Week 11: Underserved Populations, Vulnerable Populations, and Intimate Partner Violence Flashcards
IPV
intimate partner violence
a pattern of abusive behaivors and coercive control within an intimate relationship
SV
sexual violence
sexual activity in which consent is not obtained or freely given
Health Consequences of Violence
unintended pregnancy
chronic pain
GI disorders
migraine HA
anxiety and depression
PTSD
injury and death
What is the USPSTF Screening and Referral Recommendation
recommends that health care professionals screen women of childbearing age (14-46 yo) for IPV and provide or refer women who screen positive to intervention services
HOWEVER…the recommendation does not specify in what conditions screening should occur - only that it include women
What do we know about IPV screening
- Adequate evidence that available screening instruments can ID current and past abuse or icnreased risk for abuse
- Adequate evidence that effective interventions can reduce violence, abuse, and physical or mental harms for women of reproductive ages (14-46 yo)
- Adequate evidence that the risk for harm to the individual from screening or interventions is no greater than small
Screening women of childbearing age for IPV has a …
MODERATE NET BENEFIT
Barriers to Screening for IPV
inadequate prep and education
providers believing IPV does not affect patient population
discomfort with the subject and assessing the danger
lack of belief in usefulness of screening
time constraints
inadequate rapport with patient
personal history of abuse
fear of being offensive or endangering patients
lack of effective interventions, resources, protocols, support staff, or confidence in the legal system
lack of knowledge or access of screening tools
belief that only physical violence is legitimate health concern
belief that it is a private issue and patients should come forward on their own
dilemma of caregiver abuse of an elderly or disabled person
language and cultural differences
RADAR Assessment Process
R - Routine Screening
A - Ask direct questions in a kind nonjudgmental way
D - document findings
A - assess patient safety
R - review options and referrals
Factors to consider r/t patient safety
Any increase in frequency and severity of the violence
threats of homicide or suicide
presence of firearms in the home
separation from or plans to leave partner
highly controlling behavior
womans assessment of his likelihood to kill her
Danger Assessment
insturment that helps to determine the level of danger an abused woman has of being killed by her intimate partner
in 2008 it was revised to include reassault in abusive female same sex relationships too
What happens if you scores 4-5; 3; 2; or 1 Yes to the Danger Assessment
4-5: Allow them to call police and follow through by calling victim or hand off to knowledgable advocate
3 yes: full DA
2: tell them of risk factors
0 or 1: proceed with normal referral for domestic violence
What is an essential part of screening and counseling for IPV
safety planning discussion:
review options and provide referrals: numbers, websites, services
Some important components of a safety plan
pack a bag in advance
have personal documents ready
hide extra sets of house and car keys
establish a code word with friends and family
ID a safe place to go
With IPV the provider is not ____ the problem the key is to…
fixing; the key is to be there, listen, educate, refer
IPV public health success is what compared to not being what?
it is routine screening, assessment education
it is not disclosure and them leaving the relationship (this increases severe injury or death risk)
Importance of Screening
validates violence as a health care issue
opens dialogue - “plant a seed”
provides an opportunity for education, services, and referral
opportunity to conduct a safety and lethality assessment
integral to assessment and tx
Nurses have an ethical mandate to…
treat all people with compassion and respect for the inherent dignity
Correctional health care needs and challenges
lakc of consistent access to tx
arrive to prisons and jails with undiagnosed conditions
correctional nursing occurs in an environment that often does not embrance health care as its core purpose (safety and a safe environment is the top priority)
correctional nurse is the only initial and primary link to healthcare services
Common correctional health issues
mental illness (#1)
drug dependence
chronic illnesses like DM HTN and asthma
communicable diseases like Hep C HIV Staph TB and an STI
aging population incarcerated with mobility problems, vision and hearing issues, and cognitive issues
Process Algorithm
algorithm for nurses in clinical settings to assess social determinants of heatlh
___ to ___% of incarcerated individuals will eventually return to their communities
85-95%
Vulnerability
susceptibility through actual or potential stressors that may lead to an adverse effects
What are the contributors to vulnerable population disparities
poverty and such not race and ethnicity
Disenfranchmisement
feelings of being separated from mainstream society
Epidemiologic Triangel
interplay of environment, agent, and host impact health
agent - what
host is who
evnironment is where
Causes for vulnerable populations
combined effects of limited resources (social, actual things, etc)
predisposing factors
___ is the primary cause of vulnerability
poverty (as is age)
Setting the satge for vuln pop assessment
comfortbale non threatening environment
cultural competence
RESPECT CLIENTS PRIORITIZATION (non health concerns need address first)
collaboration with other resources and other progessions
Seize the Oppotunity
assessment of client in vuln pop is limited so really balance the assessment and get a lot done and educate
Nursing dx of vuln pop client is made according to…
maslows hierarchy fo needs
Maslows Hierarchy
Self actualization (intellectual and spiritual)
Self esteem (emotional)
Love and belonging (sociocultural)
safety and security (environment)
physiologic needs
Individual level nursing interventions
centered on improving asccess
minimize hassle
culturally sensitive
culturally competent
educaiton in terms of health promotion and disease prevention
Community level nursing interventions
public service announcements
health fairs
Examples of ways to act with community vulnerable popualtions
create a caring environment
show respect, compassion, and concern
dont make assumptions
cordinate a network of services and providers
advocate for accessible health care services
One Stop Comprehensive Services
providing information on multiple topics (immunizatinos, flu care, diet, etc) all at once
Wrap Around Services
social and economic assistance wiht the health care at the same time
Mental Health
being able to engage in productive activities and fulfilling relationships with other people to adapt to change and to cope with adversity
mental disorder
conditions that are characterized by alterations in thinking, mood or behavior which are associated with distress and impaired functioning
mental illness
refers collectively to all diagnosible mental disorders
Older Adults
65+
Factprs making older adults more vulnerable
chronic illness causing disabillity
abuse and neglect
injury
cognition may not allow self advocacy
5 I’s
5 I’s
intellectual impairment
immobility
instability
incontinence
iatrogenic drug rxns (aka adverse rxns)
all these impact adult health
3 D’s of INtellectual Impairment
Dementia
Delirium
Depression
Nursing Dx for Older Adults
risk for falls
confusion
ineffective protection
knowledge deficit
impaired physical mobility
ineffective health maintenance
acute and chronic pain
self care deficit
caregiver stress
Nursing Interventions for Older Adults
assess self care abilities
promote independece
education
medication reconciliation
secondary prevention - asking or screening caregivers for role strain
tertiary prevention - refer to respite, encourage support groups
Nursing INterventions for pregnant adolescents
ID those at risk (poor)
dispel myths
understand their developmental level
tertiary prevention
school based sex ed
Infant
1 month to 1 year
5 H Club
For INfants
Hungry Homeless Hopeless Hugless Without Health Care
Nursing Interventiosn for INfants
assess
educate and prevention education
refer
promote
mandated reporter
