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Domestic Violence A Womans Perspective

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					   Violence:
Impact on Nursing

    Robert T. Rosso
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      Healthy People 2010
 Healthy People 2010 lists 28 Focus
               Areas.

Injury and Violence Prevention is listed.

Healthy People 2010 lists 10 Leading
          Health Indicators.

     Injury and Violence is listed.
    Types of Violence

Firearm        Domestic




Workplace        Child
             Firearm Violence
        Every day, more than 80 Americans
              die from gun violence.

 The rate of firearm deaths among kids under age 15
is almost 12 times higher in the United States than in
     25 other industrialized countries combined.

    American kids are 16 times more likely to be
murdered with a gun, 11 times more likely to commit
suicide with a gun, and nine times more likely to die
 from a firearm accident than children in 25 other
        industrialized countries combined.
               Healthcare Costs

In a book published in 2000, Professors Philip J. Cook
and Jens Ludwig estimate that the total annual cost of
   gun violence in the U.S. is $100,000,000,000 (One
               Hundred Billion dollars).

The estimated cost of direct health care expenditures
  for firearm-related injuries in the US in 1995 was
         $4,000,000,000 (Four Billion dollars).

The costs of treating gunshot wounds can reach over
     $100,000,000 (One Hundred Million dollars)
           at an average county hospital.
               Firearm Violence


Think about the devastation to the human body a bullet
              fired from a gun can inflict.

 The costs associated with a bullet entering the body
      exceed most other care costs in hospitals.
   (Who pays when uninsured patients are shot??)

   What can nurses do to decrease costs, prevent
                    injuries?
          Firearm Violence
             Levels of Prevention
Primary Prevention:
Education on stress coping techniques
Attention to personality development
Secondary Prevention:
Arresting injury process and preventing death
Tertiary Prevention:
Restoration and rehabilitation of body after
wound is stabilized/healing
Intimate Partner Violence
Of persons first injured by domestic violence, 75%
continue to experience abuse.

Half of battered women who attempt suicide try
again.

Eighty-nine percent of victims reported previous
assaults by their current assailants, with 35%
experiencing violence on a daily basis.

The ultimate result of domestic violence may be
death from suicide or homicide.
Intimate Partner Violence
Women in abusive relationships have
similar patterns of thought about their
              situations.

A group of nurses researched women
who were in, or who had left abusive
            relationships.

Their findings bring to light the similar
      feelings of abused women.
    Intimate Partner Violence
The nurses researching the women in the study found
similar attitudes in 4 areas:

Living an Unnatural Life, The Experience of Telling, The
Leaving Experience, and Reducing Barriers

Nurses can educate themselves on how hard it is to
understand the plight of these women, how difficult it
can be to tell others and ask for help, and how they are
treated by uncaring medical professionals.

Understanding and a willingness to help these victims
can be the difference!!!

We Must Treat The Causes, Not Just The Injuries!!
    Intimate Partner Violence
              Levels of Prevention
Primary Prevention:
Education on stress coping techniques
Marriage/Partner Counseling
Secondary Prevention:
Arresting injury process and preventing death
Tertiary Prevention:
Use of sheltered colony – leaving abusive situation
      Workplace Violence

Workplace violence -- including assaults
and suicides -- accounted for 16% of all
work-related fatal occupational injuries
                 in 2003.

Homicides are perennially among the top
 three causes of workplace fatalities for
              all workers.
         Workplace Violence
     Understanding Predispositions and
       Additional Factors Leading to
           Workplace Violence:

Predispositions:            Additional Factors:
Poor Interpersonal Skills   Lack of Privacy
Poor Employment History     Loss of Control
Withdrawn/Loner             Loss of Dignity
Problems with Authority     Loss of Identity
Shunned by Coworkers        Loss of Independence
Views World as Hostile      Frustration with System
         Workplace Violence
              Levels of Prevention
Primary Prevention:
Education on stress coping techniques
Provision of agreeable working conditions
Secondary Prevention:
Arresting injury process and preventing death
Tertiary Prevention:
Selective placement – may involve changing jobs
     Maltreatment of Children
According to the HHS study, the number of total
     child maltreatment instances that were
    investigated by state agencies remained
   constant from 1986 to 1993; however, the
   percentage of cases investigated declined
                  dramatically.

An estimated 1,500 children were confirmed to
  have died from maltreatment; 36% of these
 deaths were from neglect, 28% from physical
  abuse, and 29% from multiple maltreatment
                    types.
     Maltreatment of Children
       What can nurses do to help??

  One research study indicated that 40% of
    medical staff have never cared for an
  abused child, yet 60% assumed they could
                 identify one.

Educating our nursing staff on the signs of an
     abused child can stop the pattern of
                maltreatment.
       Maltreatment of Children
              Levels of Prevention
Primary Prevention:
Education on stress coping techniques
Agression Counseling
Secondary Prevention:
Arresting injury process and preventing death
Tertiary Prevention:
Selective Placement – Child Protective Services
         Confidentiality
         Tarasoff v. Regents
   of University of California, 1976

Case to explain high risk and breach of
            confidentiality.

      When is it ethical to break
          confidentiality?
         Confidentiality
     According to the court, once a
     therapist determines, or under
  professional standards should have
  determined, "that a patient poses a
 serious danger of violence to others,
he bears a duty to exercise reasonable
 care to protect the foreseeable victim
            of that danger.”
         Confidentiality
What can a nurse do to break the cycle
    of violence without breaking
          confidentiality??

Patients need to believe that their care
    givers will not break their trust.

We must protect our ethical practice,
    but also protect the patient.
             Education
 Abused persons do not readily seek
  out assistance for their problems.

 Healthcare workers need to be aware
of possible signs of abuse and be non-
 judgmental in offering assistance and
         options for the victim.
                                        References
Center for Disease Control and Prevention. (n.d.) Retrieved July 15, 2006, from http://www.cdc.gov/

Coalition to Stop Gun Violence. (n.d.) Retrieved July 15, 2006, from http://www.csgv.org/

Edelman, Carole Lium & Mandle, Carol Lynn. (2002). Health Promotion Throughout the Lifespan (5th ed.). St. Louis,
    MO: Mosby.

Federal Employee Occupational Safety & Health Program. (n.d). PMDB Predisposing and Precipitating Factors.
    Retrieved July 15, 2006, from http://www.eh.doe.gov/FEOSH/contacts/workplaceviolence.pdf

Goods for Guns of Alleghany County, Inc (n.d.) National Gun Violence Statistics. Retrieved July 15, 2006, from
    http://goodsforguns.org/nationalfacts/index.html

LSU Law Center. (n.d.) California requires psychiatrists to warn about dangerous patients - Tarasoff v. Regents of
    University of California, 17 Cal. 3d 425, 551 P.2d 334, 131 Cal. Rptr. 14 (Cal. 1976). Retrieved July 15, 2006, from
    http://biotech.law.lsu.edu/cases/privacy/tarasoff.htm

Lutenbacher, M., Cohen, A., & Mitzel, J. (2003). Do We Reallyu Help? Perspectives of Abused Women [Electronic
     Version]. Public Health Nursing, 20(1), 56-64.

Paavilainen, E., Astedt-Kurki, P., Paunonen-Ilmonen, M., & Laippala, P. (2002) Caring for Maltreated Children: A
    Challenge for Health Care Education [Electronic Version]. Journal of Advanced Nursing, 37(6), 551–557.

US Department of Health and Human Services Administration for Children & Families. (n.d.). Survey Shows Dramatic
    Increase in Child Abuse and Neglect, 1986-1993. Retrieved July 15, 2006, from
    http://www.acf.dhhs.gov/news/press/1996/nis.htm

US Department of Labor Bureau of Labor Statistics. (n.d.) Retrieved July 15, 2006, from
    http://www.bls.gov/iif/peoplebox.htm

VirtualPsycheCentre.com (n.d.) Retrieved July 15, 2006, from
     http://www.virtualpsychcentre.com/diseases.asp?did=478
The
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