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  2. CHAPTER 10: ASSESSING FOR VIOLENCE Violence • Actual, attempted, or threatened physical harm that is deliberate and non consenting • Includes violence against victims who cannot give full, informed consent • Includes fear-inducing behavior, where threats may be implicit or directed at third parties Aggression - a forceful action or procedure especially when intended to dominate or master
  3. McCue - this theorist presented five theories related to domestic violence for why men batter women According to McCue why do men beat women? Psychopathology-suffer personality disorder Social learning Biologic Family system Feminist
  4. Walker's Cycle of Violence This theory discuss the cyclin nature of violence. It explains that abuse occurs in a predictable pattern Criticism This is the first stage of Walker's Cycle of Violence: Tension building stage The abuser makes unrealistic demands Acute battering This is the second stage of Walker's Cycle of Violence: May be triggered by something minor but results in violence lasting up to 24 hours. The victim is rarely able to stop the abuse
  5. Honeymoon This is the third stage of Walker's Cycle of Violence: Described as a period of reconciliation This stage begins after an incident of battery. The abuser is loving, promises never to abuse the victim again, and is very attentive to the victim. Then the cycle starts again
  6. Family violence The controlling, coercive behaviors seen through the intentional acts of violence inflicted on those in familial or intimate relationships
  7. What are the different types of Family Violence? • Physical abuse • Psychological abuse • Economic abuse • Sexual abuse
  8. Physical abuse • Includes pushing, shoving, slapping, kicking, choking, punching, and burning • Using restraints on a victim
  9. Psychological Abuse Involves the use of constant insults or criticism, blaming the victims for things that are not the victims fault, threats to hurt children or pets.
  10. Economic abuse May be evidenced by preventing the victim from getting or keeping a job, controlling money and limiting access to funds, spending the victim's money, and controlling knowledge of family finances
  11. Sexual abuse Involves forcing the victim to perform sexual act against her or his will Intimate partner violence
  12. Child abuse • Elder mistreatment • The World Health Organization (WHO) defines child maltreatment as “all forms of physical and emotional ill- treatment, sexual abuse, neglect, and exploitation that results in actual or potential harm to the child’s health, development or dignity.” There are four main types of abuse: neglect, physical abuse, psychological abuse and sexual abuse.
  13. What are the categories of Family Violence? • Intimate partner violence -is physical, sexual, or psychological harm by a current of former partner or spouse • Child abuse -According to CAPTA, a recent act of failure to act on part of a parent or caretaker which results in death, serious physical or emotional harm, sexual abuse or exploitation. -Child Abuse Prevention and Treatment Act A federal law passed in 1974 requiring physicians to report cases of child abuse.
  14. Elderly Mistreatment -Neglect, Physical abuse, sexual abuse , financial abuse, psychological abuse, exploitation, abandonment, or prejudicial attitudes that decrease quality of life and are demeaning to those over the age of 65 years old.
  15. For Human trafficking victims what signs should you recognize? • Common work and living conditions • Poor mental health or abnormal behavior • Poor physical health • Lack of control • Unable to clarify where he/she is staying/address • Lack of knowledge of whereabouts • Loss of sense of time • Has numerous inconsistencies to their story
  16. What is the physical examination to assess abuse? Perform a general survey Assess mental status Evaluate vital signs Inspect skin Inspect the head, neck, eyes Assess the ears, abdomen, genitalia and rectal area, musculoskeletal system, neurologic system
  17. What should you validate and document findings of? • Health promotion diagnoses • Risk diagnoses • Actual diagnoses • Collaborative problems • Medical problems
  18. Health promotion diagnosis -“a clinical judgment concerning motivation and desire to increase well-being and to actualize human health potential.” These responses are expressed by the patient's readiness to enhance specific health behaviors.
  19. The goal of a health promotion nursing diagnosis is to improve the overall well-being of an individual, family, or community. Examples of this type of nursing diagnosis include: •Readiness for enhanced family processes •Readiness for enhanced hope •Sedentary lifestyle
  20. Risk nursing diagnosis A risk nursing diagnosis applies when risk factors require intervention from the nurse and healthcare team prior to a real problem developing. Examples of this type of nursing diagnosis include: •Risk for imbalanced fluid volume •Risk for ineffective childbearing process •Risk for impaired oral mucous membrane integrity This type of diagnosis often requires clinical reasoning and nursing judgment.
  21. A problem-focused diagnosis (also known as actual diagnosis) is a client problem present at the time of the nursing assessment. These diagnoses are based on the presence of associated signs and symptoms. Actual nursing diagnosis should not be viewed as more important than risk diagnoses. There are many instances where a risk diagnosis can be the diagnosis with the highest priority for a patient.
  22. Problem-focused nursing diagnoses have three components: (1) nursing diagnosis, (2) related factors, and (3) defining characteristics. Examples of actual nursing diagnoses are: •Ineffective Breathing Pattern related to pain as evidenced by pursed-lip breathing, reports of pain during inhalation, use of accessory muscles to breathe •Anxiety related to stress as evidenced by increased tension, apprehension, and expression of concern regarding upcoming surgery •Acute Pain related to decreased myocardial flow as evidenced by grimacing, expression of pain, guarding behavior. •Impaired Skin Integrity related to pressure over bony prominence as evidenced by pain, bleeding, redness, wound drainage. •Delayed Surgical Recovery related to increased blood glucose level and obesity as evidenced by poor wound healing, fatigue, and excessive time.
  23. Collaborative problems -are potential problems that nurses manage using both independent and physician-prescribed interventions. These are problems or conditions that require both medical and nursing interventions, with the nursing aspect focused on monitoring the client’s condition and preventing the development of the potential complication.
  24. Medical diagnosis is made by the physician or advanced health care practitioner that deals more with the disease, medical condition, or pathological state only a practitioner can treat. Moreover, through experience and know-how, the specific and precise clinical entity that might be the possible cause of the illness will then be undertaken by the doctor, therefore, providing the proper medication that would cure the illness. Examples of medical diagnoses are Diabetes Mellitus, Tuberculosis, Amputation, Hepatitis, and Chronic Kidney Disease. The medical diagnosis normally does not change. Nurses must follow the physician’s orders and carry out prescribed treatments and therapies.
  26. Performing a cultural assessment A cultural nursing assessment is a systematic way to identify the beliefs, values, meanings, and behaviors of people while considering their history, life experiences, and social and physical environments. In a brief cultural assessment, you should ask about ethnic background, religious preference, family patterns, food preferences, eating patterns, and health practices.
  27. Before the assessment, know the key topics to address and know how to address them without offending the patient and family. Determine if you’ll need an interpreter, and identify a patient confidante who may help bridge the cultural gap. Also, interview other providers who know the patient to obtain relevant information. Select a strategy for gathering data, such as a formal interview, an informal conversation, or observation.
  28. During the assessment, be aware of the environment. Look around. Assess verbal and nonverbal communications. The brief cultural assessment helps determine the need for an in-depth cultural assessment, which can be conducted over the course of the nurse-patient relationship, as trust builds. Questions may include: •What do you think caused your health problem? •What do you think made it start when it did? •What does your sickness do to you? •How severe is your sickness?
  29. •How long do you expect it to last? •What problems has your sickness caused? •What do you fear about your sickness? •What kind of treatment do you think you should receive? •What results do you hope to receive from your treatment? After making your nursing diagnoses, review patient and family responses regarding cultural beliefs and Western medical goals, so you can identify cultural factors that may influence the effectiveness of interventions.
  30. After establishing a culturally sensitive environment, nurses should incorporate a cultural assessment when caring for all patients. There are many assessment guides used for patient interviews that are adaptable to a variety of health care settings and are designed to facilitate understanding and communication. The Four Cs of Culture model is an example of a quick cultural assessment tool that asks questions about what the patient Considers to be a problem, the Cause of the problem, how they are Coping with the problem, and how Concerned they are about the problem.
  31. Four Cs of Culture 1. What do you think is wrong? What is worrying you? (In other words, discover what the patient Considers to be the problem and what they Call it.) A patient with a diagnosis of pneumonia believes his body is “unbalanced.” 2. What do you think Caused this problem? How did this happen? The patient believes this illness is a punishment for a misdeed. The patient avoids eating certain foods to treat the illness while also using home remedies such as herbal tea. 3. How serious is this problem for you? How Concerned are you? A patient views the illness as being “God’s will” and states, “It’s in God’s hands.”
  32. Overcoming cultural difference As a community health nurse, you may experience cultural difference, a sense of discomfort brought on by patient beliefs that are difficult to negotiate. Remember, every patient is unique, yet all have the same basic needs.
  33. The LEARN model can help: •Listen with sympathy and understanding to the patient’s perception of the problem, using a nonjudgmental manner that encourages dialogue. •Explain your perception of the problem. •Acknowledge and discuss the differences and similarities between the two perceptions and build on the similarities. •Recommend treatment from a cultural perspective. •Negotiate an agreement regarding treatment that incorporates cultural aspects.
  34. Ultimately, cultivating trust, understanding, and respect will promote the best outcomes. You can use three approaches to facilitate the delivery of culturally competent care: cultural preservation cultural accommodation cultural repatterning. A nurse using cultural preservation supports the use of scientifically sound cultural practices, such as acupuncture for managing pain in a Chinese patient, and interventions from the biomedical healthcare system, such as using lower doses of opioid analgesics.
  35. A nurse using cultural accommodation supports and facilitates the use of cultural practices that have not been proven harmful—for instance, placing a key, coin, or other metal object on the umbilicus of a Mexican newborn, which is believed to promote healing. A nurse using cultural repatterning works with a patient to help him or her change cultural practices that are harmful. If, for example, a patient comes from a culture that values the use of herbs, a nurse needs to negotiate abstinence from particular herbs that can cause adverse effects.
  36. Accommodating valued traditions usually produces the desired outcome, but the accommodation must be based on knowledge of the culture. A nurse can gain this knowledge from conversations, direct assessment, and other resources. A failure to provide culturally competent care may result from a lack of understanding, organizational pressure regarding productivity, or peer influence. Stereotyping, prejudice, racism, ethnocentrism, cultural blindness, cultural imposition of one’s values on others, and cultural conflict arising from misunderstood expectations all can diminish or destroy a patient-nurse relationship.
  37. Role of nurses Community health nurses must be active in efforts to deliver appropriate care to diverse populations. If patients can participate in their care and have a choice in their health-related goals, plans, and interventions, both patient compliance and outcomes will improve. As a community health nurse, you should constantly strive to provide the best possible care, while continuing to learn about others and about yourself.
  38. Assessing spirituality and the spiritual needs of patients is fundamental to providing effective spiritual care. Several formal spiritual assessment tools are available to assist nurses to identify patients’ spiritual needs and to determine whether they are experiencing spiritual distress. However, it may be more appropriate to assess patients’ spirituality informally, by asking open questions about their spiritual beliefs and needs. It is important for nurses to be aware of the limits of their competence in undertaking spiritual assessment and providing spiritual care, and to refer patients to the healthcare chaplain or other spiritual support personnel where necessary.
  39. A spiritual assessment is necessary to find out if any beliefs could impact health. There are formal spiritual assessment tools, a few of which we will discuss later on, that help healthcare professionals in identifying patients’ spiritual needs. Assessment tools can also be used to see whether patients are experiencing spiritual distress. However, informally assessing patients’ spirituality by asking open questions about their spiritual beliefs and needs is also an effective way to determine patients’ spirituality. Let’s first take a look at the nature of spirituality and the areas that need to be addressed during a spiritual assessment.
  40. Spirituality means different things to different people, and it is an intensely personal issue for many. In general, spirituality is the way in which individuals fulfill what they believe to be the purpose of their lives. It’s a way of life that comes from a person’s inner realm which can be from a secular or religious point of view.
  41. Spirituality is important to our psychological well-being because it can provide direction and energy. Therefore, spiritual awareness can provide these vital points: • It helps an individual discover a sense of meaning and purpose in life • It provides a healthy sense of belonging • It points us in the right direction when we're seeking to define and stick to our values Studies support that spirituality helps prevent and heal disease. It also helps those who are enduring distress and disability. So, a spiritual assessment can help pinpoint areas in life that may help a person recover.
  42. Spiritual Beliefs Spiritual beliefs can involve God, prayer, or meditation. Beliefs Beliefs frequently include the relationship people have in relation to God (or a superior being) which influences their perspectives on life, death, and reality. Faith Faith usually has to do with God. People with faith in God perceive God as essential in providing strength to deal with daily challenges. God is called upon for help in healing physical or mental illnesses.
  43. Religion Religion includes practices and rituals such as prayer or meditation and engaging with people in the religious community, such as fellow church members and clergy. Spiritual and religious beliefs do overlap in many important areas – both can have a heavy influence when it comes to coping with illness. Also, it’s essential to look at both of these concepts, because some individuals see themselves as as spiritual but not necessarily religious.
  44. Spiritual needs in healthcare can be separate and distinct from religious ones. Spiritual beliefs may or may not be religious, but most religious individuals are spiritual. Most people, especially when they’re faced with illness and the questions of life and death, will have spiritual needs and concerns that should be viewed as essential to high-quality patient care. To address spiritual needs, healthcare professionals must understand how each individual fulfills their purpose in life. For some patients, it’s in non-religious ways, and for others, it is highly religious. Therefore, performing a spiritual assessment helps a healthcare professional learn how spirituality can help the healing process.
  45. In a hospital setting, religious needs could translate into special diets, not being in a mixed-gender ward, the availability of places to pray (non-secular or secular chapels), the availability of chaplains in patients’ faiths, and how people with fatal illnesses are allowed to die.
  46. Spiritual Gifts The spiritual gift and its expression are concepts that innate talents, such as artistry, allow a person to better self- expression. When spiritual gifts are used, it increases the potential for individual success and happiness. As part of a formula for healing, if a person is using their spiritual gifts to bring joy to themselves or others, it can provide peace and pleasure.
  47. Spiritual Tools Spiritual tools are the ways patients can help to change their mindsets from fear to a more confident, positive approach to the world. Some examples of spiritual tools include meditation, practicing surrendering to a higher power daily, taking a personal inventory, prayer, saying affirmations, and reading devotionals.
  48. Who Performs a Spiritual Assessment? • Physicians doctors are the frontline of medical care and become familiar with their patients with repeat visits. • Nurses Nurses are one of the main providers of spiritual care to patients. Hands-on nursing care in hospitals and other medical settings permits close relationships between nurses and their patients, giving nurses ample opportunities to provide spiritual care to patients. • Other Healthcare Professionals most notably psychiatrists, psychologists, and addiction t treatment specialists, also offer opportunities for spirituality to figure into more effective and successful treatments.
  49. Spiritual Assessment Tool The HOPE Assessment Tool for Spiritual Assessment can help identify personal sources of hope and meaning, as well as spirituality and practices. HOPE is an acronym used in the following ways: H: Hope, strength, comfort, and how patients deal with difficult times O: Organized religion - learning if patients are part of a religious community and how it helps them P: Personal spiritual beliefs and what practices patients find most helpful E: Effects on medical or end-of-life issues as they relate to the patient's spiritual resources, and if there are any specific spiritual practices that patients want to be included in their medical care
  50. FICA Spiritual History Tool The FICA tool is used for a clinical assessment of spirituality. The FICA spiritual assessment can be used as a guide for spiritual history by framing questions rather than relying on a checklist. The FICA Spiritual History Tool gets its name from the four categories it assesses: Faith and belief: finding out the patients' spiritual beliefs and what gives their life meaning Importance: discovering how spiritual beliefs are used in dealing with illness Community: learning how patients are involved in a spiritual or religious community Address in Care: asking how they would like their healthcare professionals to address these spiritual issues in the healthcare process
  51. Using the FICA spiritual assessment is an important tool for healthcare professionals to provide the best care to the patient. The information learned in the assessment may direct treatment and recovery.
  52. How Does a Spiritual Assessment Improve Healthcare? A patient’s spiritual assessment can improve healthcare in the following ways:  The introduction of spirituality in the doctor-patient relationship can help build trust and understanding, which broadens the scope of the doctor-patient relationship and increases its effectiveness.  A spiritual assessment can help reveal spiritual or emotional challenges affecting mental and physical health.  Recognizing and handling spiritual issues may teach how to tap into an effective source of coping and healing.  Spirituality can help provide comfort during times of illness and can also improve quality of life.
  53. If spirituality is an important part of your life. Because findings support that attention to the spiritual aspects of care can lead to better outcomes, our healthcare professionals can perform a spiritual assessment and attend to your spiritual concerns during treatment.