Archive for the ‘Domestic Abuse & Neglect’ Category

Mental retardation and abuse

January 25, 2010

I have always had a passion for individuals with a developmental delay. It makes me shudder at the thought that certain individuals may abuse, neglect or even kill them. Understandably, diseases like Turners Syndrome, Downs Syndrome, and other disorders are horrible. Those individuals will never have the potential that someone without these disorders will. But that is not to say that those individuals will have an input on the world. For example, my mother’s best friend has a son with Downs Syndrome. With his disorder and personal development, it will be hard for him to live alone, so he still lives at home. His mother has been diagnosed with MS and is confined to a wheelchair. Without the help of her son, she would be completely alone. It is not our place to mistreat individuals because we get frustrated or don’t grasp their existence. But on a forensic level, it must be very very hard to understand the causes of death in these individual if cause by abuse and neglect – with their facial deformations and bodily dysfunctions. This is all the more reason for us as individuals with typical development to stand up for these people and advocate for them.

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Screening for abuse, comment

January 6, 2010

I agree with reporting any suspected abuse as being our obligation. We should report any sign of possible abuse whether we are definite or not to be efficient in the care of our patients. I did a little research on signs of child abuse that are not so obvious. One sign that I found to be consistent is the inability of the child to concentrate. We tend to recognize the physical aspects of abuse, but do not put as much emphases on the emotion effects.

Original Post
October 12, 2009
Title: Screening for abuse, comment
As I read through the various postings, many readers have voiced the same concern – the need for doctors and in particular nurses, to be further educated in the screening and assessing of suspected victims of abuse. I agree with the theory that the medical profession has an obligation to reach out to this patient population -whether they are willing or not to admit they are in an abusive relationship. I have a lot of mixed emotions on this topic – I think what is needed is a bit more than assessing our patients. I think it has to start with us, the nurses – taking a look at ourselves and our own relationships. In the past week I had to take my daughter to a wake and two funerals. One of her best friends had to bury both her parents, separately. The mother died a violent death – the victim of domestic violence, the father then took his own life. The mother was not only a truly loving and special person, she was a smart, educated professional. A nurse. I think as nurses, doctors – "healers" – we sometimes overlook the very things that we are trained to look for. Most of us enter this profession to "help" others, to make a difference, to not allow our patients to give up, but rather to be strong and overcome. I think it is in most of our nature to root for the underdog, take on the stray – we can help and change those who can’t help themselves. This young woman saw the signs, began to live in fear for the safety of not only herself, but for her children as well. She tried to help her husband deal with his emotions and his behaviors. She tried to help and be supportive. Tragically, the very day she took legal steps to protect her family, was the day she died. I think as healthcare professionals we not only hold an obligation to help those we provide care for, but we must also recognize the obligation to help ourselves. To reach out to our peers and our co-workers. I think that sometimes we are just blinded by the need to make things better.

Original Post
September 28, 2009
Title: Screening for abuse, comment
I think that all nurses and doctors should receive additional training in screening for abuse depending on their specialty area. Patients will present differently depending on whom they are being interviewed by. Many times in the situation of children they are with their abuser when they present and it is difficult to separate the two. The abuser does not want you to have words alone with their child. I worked many years as a school nurse and suspected many cases of abuse that were reported to the appropriate authorities only to find that the child was disbelieved and then years later found to be telling the truth. Adults are very savvy at making a child look like a liar but seldom do these children have the capabilities to make up the horrendous story I heard. Unfortunately the investigators seem to want to believe the abuser. These children were also ones with poor grades (not sleeping at night due to the abuse), behavioral issues (they just wanted someone to listen) and many times documented storytellers (the only way to get attention) so it was very easy for the abuser to discredit them. If we are all trained to look for something other than physical marks we may start to diminish abuse against our children. Part of the assessment should not include where the parents reside in society. Several times the investigators simply found out what the parents did for a living and that in itself ended the investigation.

Original Post:
September 8, 2009
Title: Screening for abuse
Thank you for this important message. It is absolutely imperative that ALL providers know the signs and symptoms of physical, emotional and sexual abuse. Furthermore, it is absolutely necessary that ALL providers screen every patient at EVERY patient encounter for abuse. Providers should incorporate screening for abuse into their health assessment. It is very easy to do. Providers can accomplish this important task by 1. Printing the screening question on the pre-assessment paperwork, 2. Asking the patient during the assessment, "Do you feel safe at home?" 3. Knowing the s/sx and incorporating screening into every pt encounter. So very important.

Original Post
September 2, 2009
Title: Abuse
Child and elder abuse continue to be very under reported making it imperative that doctors and nurses have education on signs of abuse. Nursing home abuse is also very under reported since nursing home pts. are lacking in visitors and seen as demented. Nurses also need to know who to contact should abuse be suspected.

Legal Services regarding abuse

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Screening for abuse, comment

October 12, 2009

As I read through the various postings, many readers have voiced the same concern – the need for doctors and in particular nurses, to be further educated in the screening and assessing of suspected victims of abuse. I agree with the theory that the medical profession has an obligation to reach out to this patient population -whether they are willing or not to admit they are in an abusive relationship. I have a lot of mixed emotions on this topic – I think what is needed is a bit more than assessing our patients. I think it has to start with us, the nurses – taking a look at ourselves and our own relationships. In the past week I had to take my daughter to a wake and two funerals. One of her best friends had to bury both her parents, separately. The mother died a violent death – the victim of domestic violence, the father then took his own life. The mother was not only a truly loving and special person, she was a smart, educated professional. A nurse. I think as nurses, doctors – "healers" – we sometimes overlook the very things that we are trained to look for. Most of us enter this profession to "help" others, to make a difference, to not allow our patients to give up, but rather to be strong and overcome. I think it is in most of our nature to root for the underdog, take on the stray – we can help and change those who can’t help themselves. This young woman saw the signs, began to live in fear for the safety of not only herself, but for her children as well. She tried to help her husband deal with his emotions and his behaviors. She tried to help and be supportive. Tragically, the very day she took legal steps to protect her family, was the day she died. I think as healthcare professionals we not only hold an obligation to help those we provide care for, but we must also recognize the obligation to help ourselves. To reach out to our peers and our co-workers. I think that sometimes we are just blinded by the need to make things better.

Original Post
September 28, 2009
Title: Screening for abuse, comment
I think that all nurses and doctors should receive additional training in screening for abuse depending on their specialty area. Patients will present differently depending on whom they are being interviewed by. Many times in the situation of children they are with their abuser when they present and it is difficult to separate the two. The abuser does not want you to have words alone with their child. I worked many years as a school nurse and suspected many cases of abuse that were reported to the appropriate authorities only to find that the child was disbelieved and then years later found to be telling the truth. Adults are very savvy at making a child look like a liar but seldom do these children have the capabilities to make up the horrendous story I heard. Unfortunately the investigators seem to want to believe the abuser. These children were also ones with poor grades (not sleeping at night due to the abuse), behavioral issues (they just wanted someone to listen) and many times documented storytellers (the only way to get attention) so it was very easy for the abuser to discredit them. If we are all trained to look for something other than physical marks we may start to diminish abuse against our children. Part of the assessment should not include where the parents reside in society. Several times the investigators simply found out what the parents did for a living and that in itself ended the investigation.

Original Post:
September 8, 2009
Title: Screening for abuse
Thank you for this important message. It is absolutely imperative that ALL providers know the signs and symptoms of physical, emotional and sexual abuse. Furthermore, it is absolutely necessary that ALL providers screen every patient at EVERY patient encounter for abuse. Providers should incorporate screening for abuse into their health assessment. It is very easy to do. Providers can accomplish this important task by 1. Printing the screening question on the pre-assessment paperwork, 2. Asking the patient during the assessment, "Do you feel safe at home?" 3. Knowing the s/sx and incorporating screening into every pt encounter. So very important.

Original Post
September 2, 2009
Title: Abuse
Child and elder abuse continue to be very under reported making it imperative that doctors and nurses have education on signs of abuse. Nursing home abuse is also very under reported since nursing home pts. are lacking in visitors and seen as demented. Nurses also need to know who to contact should abuse be suspected.

Legal Services regarding abuse

Forensic Nursing Online Certificate Program

Forensic Nursing Online Introduction Course

Tags: , , , , , , ,

Screening for Abuse

September 8, 2009

Thank you for this important message. It is absolutely imperative that ALL providers know the signs and symptoms of physical, emotional and sexual abuse. Furthermore, it is absolutely necessary that ALL providers screen every patient at EVERY patient encounter for abuse. Providers should incorporate screening for abuse into their health assessment. It is very easy to do. Providers can accomplish this important task by 1. Printing the screening question on the pre-assessment paperwork, 2. Asking the patient during the assessment, "Do you feel safe at home?" 3. Knowing the s/sx and incorporating screening into every pt encounter. So very important.

Original Post
September 2, 2009
Title: Abuse
Child and elder abuse continue to be very under reported making it imperative that doctors and nurses have education on signs of abuse. Nursing home abuse is also very under reported since nursing home pts. are lacking in visitors and seen as demented. Nurses also need to know who to contact should abuse be suspected.

Legal Services regarding abuse

Tags: , , , , ,

Other Options in Treating the Skin

September 2, 2009

Caring for our skin over the course of a lifetime takes preventative measures, though it is sometimes not always easy to detect a potential problem. When skin issues are reported to a health care provider, a nurse needs to investigate a variety of possibilities that may have caused a negative outcome to specific areas of the body. Stress often aggravates and intensifies certain conditions, with skin being the most visible. When the nervous system is affected negatively with on-going stress, particularly within an abusive relationship, the epidermis can be irritated by itching. Acne, psoriasis, dermatitis and hair loss are related diagnoses from stress-related instances. According to Lehne (2007), “Topical glucocorticoids are employed to relieve inflammation and itching associated with a variety of dermatologic disorders (eg, insect bites, minor burns, seborrheic dermatitis, psoriasis, eczema, pemphigus)” (Pg. 1201). Under the “Actions and Uses” section of this textbook, no other alternatives are discussed for relieving such symptoms, except for the use of medication. Why? With our society becoming more and more accustomed to using drugs as a way to “fix” physical symptoms and concerns, should not the emotional, social and spiritual characteristics of human beings be considered when attempting to properly diagnose patients of all ages. As an example, if a patient were to be removed from his or her daily environment or living conditions changed for a period of time, might negative symptoms diminish or possibly disappear without medication of any kind? With that said, incorporating a more comprehensive approach when evaluating patients may result in a more favorable outcome when treating specific physical ailments. Hormonal effects may also play a role in skin irritations, and coupled with other stressors may cause symptoms such as those listed above. Lehne (2007) noted, “About 85% of teenagers develop acne, which often persists into adulthood. Acne is a chronic skin disorder that usually begins during puberty” (Pg. 1203). While the increase in hormones during this timeframe is significant, so to is the heightened inability to cope with new stressors such as peer pressure and dating. Any type of abusive situations at home could also significantly contribute to a teenagers physical well-being. Lehne (2007) stated in the nondrug therapy for acne, “Dietary measures don’t help” (Pg. 1204). I do not totally agree with this observation, since total health and well-being include nutrition, sleep patterns, family and social interactions and one’s spirituality, any of which may require evaluation to properly diagnose skin conditions. Medication should be carefully administered, with minimal doses considered, in an effort avoid adverse reactions to a patient. Atopic dermatitis (eczema) is often a common skin reaction when stress is heightened. Lehne (2007) defined, “Atopic dermatitis as a chronic inflammatory skin disease characterized by dry, scaly skin and intense pruritus that often leads to scratching and rubbing, which in turn can lead to erythema, abrasions, rash erosions with an exudates, an increased susceptibility to skin infection. Treating this condition glucocorticoids can cause skin atrophy, hypopigmentation, telangiectasis (permanent focal red lesions)” (Pg. 1212). With the prospects of such reactions, why does the textbook not also suggest other options to reduce such irritating symptoms? To effectively treat patients with any type of skin ailment, nursing professionals should investigate a patient’s background and share such with their doctor before he/she prescribes drug therapy. As a nursing student with a specialized interest and knowledge in domestic violence, I questioned whether current medical/nursing curricula adequately correlates, recognizes and prescribes treatment, both physiological and psychological, for skin conditions and one’s resultant well-being. References Lehne, R.A. (2007). Pharmacology for Nursing Care (Sixth Edition). Pgs. 1201-1212.

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Abuse

August 20, 2009

There was only brief mention in a few places in our Nursing Assessment text about the identification of abuse, and I think this is a topic worth covering. Whether it is elder, child, or spousal abuse, I feel this is just as important a skill as many covered in the text. As health professionals we are constantly coached to be impartial and objective. Also, we have become a society that values personal rights to a degree that we often allow injustices occur right before our eyes. To ask probative questions regarding the mechanism of injury or to involve CPS in a case that we feel strongly about also something clinicians should be trained and coached in.

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Women’s Health and Fertility Concerns

August 19, 2009

A few of these chapters brought back memories of my four-year experience with infertility some ten years ago. Keeping my follicular and luteal phase exactly on schedule before each of the seven inseminations, which were followed by four Invitro procedures, created a world-wind of anxiety and hope. With many fertility medications also taken over this timeframe, precautions, side-effects and possible future cancer diagnoses were discussed with my fertility doctor. According to Lehne, (2007), "Regardless of whether estrogens cause breast cancer, there is no question they promote the growth of certain cancers that have estrogen receptors" (Pg. 705). Other side effects that remain vivid in my mind included hot flashes, swollen and sometimes very painful ovaries resulting in ovarian hyperstimulation syndrome, mood swings and weight gain. According to Lehne (2007), "Mild to moderate ovarian enlargement is common, occurring in about 20% of patients. This condition is benign and resolves spontaneously after discontinuing drug use" (Pg. 740). Unfortunately, I was one of those patients experiencing ovarian hyperstimulation syndrome and it did resolve itself once the drugs were eliminated. Frequent sonograms were necessary to monitor my ovarian enlargement and egg stimulation. The drug mostly responsible for this significant discomfort is human chorionic gonadrotropin (hCG). During this drug induced time span, I was diagnosed with painful gallstones resulting in a cholecystectomy at the age of 32. Lehre (2007) noted, "The incidence of cholecystectomy among hormone therapy users was 48% higher than among nonusers" (Pg. 713). After reading this section with regard to hormone therapy for menopausal women, a prospect on which my fertility doctor did not comment, I concluded that the fertility estrogen-based drugs may have indeed contributed to the gallstone diagnosis. Lehne (2007) stated, "Birth control can be accomplished by interfering with the reproductive process at any step from gametogenesis to nidation (implantation of a fertilized ovum)" (Pg. 720). Using the pill for the regulation of my cycle was a mandatory part of the Invitro procedure, as well as drawing daily blood to monitor and evaluate levels to determine when I would be ready for retrieval of my harvested eggs. After finally becoming pregnant after the fourth Invitro, memories of not enduring these fertility drugs was such a relief. Fifteen months later, I became pregnant naturally with my second child without any medical intervention. When looking back on why and how hormone levels are effected, it seems clear that stress and how to manage it, can have a significant impact on our human body. Over a four-year infertility journey that created uncertainty as to exactly why I was not becoming pregnant, stress was mentioned as a possible factor. While a meditation course was also offered to all infertility patients prior to Invitro procedures, questions on marital relationship difficulties were never discussed. Though some patients are in desperate need of fertility drugs to become pregnant, how many of these women are counseled for stress that results from abusive relationships? It is my hope to clinically address the interrelationship between infertility and domestic violence issues, suggesting evaluation of spouse(s) personality type. This approach might help determine the real causes of infertile patients prior to their receiving a prescription for infertility drug treatment. References Lehne, R. A. (2007). Pharmacology for Nursing Care (Sixth Edition). Pgs. 70

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The Specialty of Forensic, comment

August 10, 2009

In nearly all healthcare settings nurses are faced with dealing with some form of forensic matter. Most of the time these matters either goes unnoticed or ignored this is usually due to lack of training. I think all nurses should have some type of forensic training. These programs equip nurses with specialized skills of focusing on details, to name a few, to aid in detecting signs of abuse/neglect regardless of whether the victim is non-verbal due to cognitive status or age. Forensic nurses are able to clue in and recognize behavioral and physical signs that indicate some form of a problem   Also this training provide them with skills of deciphering whether the bruise or fractures are the result of abuse or the disease process and finding clues about the type of weapon used to cause trauma wounds. These nurses are trained in collecting and preserving valuable evidence at the crime scene such, as using care when removing the clothing of a gunshot wound victim, or cleaning a trauma wound. The forensic nurses services encompasses the victim and perpetrator and  these nurses knows the importance of protecting evidence and its usefulness in a court of law, in assisting in determining a verdict and seeing justice served.

Original Post
August 7, 2009
Title: The Specialty of Forensic, comment
I completely agree with the below post. Nurses should be prepared to deal with patients who are abused in any way. Patients are provided direct care by nurses thus nurses should be comfortable with assessing the patients for any type of abuse and implementing a plan of care. More information and education regarding different types of abuse, along with signs and symptoms should be provided during nursing school. This would be a great benefit to healthcare since abuse and neglect cases are rising and are often unidentified.

Original Post
July 20, 2009
Title: The Specialty of Forensic Nursing
Personally, I think that Forensic Nursing course should be incorporated into all nursing program curriculums, because in most of all healthcare settings nurses are faced dealing with some type of forensic matter; such as abuse/neglect, med errors or injuries. Sometimes these matters do become legal issues. This specialized training equip nurses with knowledge and skills in dealing with different cases that require protecting valuable evidence. Also these nurses are able to clue in on behavior responses or physical changes that may be indicative of some form of abuse/neclect.

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The Specialty of Forensic Nursing, comment

August 7, 2009

I completely agree with the below post. Nurses should be prepared to deal with patients who are abused in any way. Patients are provided direct care by nurses thus nurses should be comfortable with assessing the patients for any type of abuse and implementing a plan of care. More information and education regarding different types of abuse, along with signs and symptoms should be provided during nursing school. This would be a great benefit to healthcare since abuse and neglect cases are rising and are often unidentified.

Original Post
July 20, 2009
Title: The Specialty of Forensic Nursing
Personally, I think that Forensic Nursing course should be incorporated into all nursing program curriculums, because in most of all healthcare settings nurses are faced dealing with some type of forensic matter; such as abuse/neglect, med errors or injuries. Sometimes these matters do become legal issues. This specialized training equip nurses with knowledge and skills in dealing with different cases that require protecting valuable evidence. Also these nurses are able to clue in on behavior responses or physical changes that may be indicative of some form of abuse/neclect.

Forensic Nursing Introduction Course

Forensic Nursing Certificate Program

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Violence Prevention, comment

August 6, 2009

I completely agree with the above post. Nurses interact with the patient the most, and provide direct care. Abuse and neglect can be identified and reported easily by nurses if they have specialized assessment skills and knowledge. Since nurses are often the first ones to talk with the patient, for example, in the ER, it is vital that a nurse hold good knowledge and assessment skills regarding different types of abuse. They should also attain proper interviewing skills to help identify patients at risk for any type of abuse. Forensic nurses would be a great attribute to the ERs where assault and abuse cases are commonly seen.

Original Post
August 4, 2009
Title: Violence Prevention
Forensic Nurses are in a great position for assisting in reducing the alarming rate of violence in society. Through specialized assessment skills and knowledge hidden/unreported signs of abuse can be identified. Also identifying potential for high risk behavior, such as in domestic abuse cases, which can be a learned behavior for children involved, which places them at risk for violent tendencies, so implementing early prevention strategies to reduce these tendencies.

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