Violence: Impact on Nursing Robert T. Rosso

1. Violence:Impact on NursingRobert T. Rosso

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4. 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.

5. Types of Violence Firearm Domestic Workplace Child

6. 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.

7. 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.

8. 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?

9. 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

10. 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.

11. 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.

12. 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!!

13. 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

14. 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.

15. 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

16. 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

17. 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.

18. 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.

19. 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

20. 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?

21. 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.”

22. 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.

23. 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.

24. 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

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