Violence: Impact on Nursing Robert T. Rosso

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ViolenceImpact on NursingRobert 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.

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Types of Violence

• Firearm Domestic
• Workplace Child

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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.

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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.
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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?
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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
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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.
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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.
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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!!
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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
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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.
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Workplace Violence
Understanding Predispositions and Additional
Factors Leading to Workplace Violence Predisposi
tions 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
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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
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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.

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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.
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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
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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?

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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.
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Confidentiality
What can a nurse do to break the cycle of
violence without breaking confidentiality?? Patie
nts need to believe that their care givers will
not break their trust. We must protect our
ethical practice, but also protect the patient.
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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.

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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/workplac
  eviolence.pdf
• Goods for Guns of Alleghany County, Inc (n.d.)
  National Gun Violence Statistics. Retrieved July
  15, 2006, from http//goodsforguns.org/nationalfac
  ts/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), 551557.
• 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

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The End