lead to feelings of _______.
A
powerlessness
This is a common psychological impact on victims of domestic violence.
8
Q
What defines violence from one person toward another?
A
A social act involving a serious abuse of power.
9
Q
Who typically controls or injures another in acts of violence?
A
Usually a relatively stronger person controls or injures the least powerful person accessible to the perpetrator.
10
Q
What are the common relationships involved in partner violence?
A
- Partner against partner
- Adult abuse by a non-spouse or non-partner
- Parent against child
- Child against parent
11
Q
What are the three phases of the cycle of violence?
A
- Tension-building phase
- Acute battering phase
- Honeymoon phase
12
Q
Describe the tension-building phase.
A
- Minor episodes of anger
- Verbal abuse and minor physical violence
- Victim often dismisses the significance of the violence
13
Q
What occurs during the acute battering phase?
A
- Serious abuse takes place
- Victim may provoke the perpetrator
- This stage is the most violent and shortest
14
Q
What characterizes the honeymoon phase?
A
- Situation is defused
- Perpetrator becomes loving and promises to change
- Cycle begins again eventually
15
Q
What happens during periods of escalation and de-escalation?
A
- Shorter time between cycles
- Increased intensity of emotions (fear or anger)
- Feelings of powerlessness develop
16
Q
What types of violence should a nurse prepare to deal with?
A
- Violence toward a family member
- Violence toward a stranger or acquaintance
- Human-made mass-casualty incidents
- Natural disasters
17
Q
What are the mental health effects of natural disasters compared to human-made violence?
A
Mental health effects can be comparable.
18
Q
What factors increase the likelihood of violence against a person with a mental illness?
A
- Poverty
- Chaotic lifestyle
- Substance use disorder
19
Q
Who is more likely to harm strangers, a person with a mental illness or someone else?
A
A person with a mental illness is more likely to harm strangers.
20
Q
What is the strongest predictor of violence toward strangers?
A
A history of violence and critical acuity.
21
Q
What is the role of a forensic nurse?
A
Advanced training in the collection of evidence for suspected or actual cases of sexual assault or other forms of physical abuse.
22
Q
What should be ensured during interviews about family abuse?
A
Provide privacy.
23
Q
What approach should be taken when conducting nursing assessments?
A
- Be direct, honest, and professional
- Use language the client understands
- Be understanding and attentive
24
Q
What are the risk factors associated with family violence?
A
- Cultural differences
- Pregnancy
- Vulnerability of older adults
25
Who is usually the vulnerable person in family violence?
A female partner in the majority of cases, but the male partner can also be vulnerable.
26
When are vulnerable persons at the greatest risk for violence?
When they try to leave the relationship.
27
What factors may lead to an increase in violence during pregnancy?
The added responsibility or time required to care for the infant.
28
What increases the potential for violence against older adults?
* Poor health
* Disruptive behavior
* Dependency on a caregiver
29
In families with a history of violence, what is the risk for older adults?
The potential for violence is highest.
30
What is the most common target of violence within family groups?
Family and friends rather than strangers.
31
Family violence occurs across which backgrounds?
All economic and educational backgrounds and racial and ethnic groups.
32
Who can be victims of family violence?
Children, spouses or partners, or vulnerable adult family members.
33
What is a risk factor for abuse toward a child?
The child is under 4 years of age.
34
What type of child abuse occurs when the perpetrator perceives the child as different?
Abuse due to unwanted pregnancy, physical disability, or other traits.
35
Define physical violence.
Involves physical pain or harm (shaken baby syndrome, strangling, striking, kicking, pushing).
36
What constitutes sexual violence?
Sexual contact without consent, regardless of the vulnerable person's ability to give consent.
37
What is emotional violence?
Behavior that minimizes an individual's self-worth or humiliates, threatens, or intimidates a family member.
38
List the types of neglect.
* Physical care (feeding)
* Emotional care (interaction, stimulation)
* Education (enrollment in school)
* Necessary health or dental care.
39
What is economic abuse?
Failure to provide for the needs of a vulnerable person when adequate funds are available.
40
What are common characteristics of a vulnerable person?
* Low self-esteem
* Feelings of helplessness, hopelessness, powerlessness, guilt, and shame
* Attempts to protect the perpetrator
* Possible denial of the severity of the situation.
41
What are some characteristics of a perpetrator of abuse?
* Use of threats and intimidation
* Extreme disciplinarian beliefs
* Poor impulse control
* Violent outbursts
* Low self-esteem.
42
What age-specific assessment is crucial for infants regarding shaken baby syndrome?
Assess for respiratory distress, bulging fontanels, and increased head circumference.
43
What should be suspected if an infant has bruising before age 6 months?
Suspicious bruising indicating potential abuse.
44
What unusual bruising should be assessed in preschoolers to adolescents?
Bruising on the abdomen, back, or buttocks.
45
What might numerous bruises at different stages of healing indicate?
Ongoing beatings.
46
What type of burns should be assessed in children?
Burns covering 'glove' or 'stocking' areas indicating forced immersion.
47
What kind of fractures are suspicious in a child?
Fractures with unusual features, such as forearm spiral fractures.
48
What is a key nursing responsibility regarding suspected abuse?
Mandatory reporting laws require reporting suspected child or vulnerable adult abuse.
49
What should be documented during the assessment of potential abuse?
Subjective and objective data.
50
What is a component of patient-centered care for abuse victims?
Help the client develop a safety plan.
51
Fill in the blank: Emotional care includes _______.
[interacting with a child, stimulation necessary for development.]
52
True or False: All states have mandatory reporting laws for suspected abuse.
True.
53
What is the first step in conducting a nursing history?
Provide privacy
## Footnote
This involves closing the current room, ensuring security, and asking family members to leave.
54
What approach should a nurse take when communicating with a client?
Be direct, honest and professional
55
Why is it important to use language the client understands?
To ensure effective communication and comprehension
56
What qualities should a nurse exhibit during a nursing history assessment?
Be understanding and attentive
57
What type of questions should be used to facilitate communication?
Open-ended questions
58
What should a nurse inform the client about if a referral must be made?
Inform client if a referral must be made
59
What is an example of an open-ended question a nurse might ask?
Can you tell me a little bit about what brought you to the ED today?
60
When should a referral to protective services be made?
If patient is under 18 y/o or over 65 y/o
61
What should a nurse do to build trust with a client?
Minimize distractions
62
True or False: It is appropriate for a nurse to judge a client during a nursing history assessment.
False
63
What is the primary goal of early intervention in community-wide incidents?
Ensure clients are physically and psychologically safe from harm.
## Footnote
Early intervention focuses on immediate safety and psychological support.
64
What are some techniques used to reduce stress-related manifestations?
Alleviate a panic attack using various techniques.
## Footnote
Techniques may include breathing exercises, grounding techniques, etc.
65
What is the role of mental health nurses in early intervention?
Provide assessment, consultation, therapeutic communication and support, triage, and psychological and physical care.
## Footnote
Their level of expertise and training influences the type of care provided.
66
What is Critical Incident Stress Debriefing (CISD)?
A tertiary crisis intervention strategy for individuals who have experienced a traumatic event.
## Footnote
Typically used in situations involving violence.
67
What are the distinct phases involved in Critical Incident Stress Debriefing?
* Introducing the purpose of the group
* Discussing facts about the incident
* Discussing first thoughts about the incident
* Describing personal reactions
* Listing altered behaviors or physical changes
* Providing teaching on stress management
* Providing closure to the session
## Footnote
These phases help participants process their experiences.
68
What is the significance of the facilitator in a debriefing session?
Promotes a safe environment for expression of thoughts and feelings.
## Footnote
The facilitator acknowledges reactions and provides guidance.
69
What is one component of client education after a traumatic incident?
Understand expected growth and development patterns for children.
## Footnote
Parenting classes can assist in this area.
70
What are some skills that can assist with problem solving?
Assertiveness training.
## Footnote
Developing assertiveness can improve interpersonal communication.
71
What role does interprofessional collaboration play in community support?
* Encourage participation in support groups
* Use case management to coordinate services
* Assist with client relocation if needed
* Discuss beneficial therapies
* Talk with caregivers about community agencies
## Footnote
Collaboration ensures comprehensive support for individuals in crisis.
72
Define sexual assault.
Pressured or forced sexual contact, including inappropriate touching or intercourse, incest, human sex trafficking, and rape.
## Footnote
It can occur to individuals of any gender and age.
73
What is rape defined as?
Nonconsensual sexual activity involving any penetration or oral penetration.
## Footnote
It is characterized as a crime of violence, aggression, and power.
74
What types of rape exist?
* Stranger
* Marital
* Date
* Acquaintance
## Footnote
Most perpetrators are known to the victim.
75
What is a common association with date or acquaintance rape?
Alcohol and other substances.
## Footnote
These substances can impair judgment and memory.
76
Fill in the blank: Gamma-hydroxybutyrate is also known as _______.
G or liquid ecstasy.
77
Fill in the blank: Flunitrazepam is commonly referred to as _______.
Roofies, club drug, or roachies.
78
Fill in the blank: Ketamine is known on the street as _______.
Black hole, kit kat, or special K.
79
What is the primary goal of early intervention in community-wide incidents?
Ensure clients are physically and psychologically safe from harm.
## Footnote
Early intervention focuses on immediate safety and psychological support.
80
What are some techniques used to reduce stress-related manifestations?
Alleviate a panic attack using various techniques.
## Footnote
Techniques may include breathing exercises, grounding techniques, etc.
81
What is the role of mental health nurses in early intervention?
Provide assessment, consultation, therapeutic communication and support, triage, and psychological and physical care.
## Footnote
Their level of expertise and training influences the type of care provided.
82
What is Critical Incident Stress Debriefing (CISD)?
A tertiary crisis intervention strategy for individuals who have experienced a traumatic event.
## Footnote
Typically used in situations involving violence.
83
What are the distinct phases involved in Critical Incident Stress Debriefing?
* Introducing the purpose of the group
* Discussing facts about the incident
* Discussing first thoughts about the incident
* Describing personal reactions
* Listing altered behaviors or physical changes
* Providing teaching on stress management
* Providing closure to the session
## Footnote
These phases help participants process their experiences.
84
What is the significance of the facilitator in a debriefing session?
Promotes a safe environment for expression of thoughts and feelings.
## Footnote
The facilitator acknowledges reactions and provides guidance.
85
What is one component of client education after a traumatic incident?
Understand expected growth and development patterns for children.
## Footnote
Parenting classes can assist in this area.
86
What are some skills that can assist with problem solving?
Assertiveness training.
## Footnote
Developing assertiveness can improve interpersonal communication.
87
What role does interprofessional collaboration play in community support?
* Encourage participation in support groups
* Use case management to coordinate services
* Assist with client relocation if needed
* Discuss beneficial therapies
* Talk with caregivers about community agencies
## Footnote
Collaboration ensures comprehensive support for individuals in crisis.
88
Define sexual assault.
Pressured or forced sexual contact, including inappropriate touching or intercourse, incest, human sex trafficking, and rape.
## Footnote
It can occur to individuals of any gender and age.
89
What is rape defined as?
Nonconsensual sexual activity involving any penetration or oral penetration.
## Footnote
It is characterized as a crime of violence, aggression, and power.
90
What types of rape exist?
* Stranger
* Marital
* Date
* Acquaintance
## Footnote
Most perpetrators are known to the victim.
91
What is a common association with date or acquaintance rape?
Alcohol and other substances.
## Footnote
These substances can impair judgment and memory.
92
Fill in the blank: Gamma-hydroxybutyrate is also known as _______.
G or liquid ecstasy.
93
Fill in the blank: Flunitrazepam is commonly referred to as _______.
Roofies, club drug, or roachies.
94
Fill in the blank: Ketamine is known on the street as _______.
Black hole, kit kat, or special K.
95
What is the typical description of a person vulnerable to rape?
There is no 'typical' description of a person who is vulnerable to rape. Individuals of all ages are affected by sexual assault.
96
Is there a typical sexual assault survivor?
There is no 'typical' sexual assault survivor. Individuals can experience a variety of physical and emotional injuries and effects.
97
What is rape-trauma syndrome?
Sustained and maladaptive response to a forced, violent sexual penetration against the individual's will and consent.
98
What are the two types of initial emotional reactions in rape-trauma syndrome?
* Expressed reaction
* Controlled reaction
99
What characterizes an expressed reaction in rape-trauma syndrome?
An expressed reaction is overt and consists of emotional outbursts, including crying, laughing, hysteria, anger, and incoherence.
100
What characterizes a controlled reaction in rape-trauma syndrome?
A controlled reaction can appear calm with blunted affect but may also include confusion, difficulty making decisions, and numbness.
101
What are some emotional reactions that clients may experience after the initial emotional response?
* Embarrassment
* Desire for revenge
* Guilt
* Anger
* Fear
* Anxiety
* Denial
102
What are some somatic reactions that can occur later in clients?
* Muscle tension
* Headaches
* Sleep disturbances
* Gastrointestinal manifestations (nausea, anorexia, diarrhea, abdominal pain)
* Genitourinary manifestations (vaginal pain or discomfort)
103
What is acute stress disorder?
Occurs after a traumatic event (sexual assault) with manifestations similar to posttraumatic stress disorder, lasting at least 3 days and up to 1 month.
104
What distinguishes posttraumatic stress disorder from acute stress disorder?
Manifestations lasting longer than 1 month after the attack classify the condition as posttraumatic stress disorder.
105
What are long-term psychological effects of sexual assault?
* Reliving the event (flashbacks, recurrent dreams)
* Increased activity due to fear of reoccurrence
* Hyperarousal and increased emotional responses
* Avoidance, fears, and phobias
* Difficulties with daily functioning, low self-esteem, depression
106
What is a compound rape reaction?
Some survivors can experience additional disorders as a result of the sexual assault, such as mental health disorders and physical disorders.
107
What is a silent rape reaction?
The survivor does not report or tell anyone of the sexual assault, including abrupt changes in relationships, nightmares, and increased anxiety.
108
What should a nurse do when caring for a client who has been sexually assaulted?
* Perform a self-assessment
* Conduct initial and ongoing assessments of anxiety and coping mechanisms
* Provide a private environment for examination
* Follow national standard protocol for assessment
* Ensure client safety
* Provide nonjudgmental and empathetic care
* Obtain informed consent for data collection
* Treat injuries and document care
109
What is the role of a Sexual Assault Nurse Examiner (SANE)?
A specially trained nurse who performs examinations and collects forensic evidence.
110
What types of evidence can be collected during a sexual assault examination?
* Blood
* Oral swabs
* Hair samples
* Vaginal, anal, or penile swabs
* Scrapings
111
What should be avoided when collecting samples from clients?
Avoid minimizing the client's level of emotional suffering
## Footnote
Psychological responses can be subtle or not easily identifiable.
112
What type of questions should be refrained from asking during client assessment?
Refrain from asking 'Why' questions
## Footnote
This approach helps avoid placing blame on the client.
113
What should clients be informed about regarding the sexual assault?
Let the client know that the sexual assault is not their fault.
114
What should be assessed for in clients after a sexual assault?
Assess for suicidal ideation.
115
What prophylactic treatments should be administered for sexually transmitted infections?
Prophylactic treatment for:
* Syphilis
* Chlamydia
* Gonorrhea
* HIV
* Hepatitis exposure
## Footnote
As outlined by the Centers for Disease Control and Prevention.
116
What should be evaluated regarding pregnancy risk after a sexual assault?
Evaluate for pregnancy risk and provide for prevention (emergency contraception).
117
What should be assessed regarding the client’s support systems?
Assess for support systems and call the client's available personal support system if the client gives permission.
118
What should the nurse assist the client with during the acute phase of rape-trauma syndrome?
Assist the client to prepare for thoughts, manifestations, and emotions that can occur during the long-term phase of the syndrome.
119
What should be encouraged in clients following a sexual assault?
Encourage the client to verbalize their story and emotions.
120
What therapeutic techniques should be used to support the client?
Use therapeutic techniques of:
* Reflection
* Open-ended questions
* Active listening.
121
What types of resources should be provided to clients after discharge?
Provide phone numbers for 24-hr hotlines for sexual assault survivors.
122
What self-care activities should be promoted for clients?
Promote self-care activities and give follow-up instructions in writing.
123
Why should follow-up instructions be given in writing?
The client might be unable to comprehend or remember verbal instructions.
124
What types of referrals should be initiated for clients after discharge?
Initiate referrals for needed resources and support services such as:
* Individual psychotherapy
* Group therapy.
125
What is the importance of aftercare for sexual assault clients?
Emphasize importance of aftercare, as sexual assault clients historically have a poor compliance rate with follow-up visits.
126
Fill in the blank: __________ can be helpful to increase coping skills and prevent long-term disability.
[Individual psychotherapy and group therapy]
127
What should be scheduled after the assault?
Schedule follow-up calls or visits at prescribed intervals.
128
What is sexual violence?
Sexual violence occurs when sexual contact takes place without consent, whether the vulnerable person can give consent or not.
## Footnote
This includes all forms of sexual coercion and assault.
129
What does neglect include?
Neglect includes the failure to provide the physical care, emotional care, education, necessary health or dental care.
## Footnote
Examples include failing to make meals, bathe a child, or provide a stimulating environment.
130
What are examples of physical abuse?
Physical abuse can include:
* shaken baby syndrome
* strangling
* striking or kicking
* pushing
## Footnote
These actions can lead to serious injury or death.
131
What are some examples of emotional violence?
Emotional violence can include phrases like:
* 'you are no good'
* 'you always mess things up'
* 'if you don't do what I say, I will'
## Footnote
This type of abuse undermines a person's self-worth.
132
What is economic abuse?
Economic abuse occurs when a caretaker may take an elderly person's money to use as their own instead of paying necessary bills or providing for basic needs.
## Footnote
This can include not giving enough money to buy food.
133
What are common characteristics of a Vulnerable Person?
Low self-esteem, feelings of helplessness, hopelessness, powerlessness, guilt, and shame
## Footnote
These characteristics can significantly impact the mental and emotional well-being of the individual.
134
What behavior might a Vulnerable Person exhibit regarding the perpetrator?
Attempts to protect the perpetrator and accept responsibility
## Footnote
This behavior often stems from manipulation or coercion by the perpetrator.
135
What are some emotional responses a Vulnerable Person may experience?
Denial of the seriousness of the situation, anger, terror
## Footnote
These responses can complicate the individual's ability to seek help or recognize their own victimization.
136
What do all states require regarding suspected child or vulnerable adult abuse?
Mandatory reporting laws require nurses to report suspected abuse.
## Footnote
There are civil and criminal penalties for not reporting suspicions of abuse.
137
What should nurses document during an assessment of potential abuse?
Subjective and objective data obtained during assessment.
## Footnote
This documentation is crucial for legal and medical purposes.
138
What basic care should nurses provide to clients who have experienced violence?
Basic care to treat injuries.
## Footnote
This involves assessing and addressing physical injuries sustained.
139
What is one of the roles of nurses in situations of violence?
Make appropriate referrals.
## Footnote
Referrals may include mental health services or shelters.
140
How can nurses assist clients in dealing with violence?
Help clients develop a safety plan.
## Footnote
Safety plans include strategies for avoiding dangerous situations.
141
What techniques should nurses use in crisis situations related to violence?
Crisis intervention techniques.
## Footnote
These techniques aim to de-escalate potentially violent situations.
142
What should nurses identify to help prevent violence?
Behaviors and situations that might trigger violence.
## Footnote
Understanding triggers can help in planning interventions.
143
What information should nurses provide regarding safety?
Information regarding safe places to live.
## Footnote
This may include shelters or safe houses for individuals escaping violence.
144
True or False: Nurses should not intervene in family or community situations where violence has occurred.
False.
## Footnote
Nurses should use crisis intervention techniques to help resolve these situations.
145
What is the primary focus of early intervention in community-wide or mass casualty incidents?
Ensure clients are physically and psychologically safe from harm.
## Footnote
This includes assessing the immediate safety of individuals affected by incidents such as school shootings or gang violence.
146
What type of aid should be provided as part of early intervention?
Psychological first aid.
## Footnote
Psychological first aid aims to reduce initial distress and foster short- and long-term adaptive functioning.
147
What should be done to reduce stress-related manifestations during early intervention?
Use techniques to alleviate a panic attack.
## Footnote
Techniques can include deep breathing exercises, grounding techniques, and reassurance to manage acute anxiety.
148
What interventions should be provided to support rest and sleep during early intervention?
Interventions to restore rest and sleep.
## Footnote
This may involve creating a calm environment and providing resources for relaxation.
149
How can clients be supported in connecting to necessary resources during early intervention?
Connect the client to social supports and information about crucial resources.
## Footnote
This includes providing information about counseling services, community support groups, and crisis hotlines.
150
What is critical incident stress debriefing?
A crisis intervention strategy to assist individuals who have experienced a traumatic event in a safe environment.
## Footnote
It aims to help individuals process their experiences and emotions following a traumatic event.
151
What does debriefing involve?
Describing personal reactions, discussing facts, first thoughts, altered behaviors, or physical changes since the incident.
## Footnote
This process helps individuals articulate their experiences and emotions.
152
In what setting does debriefing typically take place?
In a group with a facilitator providing guidance, stress management, and referrals.
## Footnote
Group settings encourage sharing and support among participants.
153
True or False: The facilitator during debriefing does not provide any guidance.
False.
## Footnote
The facilitator plays a crucial role in guiding the discussion and providing support.
154
Fill in the blank: Tertiary crisis is a crisis intervention strategy to assist individuals who have experienced a traumatic event in a _______.
[safe environment].
## Footnote
A safe environment is essential for effective debriefing.
155
What is the term for the psychological condition experienced by survivors of sexual assault?
Rape-trauma syndrome
## Footnote
This syndrome encompasses a range of emotional and physical reactions following a sexual assault.
156
What is the first phase of rape-trauma syndrome?
Phase 1
## Footnote
This phase involves the initial emotional or impact reaction to the trauma.
157
What characterizes the initial emotional reaction in rape-trauma syndrome?
Variety of emotional reactions
## Footnote
These reactions can include confusion, shock, and disbelief.
158
What is the second phase of rape-trauma syndrome?
Phase 2
## Footnote
This phase involves more complex emotional responses as the survivor processes the trauma.
159
What are some emotional reactions experienced during Phase 2 of rape-trauma syndrome?
* Embarrassment
* Desire for revenge
* Guilt
* Anger
* Fear
* Anxiety
* Denial
## Footnote
These emotions can vary widely among survivors.
160
What is the third phase of rape-trauma syndrome?
Phase 3
## Footnote
This phase often includes somatic reactions, which are physical symptoms resulting from emotional trauma.
161
What are some somatic reactions associated with rape-trauma syndrome?
* Muscle tension
* Headaches
* Sleep disturbances
* GI issues
* GU issues
## Footnote
These physical symptoms can manifest due to emotional stress.
162
What is an expressed reaction in the context of rape-trauma syndrome?
Overt emotional outbursts
## Footnote
This can include crying, laughing, hysteria, anger, and incoherence.
163
What is a controlled reaction in the context of rape-trauma syndrome?
Ambiguous emotional response
## Footnote
The survivor may appear calm with a blunted affect or may be confused and indecisive.
164
Fill in the blank: Survivors may experience _______ as part of their somatic reaction to trauma.
Muscle tension
## Footnote
Muscle tension is a common physical response to emotional distress.
165
True or False: Survivors of sexual assault always express their emotions openly.
False
## Footnote
Survivors can have both expressed and controlled reactions to their trauma.
166
What are nursing actions for care after discharge for rape?
Possibility of STIs, long term emotions/thoughts/manifestations of rape trauma syndrome and:
Care after discharge
• Provide phone numbers for 24 hr hotlines for sexual assault survivors
• Promote self-care. Give follow up instructions in writing
• Initiate referrals
• Schedule follow up calls
• Emphasize importance of aftercare.
