Comm Final: Day Three presentations Flashcards
- combined medical and legal aspects to provide the most efficient care to victims of sexual assault, as well as other forms of abuse
- bridge between the criminal justice system and the health care system
- group of nurses gathered for a convention about sexual assault nursing: International Association of Forensic Nurses
Forensic Nursing
Treat victims of: Domestic violence, Sexual assault, Child abuse, Elder abuse, Neglect, Human trafficking
forensic nursing
- 1 in 6 women are at least once during their lifetime
- only 10-15% of these women actually report the case
- medical examination should be offered within 7 days of incident
- If after months can present with chronic issues such as: chronic pain, GI issues, severe constipation, eating disorders, unexplained vomiting, sexual dysfunction, severe depression, panic disorder
- Can lead to unwanted pregnancy
Forensic Nursing and Sexual Assault
- Assessment
- Medical and assault history
- Raise awareness
- Educate the community about the importance of seeking help
- Just ask!-
Interventions of the PHN and CHN
Forensic nursing
: date and time of the assault, location, type of assault, orifices involved, condom use, if ejaculation occurred, patient’s action after the assault, sexual intercourse within the last two weeks, drugs taken in the past four days, and alcohol consumed within 12 hours of the assault
- assess for signs of depression and/or thoughts of suicide
- collect evidence, documents injuries, and gives referrals if needed
- take pictures and have them sign the back
Interventions of the PHN and CHN
1. Assessment
Forensic nursing
- “Is somebody hurting you?; Has someone hurt you?
Did someone you know do this to you?”
Just ask!
Interventions of the PHN and CHN
Forensic nursing
-education to vulnerable populations such as young children, women, and the elderly
Levels of intervention:
1. Primary
forensic nursing
-Nurses may give them contraceptives and will perform assessments such as screenings for sexually transmitted diseases or tending to other medical issues
Levels of intervention:
forensic nursing
Secondary
-providing referrals for psychological counseling
Levels of intervention:
forensic nursing
Tertiary
chronic pain, headaches, sexually transmitted diseases, unwanted pregnancies, fear, anxiety, and depression
Impact on the victim:
forensic nursing
Spinal cord injuries or head injuries
Long-term health issues: forensic nursing
Rural areas aren’t as common because of familiarity with healthcare staff or police force
Victims of sexual assault could potentially start smoking, abusing drugs and alcohol, or other risky behaviors
Increased risk for risk of pregnancies, spread of STDs, HIV, and AIDS
More commonly reported in cities: forensic nursing
-Follow up appointments
Call victims to see if they have contacted the referrals
Evaluate that the services the victim needed were provided to them
A 2004 study noted that 50% of victims in their study were able to return to normal life within one month
in 3 to 6 months, 85% felt secure alone in public areas
At the end of 12 months, more than 90% of the survivors were entirely free of their initial assault-related anxieties and emotional discomposure
Evaluations of interventions
forensic nursing
Indiana Domestic Violence Resource – AARDVARC.org: info about abuse, reactions to abuse, labeled by county
Julian Center: services for domestic violence, domestic violence, mother and father can stay here
The Caring Place : Saturday program about hope and dreams
Referrals
forensic nursing
- Perform assessments
- Collect and document data
- Provide support and referrals
- Sit in on legal trials
- Policy that Registered nurses and other health care practitioners can attend a 40-hour training course that addresses the medical, forensic, legal and psychosocial needs of those who have experienced sexual abuse.
- instruction provided would increase the awareness and practice
Policy Development
forensic nursing
Direct caregivers, Educators, Counselors, Consultants, Case managers, Community outreach,
Collaborator
School nursing
Roles and Functions
-Traditional role of the school nurse
Attending to the ill or injured child or school staff
Boarding schools=24 hour care vs. public and private schools=6 hours a day
1. : vision, hearing, BMI, mental health, and examining for signs of abuse
Direct Caregivers
school nursing
1. Screenings
Teach children individually as well as in classrooms
- Halloween trick or treating, ice on the roads (always wear seat belt), look both ways before crossing the street, wearing warm clothes when you’re in the car, don’t talk to strangers (or take candy)
- normal growth and development things to expect
Health Educator-
school nursing
1. Safety:
2. Puberty:
Tips:
Keep the lesson to 10 mins. or less
Use a lot of examples and pictures
Remember the developmental stage when talking
school nursing health educator
- When the children consider the nurse a trustworthy person, Confidentiality
- School shooting, Someone dying, Problems at home such as abuse, Community crisis
- Can go to nurse if they have a problem or a question and etc.
- The nurse has to tell the child if there is anything that they have to report
- Participates in school crisis team
Counselor
Grief counseling:
school nursing
- Provides health information to school administrators, teachers, and parent-teacher groups
- Provides professional information
- Recommend changes in school policy
- Ask community organizations to help make the children’s school a healthier place
- Professional information about proposed changes in the school environment and their effect on the health of the children
Consultants
school nursing
-Coordinating healthcare for children with complex health problems
Examples of children with complex health problems: mental retardation, diabetes, CP and other conditions that require assistive devices
-Nurse develops Individualized Healthcare Plans (IHP) and Emergency Care Plans (ECP)
-Organizes the student’s medical consults around their academic schedule
Case Managers
school nursing
1.are in nursing language to direct nursing care for students
IHPs
case managers
school nursing
- are written lay language to guide the respond of unlicensed personnel in health related emergencies
ECPs
case manager
school nursing
Heath fair or festival in schools
Disease education: flu vaccine (teaching it as a program for the school)
Screenings: like blood pressure
Coordinating within community to provide education in schools
Community Outreach General
school nursing
Provide families with referral information
Provide them with community resources to improve access to healthcare
Assist in obtaining health insurance
Community Outreach Specific
school nursing
- Part of school educational teams
- with dietary, PE teacher and others
- Educational teams: committee on special education, the individualized educational plan (IEP) team, the section 504 team so that health related barriers to learning can be reduced for each student
- Dietary: meals close to my plate
- You can see the overlap of the roles
- with teachers about general health education in the classroom
Collaborator
school nursing
Health promotion activities: If school nurse goes into classroom, teach hand washing, tooth brushing
-Ways to spot an ill child or a child in need of counseling
Teaching healthy lifestyles: Education on preventing injuries, substance abuse, and reducing risk for development of chronic diseases
Immunizing students for school entry: Monitor immunization status for children entering school= each state has different requirements
Primary Prevention
school nursing
This is the largest responsibility for school nurses
This is similar to the role of direct caregiver
Why children seek out nurse: HA, stomachaches, diarrhea, anxiety, injuries, or maybe to hide from bullying or harassment
Nursing care for emergencies in the school
Nurses need to have set emergency plan in place
When to call 911
The individualized plans for students with ailments are here
Emergency equipment is in school nurses office:
Oxygen tanks and masks, splints for injured limbs, cervical spine collars, sterile dressings, AED, and epi-pen
Administering medication
Secondary Prevention
school nursing
- Screenings for health problems: vision, hearing, height, and weight, oral health, TB, scoliosis, and lice
Identification of child abuse and neglect:
Does the story match, multiple stages of healing and etc.
Nurse is mandated by state law to report suspected cases
Communicating with family physicians or other health care providers if a health care problem arises
Important for nurse to hold educational programs and teach faculty about what to look for in cases of prevention for suicide and violence
Plays a vital role in the school crisis team when responding to disasters that can occur: death in school, environmental disaster or fire - Caring for ill or injured children and staff
school nursing
secondary prevention
- Caring for children with chronic health problems
- Health referrals and continuity of care
- Focused on working with people with chronic illnesses or special needs
- Involves medication, any type of therapy, and also advocating for the student to have a seat in the class which allows them to hear and see better
- Management programs and teaching symptoms and factors that can cause asthma attack
- Responsible for preparing teachers for possible communication problems, teaching parents and other students about autism
- Facilitating communicating through other means like picture boards
Tertiary Prevention
school nursing
can keep track of indoor air quality so the school has data about what can affect children such as chalkboard dust and mold
-Children with asthma: School nurse
tertiary prevention
- Need to be able to have access to rooms and restrooms (ramps)
- Establish a plan of care for children including: monitoring blood glucose, giving insulin, and special nutritional needs
- Give medications
tertiary prevention
Ambulation disabilities:
Diabetes:
Autism:
- education provided empowers the students and parents to have some control over their own health : You want to do this with them, not to
- Eating heathier and exercising (through the collaboration with other teachers) can allow for children to have a healthier lifestyle
- For some children school nurses provide their only source of healthcare and screenings
- Only health care: some children are LES and so not have access to healthcare
Community Impact
school nursing
It will help parents to be more cognitively aware of the problem, allowing for a better support system at home
community impact
Increased support systems:
through health promotion and disease prevention as well as the overall wellness of the staff
community impact
Improved attendance rates:
: If students and parents are aware of risk factors they can take action and prevent disease
community impact
Prevention of chronic diseases later in life
- Improving student-to-nurse ratio
- Amount of healthcare given in schools is increasing
- Focus has changed to primary and secondary prevention
- More concern for being culturally competent
- According to NASN.org school nurses are actively trying to get the ratio improved through legislature
- Direct caregiver role is increasing and nurses have taken on more roles for the betterment of the students
- This would be like teaching and screenings; prevention instead of treatment is key
- In Indianapolis specifically we have a lot of Burmese, Hispanics, and Chinese and it is the nurses responsibility to make sure that they have care that is culturally sensitive
Current Trends
school nursing
-an intricate sector of nursing, managing a diverse community of individuals with different socioeconomic classes, belief systems, and health statuses.
Correctional Facility Nursing
-Intake screenings, Assess physical and mental health status, Disease management; administering medications, Discharge, Health promotion, Maintain confidentially, Advocacy
Correctional Facility Nursing
Responsibilities
-Safety concerns Strong need to maintain boundaries Sharing experience details are inappropriate Diversity of population May not be able to hug or touch Time constraints: Everything moves more slowly due to facility rules and inmates' tight schedule Lack of patient privacy Higher rate of infectious disease
Correctional Facility Nursing
What makes it different?
- Spread of infectious disease: CA-MRSA, TB, HIV, Hepatitis
- Lack of resources/funding
- Staff corruption
- Disease management: MRSA, LTTB, Hepatitis, Diabetes, HTN, Pain, Alcoholism, Substance abuse & withdrawal
Correctional Facility Nursing
Current Trends
Testing & Treatment
- TB-Meds are administered to control & treat symptoms
- HIV & STD’s- Only those report being at-risk are tested and those that test positive are treated appropriately
- Diabetes, HTN, alcoholism, substance abuse, & withdrawal are common- Meds are administered to control & treat symptoms
Correctional Facility Nursing
- Observation of RN/NP at Reception Diagnostic Center (RDC)
- Community-Associated MRSA (CA-MRSA)
1. Poor utilization of protective equipment
2. Non-adherence to standard precautions
3. Unwillingness to test MRSA to keep the infectious disease rates low
4. Treated with Bactrim and Clindamycin if MRSA if suspected
5. Vancomycin is preferred treatment
Correctional Facility Nursing
Focus of Content
- Stressing blood-borne pathogen regulations to the staff
- Mandating the Federal Bureau of Prisons (FBOP) guidelines: focus on prevention, education, and independent variables to prevent spread of infection that can be controlled within the facility by staff and inmates.
- State demands that the facility follow CDC guidelines; but in the past, the FBOP has failed to mention control of organisms like MRSA.
Correctional Facility Nursing
Primary Levels of Prevention
- Assess the individual’s risk of contracting MRSA during the intake process and conduct screenings in the facility.
- Educate the individual of the possibility of contracting MRSA during their stay at a high risk facility.
- Successful helps to detect MRSA early and averts the physical suffering, financial burdens, and treatment needs that are associated with disease.
Correctional Facility Nursing
secondary intervention
- before and after meals
- after using community workout equipment
- after using the restroom
Correctional Facility Nursing
secondary prevention
-Wash at appropriate times
- It is imperative that the material easy to understand, follow, and is accurate
- How the infection is prevented, transmitted, treated, and contained
- Teaching proper hand washing technique
Correctional Facility Nursing
Educate the individual of the possibility of contracting MRSA during their stay at a high risk facility.
secondary prevention
- Provide inmates with appropriate resources
- allowing them to better manage their condition
- reduce complications throughout treatment.
- At this stage, MRSA has been recognized and diagnosed; indicating that primary and secondary prevention efforts may have been ineffective.
Correctional Facility Nursing
Tertiary Levels of Prevention
- Provide a comprehensive infection control system that maximizes protection against communicable diseases for all members and for the public that they serve
- Regard all patient contacts as potentially infectious. Universal precautions will be observed at all times and will be expanded to include all body fluids and other potentially infectious material (body substance isolation)
- Provide all members with the necessary training, immunizations and personal protective equipment (PPE) needed for protection from communicable diseases
- Recognize the need for work restrictions based on infection control concerns
- Provide screening to all inmates upon their intake
- Inmates should be asked if they have any symptoms of MRSA, such as any skin lesions or boils
- Education should be provided to all prisoners in regards to MRSA
Correctional Facility Nursing
Policy Statement
- Each year about 10 million people are processed in the U.S. correctional system.
- Nearly 600,000 state prison inmates are released into the community annually; therefore, prevention of the spread of MRSA within the correctional facility is crucial.
- RDC is an intake facility in which all Indiana prisoners are processed prior to being sent to the prison where they will do their sentence.
- Facilities that house inmates for a shorter duration have a higher turnover rate and receive the majority of admissions to correctional facilities. This means they may receive more infected or colonized individuals and send more newly infected or colonized individuals into the community.
- Poor hygiene practices overall
Correctional Facility Nursing
Impact on Community
-The recruiting, harboring, moving, or obtaining, of a person, by the use of force, fraud, or coercion, for purposes of involuntary servitude, debt bondage, slavery, or the sex trade.
HUMAN TRAFFICKING
- There have been over 130 suspected cases but only a few have lead to charges.
- Super Bowl in 2012 contributed to this number and two victims were identified and rescued.
- Just because there have been few confirmed cases does not mean it is not happening.
Human trafficking in Indiana
- 300,000 US children, both male and female are at risk
- Generally target runaways, homeless youths, undocumented migrants, and people in high poverty areas.
HUMAN TRAFFICKING The victims
factories, restaurants, hotels, health and beauty industries, sex industry, forced labor and agriculture, and construction industries
HUMAN TRAFFICKING
-Common places discovered:
as indentured servants such as nannies, housekeepers, and servants
HUMAN TRAFFICKING
-commonly found in roles
- Removes individuals from productive roles in society.
- PTSD, depression, emotional/physical abuse, risk for drug abuse.
- Transmission of STD’s.
- Victims typically taken at ages in which they should be going to school, learning a trade, and developing personal values.
- Acts as a magnet for other underground activities.
- Tarnishes countries’ reputation.
HUMAN TRAFFICKING
Impact on the Community
1. Economic:
2. Personal:
Education for prevention and awareness
Health implications, public health safety, prevalence, risk factors, how it affects the public health
Schools, neighborhoods, general public
HUMAN TRAFFICKING
Nurse’s Role
1. Primary Prevention:
- Detect high risk populations
-High poverty, the oppressed, runaway children, homeless youths, undocumented migrants
-Advocate for increased police activity in these areas
-Advocate for increased legislation to crack down & encourage people to come forward
Protection against the law, record clearing
HUMAN TRAFFICKING
Secondary Prevention:
Signs when victims come into the hospital
Bruising, broken bones, recurrent STDs, malnutrition
* ask open-ended questions Red flag- no id, wallet, person answers questions for pt, sti
Helping victims recover: Support, treatment, counseling/ Could refer them to safe living areas
/ Can counsel themselves, but also referring them to a counselor
HUMAN TRAFFICKING
Tertiary Prevention:
Julian Center, IPATH-resource to proactively fight, Keys
HUMAN TRAFFICKING
Organizations Local-
Abbie’s Intermission: underground railroad safe houses to stay and escape, International Justice Mission: us based nonprofit to rescue victims of human right, Global Alliance Against Traffic in Women: network of several countries, non-governmental women and children
HUMAN TRAFFICKING
Organizations International
Warning Signs: brand employees with younger, Risk Factors, Safety Tips=don’t go out by self, Responding/Reporting Suspicious Activity: tell supervisor
For: Nurses, Other Healthcare professionals, Law Enforcement
HUMAN TRAFFICKING
Policy Recommendations
Education About:
