Text of Domestic Violence: Domestic Violence: The medical response
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Domestic Violence: Domestic Violence: The medical response
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Objectives: Review Data on DV Discuss how victim may enter
healthcare system Reporting vs. non reporting How is a forensic
exam helpful Victim Judicial system What is a forensic exam and how
is it different from a routine exam. Evidence collection
Recognizing Strangulation Treatment options Testimony of the
forensic nurse
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Domestic Violence Domestic violence is an assault on our
society. It encompasses all manner and form of injury: Physical,
mental, financial, and property
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Violence & Trauma in Texas: 2009 111 women lost their lives
to domestic violence/ trauma 179,435 hotline calls 12,905 Adults
sheltered 35,588 Adults receiving non-residential care 15,588
children required emergency shelter (not counting those sent to
other family members) Texas Council on Family Violence
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How big is the problem? DV Cases seen in hospitals Best
estimates report that between 20 & 30 percent of women and 7.5
percent of men in the United States have been abused by their
intimate partner.
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What if? Physical violence without forensic exam Mary. Late 70s
Triaged with husband. Accidental fall Seen by ER MD X-rays
performed Treated for bruises and sprain Followed up as directed
with PMD 3 days later. Physical violence with forensic exam Mary is
triaged with husband Accidental fall Seen by ER MD who examines
patient without husband present Notes that patient gives
inconsistent history Patient admits to being abused by husband. Due
to Marys age, LE is involved and a Forensic Exam is ordered.
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Which evidence is more compelling? Sterile ER record
documenting bruises and statement by patient and patients husband
that she fell down in the homeseveral times over the past two days.
Comprehensive medical and forensic examination with use of diagrams
and photo- documentation. Patient statements admitting that her
husband hit her arms and legs repeatedly with her purse because she
did not make what he wanted for dinner.
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What is the difference? Non forensically trained medical
personnel MDs Little to no education on specialty of forensics See
one- Do one- Teach one method of learning. RNs BON requires 2 hrs.
of forensics.once in a career Forensically trained MDs University
level specialized training Child Abuse Elder Abuse Sexual Assault
RNs University Level training Professional Association
Certifications State Certifications
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Case Review: Police involved Patient arrival/ report screening
Determine if they want police involved Contact police for
appropriate jurisdiction
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Police Arrive Depending on agency policy Police arrive within
minutes of call Talk to victim Obtain authorization to have
Forensic Nurse Exam Authorize FNE to provide exam
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Activation of Forensic Nurse Charge nurse/ physician activates
SANE/ FNE SANE/ FNE contacts Victim Advocate on Call SANE/ FNE
reports to hospital to see patient
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Consent and explanation Written and or verbal consent prior to
starting exam Right to refuse Right to have advocate present
(specific to SA) Right to retain clothes Right to stop at any time
Right to refuse blood or urine collection
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History of event Key to understanding events as they happened.
Medical examination NOT a criminal (forensic) investigation
interview We need some of the same information as LE but are
primarily concerned about signs, symptoms, and potential outcomes
(physical and emotional)
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History continued Medical Need to Know When did it happen? Time
line for injuries Where were you? Safety planning What happened to
you? What type of injuries can I expect to find? What did the
person, who hurt you, do? Injury (physical and emotional)
expectations Positions during event Injury potential Types of
injuries inflicted, if known? Treatment options Did you attempt to
injure or ward off the other person? How? Emotional/physical
powerlessness
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Purpose of history True purpose To determine actual and
possible injuries as they are conveyed by mechanism of injury. i.e.
He hit me on the left side of my face with a pillar candle Given
the history, the patient would need a CNS exam, possible CT of the
head, and sutures for the large laceration. Secondary, legal
advantage for the patient Medical personnel who obtain a history
during the course of an examination may testify as to what the
patient told them as a part of the medical examination. Exception
to the Hearsay Rule.
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Importance of history Without a history the caregiver is made
to rely solely on what can be seen. Many injuries do not appear
until hours, days, or weeks later.
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Who should be present during history taking Differing schools
of thought Patient has the right to have the persons of their
choosing Interpretation of the law is varied. Discussion: Advocate
Family Nurse only Law Enforcement
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Value of history to LE Provides details of the incident as it
pertains to injuries, time, persons involved. As a rule, nurses are
confided in more often than law enforcement. The assumption by most
individuals is that nurses are here to take care of me while the
police have to figure out where the truth lies..
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Difference Medical history Used to determine type of injuries
Render a diagnosis Formulate a plan of care Provide treatment Fault
not a consideration LE Interview Used to determine what kind of
crime occurred Who was involved? Who is the perpetrator? What
connection does the victim have to the perpetrator? Is the
complaining witness the victim?
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BREAK
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Physical portion of exam
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Head to toe looking for trauma
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Provide compelling testimony
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Why trauma? Trauma informed care Trauma informed care in very
simple terms, means that we evaluate the patient based on an
assumption that trauma occurred, either mental or physical or both,
and apply nursing process to that ends.
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Linking history to exam When a history is taken we use the
information gained in the history to guide us in our overall
physical and mental assessment. Person Place Time Acts Responses
Actions during Actions after Discharge options
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Head
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Torso
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Extremities
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Ano-genital with consent
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Female / Male
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Cervix
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Vaginal
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Anal
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Evidence Collection Medical exam findings Labs X-rays
Medications administered Pain Infection prevention Referrals to
specialists Forensic History Exam Swabs Photos Treatment
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Kit CONTENTS: 1- 999-550 FDA Manufacturers Insert 2- KCP118
Integrity Seals 1- KCP206 Biohazard Label, 1 x 1.25 (2.5cm x
3.2cm), Black on Orange 1- VEC1001 Kit Box, Factory-Sealed 1-
VEC1002 Kit Instruction Sheet 1- VEC101 Authorization for
Collection & Release Form, 3- Part 1- VEC102 Victim Medical
History & Assault Information Form, 3-Part 1- VEC103A Foreign
Material Bag with 23 x 35 (58.4cm x 88.9cm) Paper Sheet 1- VEC103B
Panties Bag,br> 2- VEC103C Outer Clothing Bags 1- VEC104 Debris
Collection Env. w/Paper Bindle, Swab Box & Nail Scraper 1-
VEC105 Pubic Hair Combings Env. w/Towel & Plastic Comb 1-
VEC106 Pulled Pubic Hairs Env. 1- VEC107 Vaginal Swabs & Smear
Env. w/Slides, Sterile Swabs & Boxes 1- VEC108 Rectal Swabs
& Smear Env. w/Slides, Sterile Swabs & Boxes 1- VEC109 Oral
Swabs & Smear Env. w/Slides, Sterile Swabs & Boxes 1-
VEC110 Pulled Head Hairs Envelope 1- VEC111 Known Saliva Sample
Env. w/Specimen Disc 1- VEC112 Known Blood Sample Env. w/6ml ACD
& 7ml EDTA Blood Tubes 1- VEC113 Anatomical Drawings Form,
3-Part NCR 1- VEC114 Law Enforcement Forms Env.
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Photo documentation
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Documentation
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Interpretation of findings
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What does it all mean? Discussion with LE Discussion with
MD
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Testimony Expert Fact
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Questions Please be advised that we are unable to answer ANY
math questions.