Week 11: Underserved Populations, Vulnerable Populations, and Intimate Partner Violence

Question 1

IPV

Answer 1

intimate partner violence

a pattern of abusive behaivors and coercive control within an intimate relationship

Question 2

SV

Answer 2

sexual violence

sexual activity in which consent is not obtained or freely given

Question 3

Health Consequences of Violence

Answer 3

unintended pregnancy

chronic pain

GI disorders

migraine HA

anxiety and depression

PTSD

injury and death

Question 4

What is the USPSTF Screening and Referral Recommendation

Answer 4

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

Question 5

What do we know about IPV screening

Answer 5

1. Adequate evidence that available screening instruments can ID current and past abuse or icnreased risk for abuse
2. Adequate evidence that effective interventions can reduce violence, abuse, and physical or mental harms for women of reproductive ages (14-46 yo)
3. Adequate evidence that the risk for harm to the individual from screening or interventions is no greater than small

Question 6

Screening women of childbearing age for IPV has a …

Answer 6

MODERATE NET BENEFIT

Question 7

Barriers to Screening for IPV

Answer 7

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

Question 8

RADAR Assessment Process

Answer 8

R - Routine Screening

A - Ask direct questions in a kind nonjudgmental way

D - document findings

A - assess patient safety

R - review options and referrals

Question 9

Factors to consider r/t patient safety

Answer 9

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

Question 10

Danger Assessment

Answer 10

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

Question 11

What happens if you scores 4-5; 3; 2; or 1 Yes to the Danger Assessment

Answer 11

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

Question 12

What is an essential part of screening and counseling for IPV

Answer 12

safety planning discussion:

review options and provide referrals: numbers, websites, services

Question 13

Some important components of a safety plan

Answer 13

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

Question 14

With IPV the provider is not ____ the problem the key is to…

Answer 14

fixing; the key is to be there, listen, educate, refer

Question 15

IPV public health success is what compared to not being what?

Answer 15

it is routine screening, assessment education

it is not disclosure and them leaving the relationship (this increases severe injury or death risk)

Question 16

Importance of Screening

Answer 16

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

Question 17

Nurses have an ethical mandate to…

Answer 17

treat all people with compassion and respect for the inherent dignity

Question 18

Correctional health care needs and challenges

Answer 18

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

Question 19

Common correctional health issues

Answer 19

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

Question 20

Process Algorithm

Answer 20

algorithm for nurses in clinical settings to assess social determinants of heatlh

Question 21

___ to ___% of incarcerated individuals will eventually return to their communities

Answer 21

85-95%

Question 22

Vulnerability

Answer 22

susceptibility through actual or potential stressors that may lead to an adverse effects

Question 23

What are the contributors to vulnerable population disparities

Answer 23

poverty and such not race and ethnicity

Question 24

Disenfranchmisement

Answer 24

feelings of being separated from mainstream society

Question 25

Epidemiologic Triangel

Answer 25

interplay of environment, agent, and host impact health

agent - what
host is who
evnironment is where

Question 26

Causes for vulnerable populations

Answer 26

combined effects of limited resources (social, actual things, etc)

predisposing factors

Question 27

___ is the primary cause of vulnerability

Answer 27

poverty (as is age)

Question 28

Setting the satge for vuln pop assessment

Answer 28

comfortbale non threatening environment

cultural competence

RESPECT CLIENTS PRIORITIZATION (non health concerns need address first)

collaboration with other resources and other progessions

Question 29

Seize the Oppotunity

Answer 29

assessment of client in vuln pop is limited so really balance the assessment and get a lot done and educate

Question 30

Nursing dx of vuln pop client is made according to…

Answer 30

maslows hierarchy fo needs

Question 31

Maslows Hierarchy

Answer 31

Self actualization (intellectual and spiritual)

Self esteem (emotional)

Love and belonging (sociocultural)

safety and security (environment)

physiologic needs

Question 32

Individual level nursing interventions

Answer 32

centered on improving asccess

minimize hassle

culturally sensitive

culturally competent

educaiton in terms of health promotion and disease prevention

Question 33

Community level nursing interventions

Answer 33

public service announcements

health fairs

Question 34

Examples of ways to act with community vulnerable popualtions

Answer 34

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

Question 35

One Stop Comprehensive Services

Answer 35

providing information on multiple topics (immunizatinos, flu care, diet, etc) all at once

Question 36

Wrap Around Services

Answer 36

social and economic assistance wiht the health care at the same time

Question 37

Mental Health

Answer 37

being able to engage in productive activities and fulfilling relationships with other people to adapt to change and to cope with adversity

Question 38

mental disorder

Answer 38

conditions that are characterized by alterations in thinking, mood or behavior which are associated with distress and impaired functioning

Question 39

mental illness

Answer 39

refers collectively to all diagnosible mental disorders

Question 40

Older Adults

Answer 40

65+

Question 41

Factprs making older adults more vulnerable

Answer 41

chronic illness causing disabillity

abuse and neglect

injury

cognition may not allow self advocacy

5 I’s

Question 42

5 I’s

Answer 42

intellectual impairment

immobility

instability

incontinence

iatrogenic drug rxns (aka adverse rxns)

all these impact adult health

Question 43

3 D’s of INtellectual Impairment

Answer 43

Dementia

Delirium

Depression

Question 44

Nursing Dx for Older Adults

Answer 44

risk for falls

confusion

ineffective protection

knowledge deficit

impaired physical mobility

ineffective health maintenance

acute and chronic pain

self care deficit

caregiver stress

Question 45

Nursing Interventions for Older Adults

Answer 45

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

Question 46

Nursing INterventions for pregnant adolescents

Answer 46

ID those at risk (poor)

dispel myths

understand their developmental level

tertiary prevention

school based sex ed

Question 47

Infant

Answer 47

1 month to 1 year

Question 48

5 H Club

Answer 48

For INfants

Hungry
Homeless
Hopeless
Hugless
Without Health Care

Question 49

Nursing Interventiosn for INfants

Answer 49

assess

educate and prevention education

refer

promote

mandated reporter