April 15, 2025 • 29 mins
**For educational purposes only.***
Hello, this week we cover a very heavy topic, intimate partner violence (formerly domestic violence) and human trafficking. Please take care while listening.
These topics are difficult to face when working in healthcare, however these are real life things we can come across as you work with a variety of patient populations.
Here we learn different types of assessment tools and what their interpretations mean.
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If you have any topics you would like for me to cover, you can contact me at rosietherivetingrn@yahoo.com
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
SPEAKER_00 (00:09):
Hello, and welcome to this episode of Rosie the
Riveting RN.
I am Professor Poole, and I amhere today to help you make
those really hard concepts thatare taught in health assessment
and piece it together.
So today what we're going to betalking about is a very
difficult topic.
So I ask you to listen withcare.
(00:30):
It is family violence and humantrafficking.
So we're going to just go in anddive in on into it.
Domestic violence, the term hasactually been changed recently
to IPV, which is intimatepartner violence.
So just know that IPV, intimatepartner violence is the same
(00:50):
thing as domestic violence.
There are four main categoriesof IPV.
It's physical, sexual, stalking,and psychosocial aggression.
So that physical category isgoing to be a force causing
injury, disability, or death andsexual is attempted or completed
(01:14):
nonconsensual sexual acts.
This can be rape exposure orunwanted contact.
Stalking is repeated unwantedattention that causes fear.
And then psychosocial aggressionis that emotional abuse with
verbal or nonverbalcommunication.
Now there also is somethingcalled elder abuse, which
(01:37):
unfortunately you are probablygoing to come cross as you start
practicing as a registerednurse.
So elder abuse, it isintentional and failure to act
with any good intentions for thepatient.
Like all your intentions are notwith the benefit of the patient
in mind.
(01:58):
They are self-serving for onlyyours.
Now, the categories andcomponents for elderly abuse is
going to be physical, which isassaulted, threatened with a
weapon or inappropriatelyrestraint of the patient, sexual
abuse or sexual contact that isagainst the patient's will or
(02:21):
the person is unable to consent.
Unfortunately, this does happento our elderly patients who
can't speak up for themselves orthey don't even understand
what's happening.
Psychological or emotional abusecan occur and that is when there
are verbal and nonverbal ways tocause distress Fear.
humiliation, isolation, or evencontrol of the elderly patient.
(02:47):
Neglect is the failure of thecaregiver to provide any of the
basic needs of the patient,whether that is hygiene, medical
care, that can be medicine,compliance, food, stuff like
that.
Financial abuse or exploitation.
Unfortunately, this does happen.
This is when there isunauthorized use or improper use
(03:09):
or unauthorized authorized useor control of finances while the
person who is committing thisfinancial abuse is completely
benefiting from this.
now there's also somethingcalled human trafficking and
what is that so basically thisis your modern day slavery this
(03:31):
can happen by convincing aperson to perform acts of labor
or maybe even services thiscould be sexual this could be
not sexual it's not always goingto be sexual every single time
usually the um The victim isgoing to be promised some type
of protection or a better way oflife.
(03:52):
Basically, oh, you're going toget more money or we're going to
go places and all that stuff.
And trafficking, it's notnecessarily moving a person to
very different locations, to adifferent country, state or
city.
There have been incidences wherethe victim is actually found
blocks away from the family andthe family had absolutely no
(04:16):
idea This can be in variousindustries, this can be in
hospitality, this can be in theadult industry, this can be in
agriculture, this can be in anumber of things.
And unfortunately, humantrafficking, it does cause
severe mental illness and it canbe very difficult for us as
(04:39):
healthcare providers to reallycatch.
This can be because the patientis terrified to say anything.
Maybe the trafficker is around,making sure the patient doesn't
say anything, or maybe thetrafficker is truly brainwashed
and they don't believe that theyare trafficked.
So it can be very difficult.
(04:59):
Now there are some effects thatcan happen with violence, right?
So an immediate effect ofviolence would be trauma or
injuries to the patient.
Now that can be bruises,lacerations, you name it.
But then there are also chroniceffects of physical or any type
of abuse, right?
(05:20):
And that can be cardiovasculardisease.
Your endocrine system can beaffected.
This can cause immune issues.
You're more susceptible to beingsick, GI issues, and then women
who are pregnant are at a higherrisk.
Now, let me go back and explainthat chronic.
(05:40):
Why is cardiovascular,endocrine, and immune, and GI
issues prevalent in patientswith any type of violence.
The reason why is because youwant to remember this.
Dis-ease causes disease.
You're in a heightened state offear and stress.
And stress totally wreaks havocon your body.
(06:04):
On your cardiovascular disease,you're at a higher risk of
hypertension, CAD, PAD, DVTs,strokes.
Heart attacks, heart failure,you name it.
Your endocrine system can beoff.
Your hormones can be totallyoff.
(06:24):
Stress can induce some otherillnesses as well.
I mean, your cortisol iselevated.
That's affected by the endocrinesystem.
GI issues as well.
And then...
And so that's how chronicillnesses can actually be tied
to violence.
Now, substance abuse is prettyprevalent in those who have
(06:46):
experienced violence or even sextrafficking, or well, any human
trafficking, I should say.
This can actually cause lowbirth weights if you're being
abused or experiencing violenceand you are pregnant.
While you're pregnant and youare experiencing violence or
(07:07):
abuse, you can actuallyexperience early deliveries,
stillborns, miscarriages, andthen unfortunately your child is
also at a very high risk ofexperiencing child abuse as
well.
The cycle tends to continue.
There are something calledsocietal stressors, and these
are contributes that delaystruggles.
(07:30):
So this can be poverty, racism,fear of discrimination.
These are societal stressors andpatients who do experience this
do have a higher incidence ofcardiovascular disease and so
forth.
These patients are also gonna beat a higher risk of not having
(07:52):
access to appropriate healthcareor have good health literacy or
there may be some other thingsgoing on and all these patients
are at a higher risk of sometype of violence or even human
trafficking.
Now the legal status of thepatient can actually play a role
as well.
(08:12):
So women may not know legalrights or resources, especially
if they're not born and raisedhere in the United States.
they may not know that there'sopportunities for help that
there's shelters that they couldgo to or if they're an illegal
immigrant they may be terrifiedto ask for help because they're
(08:33):
afraid of what's going to happento them if they come forward and
so forth plus they may not knowour culture either or even speak
our language very well so thenthere's that whole aspect too
and what feels familiar is theirhome but unfortunately that's
(08:53):
more than likely where thatabuse is going to be experienced
we can also as as health careproviders we may not be
culturally competent in theirspecific culture and understand
what their needs are and so wecan give like really poor
(09:14):
cultural care for those patientsNow, patients of the LBGTQ
community, they unfortunatelyare also at a very high risk of
abuse and being trafficked.
And so there's also that wholeaspect that you need to worry
about as well.
(09:34):
Now, I've gone over the down anddirty of LBGTQ.
intimate partner violence,elderly abuse, as well as human
trafficking.
But now what do you do withdocumentation?
If you have a patient of thesepopulations in front of you,
okay, well now what do you do?
How do you document this?
Really, you document everythingverbatim, absolutely verbatim.
(09:57):
If a patient says something, youchart it, you put it in a
quotation, and you write downexactly what that patient said.
Even if the alleged abuser is inthere, you also, you write
everything down.
Everything you see, everythingyou observe, you write it down.
(10:21):
Your charting cannot be biased.
Whether or not you believe theperson, that does not matter.
Absolutely doesn't matter.
You don't need to believeanybody in order to document
anything appropriately.
All you need to do is documentverbatim.
You document everything as ithappened.
(10:43):
It is factual.
You have everything that isdetailed.
All notes are detailed.
You can do injury mapping, likeyou can look at different
injuries.
And do they make sense?
Do they not make sense?
Are they of different healingphases?
That can be a sign of abuse.
(11:04):
Now, as nurses, we do tend tounderstand different phases of
healing for bruises, but we donot document what the phase is.
And what I mean when I say thatis we don't document, oh, an old
wound or an old injury.
old bruise, right?
(11:25):
We document the location.
We document how big it is,shape, and then the color.
That is what we document.
We don't document if we believethat it's a brand new bruise.
We don't document if we believeit's a week old.
We don't do that.
A doctor can do that.
Other things that we can do forvery, very, very accurate
(11:49):
charting is photography.
So we can actually take picturesof the injuries, but make sure
prior to doing this, you get thepatient's consent signed.
You have to get a patient'sconsent to take any pictures,
even though those pictures aregoing into the patient's chart.
You want to make sure that thatconsent is in the chart prior to
(12:10):
doing any type of pictures.
Now, Who needs to be screenedfor any type of abuse?
Now, since women, especiallywomen of childbearing age, are
at a higher risk of intimatepartner violence, they need to
be screened.
So patients with the ages of 14to 46 should all be screened.
(12:37):
And when do you report abuse?
When abuse is actuallysuspected.
You don't need hardcoreevidence.
You don't need the patient'sconsent to report it.
You as a registered nurse are amandated reporter and you have a
duty to actually report that.
So the key thing with any typeof abuse, you want to hopefully
(13:01):
report catch it early on, andthat way we decrease long-term
risks and effects.
Now, those would be like thosechronic side effects like
cardiovascular disease,endocrine disease, immune, as
well as GI distress, but it canalso be saving a patient's life
as well, or the children's life,right?
(13:24):
there is an assessments toolthat we can do.
It's called HITS, H-I-T-S, andthat stands for Hurt, Insults,
Threaten, Screams.
Now, this is a four-questionscreening tool.
Each question is scored zero tofive, zero being never, five
(13:48):
being always and basically whatyou're asking is does your
partner hurt you does yourpartner insult you like
questions like that threaten youscream and so forth and then the
patient scores it like oh onezero whatever they want to score
it and then if a patient scoresabove a 10 that is indicative of
(14:10):
abuse right and then rememberyou are a mandated reporter you
need to report that so Then whatwe need to do after this
screening is ask thoseopen-ended questions.
And the reason why you don'twant to ask those closed-ended
questions, those yes or noquestions, is because you need
as much information as possiblefrom that patient.
(14:34):
So that's why you need thoseopen-ended questions.
Now, for elderly abuse, youreally need to think about
financial abuse.
Unfortunately, that That very,very commonly happens.
So we can use a tool and it iscalled the Elder Abuse Suspicion
Index.
This basically is going toassess for any signs of abuse.
(14:59):
This can be poor eye contact,malnutrition, poor hygiene, any
type of injuries, neglect, poormedication compliance, forcing
to sign documents, psychosocialand sexual abuse.
However, the patient does needto be cognitively sound, meaning
(15:22):
they can't have any type ofdelirium or dementia or any type
of mental distress, right?
They have to be cognitivelysound to get an accurate
response.
Otherwise, you can't do thisscreening, unfortunately.
Now for human trafficking, thereis absolutely no standard
(15:46):
screening tool that is usedthroughout the country.
There's little to no training onrecognition or any type of
interventions for humantrafficking really.
Victims can routinely seedoctors and doctors might not
have any idea that this patientis being human trafficked in any
(16:08):
way, shape, or form.
It is very hard to catch.
Some providers may use what'scalled the HEAL protocol,
H-E-A-L.
heel protocol, or they may usesomething called the adult human
trafficking screening tool andguide.
But again, a lot of providersthese days, they don't really
know that that is available andthey don't know what to do with
(16:31):
it.
And then, okay, so what if itcomes out positive, but then
what?
The patient's an adult, they canmake their own decisions to go
back.
What do you, I mean, what do youdo?
So it makes it really, reallydifficult.
So that's kind of yoursubjective data.
So your objective data, the keything is that great head-to-toe
(16:52):
assessment.
This is why a head-to-toe, allyour assessment skills are so
important.
So doing a really, really goodassessment is gonna be really
helpful for these patients.
You do wanna know what theirbaseline measurements are, like
their vital signs and theirlabs.
You may wanna collect labs aswell, especially if you're
(17:13):
expecting, suspecting any typeof malnutrition or substance
abuse or something.
You want to know any medicationsthat they may be taking as well
as comorbidities as well,because sometimes there are
comorbidities or evenmedications that can cause
bruising of various stages.
(17:35):
And so that can be like bloodthinners or even coagulation
issues, right?
Like if you havethrombocytopenia, like you have
low platelets or prolongedbleeding times, you can bruise
very easily.
So then you always want to wraparound and find a reason why
does this patient have a lot ofbruising do you fall a lot do
(17:55):
you bump into things or you knowdo you they look like that they
are um like cigarette burns?
Does it look like they gotburned by something else?
Or are they like fingerprintsand stuff like that?
So those are things that youwould look out for.
Anybody who is suspected ofsexual abuse should be tested
(18:18):
for any STI.
Now, remember for HIV testing,you actually do need the
patient's consent.
That is one that you do need aconsent for.
Those of childbearing age, theywill need to be checked for
pregnancy tests.
Now, once again, with bruises,you're gonna want to document
the color, size, shape, pattern,but do not try to determine the
(18:40):
timing of the injury or likebased off the appearance, like,
oh, this looks like this hasbeen one week.
That's not good charting, juststraight up.
What is the size, color, shape,pattern?
And you don't want to justassume what this could have
caused.
You can't do that.
As a nurse, you cannot do that.
(19:01):
So you just do the size, shape,color, and then the location of
the bruise.
Now, there are some key words.
So bruise can be usedinterchangeably with contusion.
Those can be one of the same.
A laceration is related to anavulsion.
Echemosis is related to senilepurpa.
(19:24):
Now remember, there are elderlypeople who do bruise very easily
and you can't see that on theback of their hands.
So you also want to take thepatient's age into consideration
when you're looking at any typeof bruises.
Petechiae.
Petechiae is those little redspots that you may see and those
are signs of like littlecapillaries bursting.
(19:49):
And there's also perpa.
Perpa is where those petechiaestart to connect and it's a
little bit bigger.
Petechiae behind the ear, thatcan be a sign of abuse and some
type of hitting on that ear.
And that can be very painful inthe patient.
Rug burns is better documentedas a friction abrasion.
(20:12):
It's more accurate than justsaying rug burn in your
documentation.
So when you're documenting anytype of injury that looks like a
friction abrasion, that's theterm you want to go with.
You don't want to go with rugburn because you don't know if
they were actually dragged on arug.
Incision can be usedinterchangeably with a cut.
(20:33):
That is safe charting.
And then a cut can also be usedinterchangeably with any sharp
injury.
Stab wounds, of course, thoseare going to be deep penetrating
sharp injuries.
And then a hematoma is acollection of blood that is
often but not always caused byblunt force trauma.
(20:54):
So there's a couple differentkey terms to know.
Now, we do know that withbruises, they do change color.
They do often progress frompurple-blue to bluish-green,
greenish-brown tobrownish-yellow.
However, once again, you onlydocument the color, size, shape,
(21:16):
and location.
It is not up to you.
The registered nurse determinethe lifeline, like how long that
patient has had that bruising.
Other medications that can causeincreased bruising or bleeding
can not only be thoseanticoagulants, but also NSAIDs
(21:37):
as well.
Also ginkgo and garlic can causeprogressed bleeding times.
And then any type of likechemotherapy can decrease your
platelet count and that canactually cause you to have
increased bleeding as well.
So We do know that there are alot of issues and risks that
(21:59):
come along with abuse, any typeof abuse.
And unfortunately, homicide,that is a huge risk.
So to assess the chances ofhomicide, we're going to use
what is called the dangerassessment.
And it is a yes or noquestionnaire.
(22:21):
And basically it is a 20question questionnaire.
And then you count how manyyeses, right?
So basically you use a calendar.
you present a calendar to thepatient.
And then you say, please markthe appropriate dates that, or
all the dates where youexperienced some type of abuse
(22:45):
by your partner or ex-partner orwhatever.
This can be slapping, pushing,no injuries.
This can be pain, no pain,punching, kicking, verbal abuse,
anything.
And one through 20, again, It isa yes or no.
And then you add up all of theyeses.
There is no particular cutoffamount of X amount of yeses
(23:09):
mean, yeah, you're being abused.
No, you're not being abused,right?
There's no cutoff.
Basically what this is, this isto help open the patient's eyes
because with a calendar, theycan actually look at how
frequently they are experiencingabuse.
And it might be more than theyThey really realize.
And also, the more yeses thereare tells us how bad the abuse
(23:33):
is.
And then what we can do is thatwe can basically set them up
with resources and informationand shelters and so forth that
can help them, one, stay alive,and then two, get to safety.
Now, whether or not they followthrough with those
recommendations, I feel likethat's more of the hard part.
(23:58):
I mean, you can offer theseresources, but ultimately this
is an adult and they can makethe decision to go back.
You just want to documentabsolutely everything that you
did with this person.
Now, unfortunately, more than70% of murder-suicide cases are
related to intimate partnerviolence.
And the majority of that, about94% of that, those victims are
(24:21):
female.
And if there is any type of gunpresent in the home, that risk
of homicide increases by 500%.
Those who are of minorities,they are at a very, very high
risk of experiencing homicidewith abuse.
(24:43):
And then failure to routinelyassess for intimate partner
violence, that is absolutely adisservice to the patient.
And then where we could havepossibly done a screening, like
the danger assessment, and wecould have allowed the patient
to have an opportunity for aneye-opening moment and possibly
(25:05):
save their life.
So there's that.
I know this is not like a funlecture, so I'm sorry.
So human trafficking, what areyour risk factors for human
trafficking?
It's those who are homeless,like they're kind of down on
their luck.
They have nowhere to go.
They're a runaway youth.
(25:25):
Those of the LBGTQ community areat a very high risk of human
trafficking.
Those who have no financialmeans and support.
lack of legal status rightyou're an illegal immigrant
you're more likely to be humantrafficked unfortunately and
those who are minority those whohave a history of abuse any type
(25:48):
of lack of family support you'reat a higher risk of human
trafficking and those who haveany type of substance abuse
regardless if that's drugs oralcohol or if there's some
mental health um issues you areat a higher risk of human
trafficking And some signs ofhuman trafficking could be, no,
(26:13):
key word is could be.
This is not like a given thingbecause this can be a number of
things too.
But signs that could indicatehuman trafficking is if the
patient delays medical care,their stories are absolutely
inconsistent with the injuriesand how they are presenting to
the doctor or whatever.
There's bruises of various typesof or other injuries of various
(26:41):
phases of healing.
The patient is completelywithdrawn.
There is some type ofself-mutilation.
There also could be brandinglike tattoo branding or even
like brand like you know likethat burning of like the the
cows and stuff like that canhappen as well they can be a
hyper sexualized that can alsobe a sign of human trafficking
(27:05):
they can be malnourished unawareof really where they are what
time it is um not be aware ofthe date Poor hygiene is also
something that we can see aswell, or even be hesitant to
answer any type of questions.
If a patient seems to have arehearsed answer or response,
(27:28):
this can be a indication ofeither human trafficking or
either any type of abuse,whether it's physical,
emotional, all that stuff.
So those are some of the signsthat can indicate that the
patient is not safe.
And what you would want to do isget that patient away from their
(27:51):
alleged abuser.
If they did come in withsomebody into the ER, hospital,
whatever, the best thing to dois really separate them from
whoever the other person is sothat we can get all the details
that we need and hopefully wecan follow through with what
this patient needs to be safe,right?
(28:12):
So this is your humantrafficking, episode.
I'm sorry, I know it's a prettyDebbie Downer episode, I know,
but these are very, veryimportant things to be very
aware of.
You can definitely see this inyour patients, and it's
important to know what yourresources are and what your
(28:33):
scope of practice is so that youcan safely help these patients.
So I hope you guys have a greatday.
I hope you were able to takesomething away with you today.
Please let me know if you haveany topics that you want me to
cover.
Please like, rate, subscribe,and comment.
(28:53):
That really does help.
And please share this with yourother nursing friends, whether
they're in the same school or adifferent school.
I would greatly appreciate it.
And I hope you have a great day.
Bye-bye.
Hello, and welcome to this episode of Rosie the
Riveting RN.
I am Professor Poole, and I amhere today to help you make
those really hard concepts thatare taught in health assessment
and piece it together.
So today what we're going to betalking about is a very
difficult topic.
So I ask you to listen withcare.
(00:30):
It is family violence and humantrafficking.
So we're going to just go in anddive in on into it.
Domestic violence, the term hasactually been changed recently
to IPV, which is intimatepartner violence.
So just know that IPV, intimatepartner violence is the same
(00:50):
thing as domestic violence.
There are four main categoriesof IPV.
It's physical, sexual, stalking,and psychosocial aggression.
So that physical category isgoing to be a force causing
injury, disability, or death andsexual is attempted or completed
(01:14):
nonconsensual sexual acts.
This can be rape exposure orunwanted contact.
Stalking is repeated unwantedattention that causes fear.
And then psychosocial aggressionis that emotional abuse with
verbal or nonverbalcommunication.
Now there also is somethingcalled elder abuse, which
(01:37):
unfortunately you are probablygoing to come cross as you start
practicing as a registerednurse.
So elder abuse, it isintentional and failure to act
with any good intentions for thepatient.
Like all your intentions are notwith the benefit of the patient
in mind.
(01:58):
They are self-serving for onlyyours.
Now, the categories andcomponents for elderly abuse is
going to be physical, which isassaulted, threatened with a
weapon or inappropriatelyrestraint of the patient, sexual
abuse or sexual contact that isagainst the patient's will or
(02:21):
the person is unable to consent.
Unfortunately, this does happento our elderly patients who
can't speak up for themselves orthey don't even understand
what's happening.
Psychological or emotional abusecan occur and that is when there
are verbal and nonverbal ways tocause distress Fear.
humiliation, isolation, or evencontrol of the elderly patient.
(02:47):
Neglect is the failure of thecaregiver to provide any of the
basic needs of the patient,whether that is hygiene, medical
care, that can be medicine,compliance, food, stuff like
that.
Financial abuse or exploitation.
Unfortunately, this does happen.
This is when there isunauthorized use or improper use
(03:09):
or unauthorized authorized useor control of finances while the
person who is committing thisfinancial abuse is completely
benefiting from this.
now there's also somethingcalled human trafficking and
what is that so basically thisis your modern day slavery this
(03:31):
can happen by convincing aperson to perform acts of labor
or maybe even services thiscould be sexual this could be
not sexual it's not always goingto be sexual every single time
usually the um The victim isgoing to be promised some type
of protection or a better way oflife.
(03:52):
Basically, oh, you're going toget more money or we're going to
go places and all that stuff.
And trafficking, it's notnecessarily moving a person to
very different locations, to adifferent country, state or
city.
There have been incidences wherethe victim is actually found
blocks away from the family andthe family had absolutely no
(04:16):
idea This can be in variousindustries, this can be in
hospitality, this can be in theadult industry, this can be in
agriculture, this can be in anumber of things.
And unfortunately, humantrafficking, it does cause
severe mental illness and it canbe very difficult for us as
(04:39):
healthcare providers to reallycatch.
This can be because the patientis terrified to say anything.
Maybe the trafficker is around,making sure the patient doesn't
say anything, or maybe thetrafficker is truly brainwashed
and they don't believe that theyare trafficked.
So it can be very difficult.
(04:59):
Now there are some effects thatcan happen with violence, right?
So an immediate effect ofviolence would be trauma or
injuries to the patient.
Now that can be bruises,lacerations, you name it.
But then there are also chroniceffects of physical or any type
of abuse, right?
(05:20):
And that can be cardiovasculardisease.
Your endocrine system can beaffected.
This can cause immune issues.
You're more susceptible to beingsick, GI issues, and then women
who are pregnant are at a higherrisk.
Now, let me go back and explainthat chronic.
(05:40):
Why is cardiovascular,endocrine, and immune, and GI
issues prevalent in patientswith any type of violence.
The reason why is because youwant to remember this.
Dis-ease causes disease.
You're in a heightened state offear and stress.
And stress totally wreaks havocon your body.
(06:04):
On your cardiovascular disease,you're at a higher risk of
hypertension, CAD, PAD, DVTs,strokes.
Heart attacks, heart failure,you name it.
Your endocrine system can beoff.
Your hormones can be totallyoff.
(06:24):
Stress can induce some otherillnesses as well.
I mean, your cortisol iselevated.
That's affected by the endocrinesystem.
GI issues as well.
And then...
And so that's how chronicillnesses can actually be tied
to violence.
Now, substance abuse is prettyprevalent in those who have
(06:46):
experienced violence or even sextrafficking, or well, any human
trafficking, I should say.
This can actually cause lowbirth weights if you're being
abused or experiencing violenceand you are pregnant.
While you're pregnant and youare experiencing violence or
(07:07):
abuse, you can actuallyexperience early deliveries,
stillborns, miscarriages, andthen unfortunately your child is
also at a very high risk ofexperiencing child abuse as
well.
The cycle tends to continue.
There are something calledsocietal stressors, and these
are contributes that delaystruggles.
(07:30):
So this can be poverty, racism,fear of discrimination.
These are societal stressors andpatients who do experience this
do have a higher incidence ofcardiovascular disease and so
forth.
These patients are also gonna beat a higher risk of not having
(07:52):
access to appropriate healthcareor have good health literacy or
there may be some other thingsgoing on and all these patients
are at a higher risk of sometype of violence or even human
trafficking.
Now the legal status of thepatient can actually play a role
as well.
(08:12):
So women may not know legalrights or resources, especially
if they're not born and raisedhere in the United States.
they may not know that there'sopportunities for help that
there's shelters that they couldgo to or if they're an illegal
immigrant they may be terrifiedto ask for help because they're
(08:33):
afraid of what's going to happento them if they come forward and
so forth plus they may not knowour culture either or even speak
our language very well so thenthere's that whole aspect too
and what feels familiar is theirhome but unfortunately that's
(08:53):
more than likely where thatabuse is going to be experienced
we can also as as health careproviders we may not be
culturally competent in theirspecific culture and understand
what their needs are and so wecan give like really poor
(09:14):
cultural care for those patientsNow, patients of the LBGTQ
community, they unfortunatelyare also at a very high risk of
abuse and being trafficked.
And so there's also that wholeaspect that you need to worry
about as well.
(09:34):
Now, I've gone over the down anddirty of LBGTQ.
intimate partner violence,elderly abuse, as well as human
trafficking.
But now what do you do withdocumentation?
If you have a patient of thesepopulations in front of you,
okay, well now what do you do?
How do you document this?
Really, you document everythingverbatim, absolutely verbatim.
(09:57):
If a patient says something, youchart it, you put it in a
quotation, and you write downexactly what that patient said.
Even if the alleged abuser is inthere, you also, you write
everything down.
Everything you see, everythingyou observe, you write it down.
(10:21):
Your charting cannot be biased.
Whether or not you believe theperson, that does not matter.
Absolutely doesn't matter.
You don't need to believeanybody in order to document
anything appropriately.
All you need to do is documentverbatim.
You document everything as ithappened.
(10:43):
It is factual.
You have everything that isdetailed.
All notes are detailed.
You can do injury mapping, likeyou can look at different
injuries.
And do they make sense?
Do they not make sense?
Are they of different healingphases?
That can be a sign of abuse.
(11:04):
Now, as nurses, we do tend tounderstand different phases of
healing for bruises, but we donot document what the phase is.
And what I mean when I say thatis we don't document, oh, an old
wound or an old injury.
old bruise, right?
(11:25):
We document the location.
We document how big it is,shape, and then the color.
That is what we document.
We don't document if we believethat it's a brand new bruise.
We don't document if we believeit's a week old.
We don't do that.
A doctor can do that.
Other things that we can do forvery, very, very accurate
(11:49):
charting is photography.
So we can actually take picturesof the injuries, but make sure
prior to doing this, you get thepatient's consent signed.
You have to get a patient'sconsent to take any pictures,
even though those pictures aregoing into the patient's chart.
You want to make sure that thatconsent is in the chart prior to
(12:10):
doing any type of pictures.
Now, Who needs to be screenedfor any type of abuse?
Now, since women, especiallywomen of childbearing age, are
at a higher risk of intimatepartner violence, they need to
be screened.
So patients with the ages of 14to 46 should all be screened.
(12:37):
And when do you report abuse?
When abuse is actuallysuspected.
You don't need hardcoreevidence.
You don't need the patient'sconsent to report it.
You as a registered nurse are amandated reporter and you have a
duty to actually report that.
So the key thing with any typeof abuse, you want to hopefully
(13:01):
report catch it early on, andthat way we decrease long-term
risks and effects.
Now, those would be like thosechronic side effects like
cardiovascular disease,endocrine disease, immune, as
well as GI distress, but it canalso be saving a patient's life
as well, or the children's life,right?
(13:24):
there is an assessments toolthat we can do.
It's called HITS, H-I-T-S, andthat stands for Hurt, Insults,
Threaten, Screams.
Now, this is a four-questionscreening tool.
Each question is scored zero tofive, zero being never, five
(13:48):
being always and basically whatyou're asking is does your
partner hurt you does yourpartner insult you like
questions like that threaten youscream and so forth and then the
patient scores it like oh onezero whatever they want to score
it and then if a patient scoresabove a 10 that is indicative of
(14:10):
abuse right and then rememberyou are a mandated reporter you
need to report that so Then whatwe need to do after this
screening is ask thoseopen-ended questions.
And the reason why you don'twant to ask those closed-ended
questions, those yes or noquestions, is because you need
as much information as possiblefrom that patient.
(14:34):
So that's why you need thoseopen-ended questions.
Now, for elderly abuse, youreally need to think about
financial abuse.
Unfortunately, that That very,very commonly happens.
So we can use a tool and it iscalled the Elder Abuse Suspicion
Index.
This basically is going toassess for any signs of abuse.
(14:59):
This can be poor eye contact,malnutrition, poor hygiene, any
type of injuries, neglect, poormedication compliance, forcing
to sign documents, psychosocialand sexual abuse.
However, the patient does needto be cognitively sound, meaning
(15:22):
they can't have any type ofdelirium or dementia or any type
of mental distress, right?
They have to be cognitivelysound to get an accurate
response.
Otherwise, you can't do thisscreening, unfortunately.
Now for human trafficking, thereis absolutely no standard
(15:46):
screening tool that is usedthroughout the country.
There's little to no training onrecognition or any type of
interventions for humantrafficking really.
Victims can routinely seedoctors and doctors might not
have any idea that this patientis being human trafficked in any
(16:08):
way, shape, or form.
It is very hard to catch.
Some providers may use what'scalled the HEAL protocol,
H-E-A-L.
heel protocol, or they may usesomething called the adult human
trafficking screening tool andguide.
But again, a lot of providersthese days, they don't really
know that that is available andthey don't know what to do with
(16:31):
it.
And then, okay, so what if itcomes out positive, but then
what?
The patient's an adult, they canmake their own decisions to go
back.
What do you, I mean, what do youdo?
So it makes it really, reallydifficult.
So that's kind of yoursubjective data.
So your objective data, the keything is that great head-to-toe
(16:52):
assessment.
This is why a head-to-toe, allyour assessment skills are so
important.
So doing a really, really goodassessment is gonna be really
helpful for these patients.
You do wanna know what theirbaseline measurements are, like
their vital signs and theirlabs.
You may wanna collect labs aswell, especially if you're
(17:13):
expecting, suspecting any typeof malnutrition or substance
abuse or something.
You want to know any medicationsthat they may be taking as well
as comorbidities as well,because sometimes there are
comorbidities or evenmedications that can cause
bruising of various stages.
(17:35):
And so that can be like bloodthinners or even coagulation
issues, right?
Like if you havethrombocytopenia, like you have
low platelets or prolongedbleeding times, you can bruise
very easily.
So then you always want to wraparound and find a reason why
does this patient have a lot ofbruising do you fall a lot do
(17:55):
you bump into things or you knowdo you they look like that they
are um like cigarette burns?
Does it look like they gotburned by something else?
Or are they like fingerprintsand stuff like that?
So those are things that youwould look out for.
Anybody who is suspected ofsexual abuse should be tested
(18:18):
for any STI.
Now, remember for HIV testing,you actually do need the
patient's consent.
That is one that you do need aconsent for.
Those of childbearing age, theywill need to be checked for
pregnancy tests.
Now, once again, with bruises,you're gonna want to document
the color, size, shape, pattern,but do not try to determine the
(18:40):
timing of the injury or likebased off the appearance, like,
oh, this looks like this hasbeen one week.
That's not good charting, juststraight up.
What is the size, color, shape,pattern?
And you don't want to justassume what this could have
caused.
You can't do that.
As a nurse, you cannot do that.
(19:01):
So you just do the size, shape,color, and then the location of
the bruise.
Now, there are some key words.
So bruise can be usedinterchangeably with contusion.
Those can be one of the same.
A laceration is related to anavulsion.
Echemosis is related to senilepurpa.
(19:24):
Now remember, there are elderlypeople who do bruise very easily
and you can't see that on theback of their hands.
So you also want to take thepatient's age into consideration
when you're looking at any typeof bruises.
Petechiae.
Petechiae is those little redspots that you may see and those
are signs of like littlecapillaries bursting.
(19:49):
And there's also perpa.
Perpa is where those petechiaestart to connect and it's a
little bit bigger.
Petechiae behind the ear, thatcan be a sign of abuse and some
type of hitting on that ear.
And that can be very painful inthe patient.
Rug burns is better documentedas a friction abrasion.
(20:12):
It's more accurate than justsaying rug burn in your
documentation.
So when you're documenting anytype of injury that looks like a
friction abrasion, that's theterm you want to go with.
You don't want to go with rugburn because you don't know if
they were actually dragged on arug.
Incision can be usedinterchangeably with a cut.
(20:33):
That is safe charting.
And then a cut can also be usedinterchangeably with any sharp
injury.
Stab wounds, of course, thoseare going to be deep penetrating
sharp injuries.
And then a hematoma is acollection of blood that is
often but not always caused byblunt force trauma.
(20:54):
So there's a couple differentkey terms to know.
Now, we do know that withbruises, they do change color.
They do often progress frompurple-blue to bluish-green,
greenish-brown tobrownish-yellow.
However, once again, you onlydocument the color, size, shape,
(21:16):
and location.
It is not up to you.
The registered nurse determinethe lifeline, like how long that
patient has had that bruising.
Other medications that can causeincreased bruising or bleeding
can not only be thoseanticoagulants, but also NSAIDs
(21:37):
as well.
Also ginkgo and garlic can causeprogressed bleeding times.
And then any type of likechemotherapy can decrease your
platelet count and that canactually cause you to have
increased bleeding as well.
So We do know that there are alot of issues and risks that
(21:59):
come along with abuse, any typeof abuse.
And unfortunately, homicide,that is a huge risk.
So to assess the chances ofhomicide, we're going to use
what is called the dangerassessment.
And it is a yes or noquestionnaire.
(22:21):
And basically it is a 20question questionnaire.
And then you count how manyyeses, right?
So basically you use a calendar.
you present a calendar to thepatient.
And then you say, please markthe appropriate dates that, or
all the dates where youexperienced some type of abuse
(22:45):
by your partner or ex-partner orwhatever.
This can be slapping, pushing,no injuries.
This can be pain, no pain,punching, kicking, verbal abuse,
anything.
And one through 20, again, It isa yes or no.
And then you add up all of theyeses.
There is no particular cutoffamount of X amount of yeses
(23:09):
mean, yeah, you're being abused.
No, you're not being abused,right?
There's no cutoff.
Basically what this is, this isto help open the patient's eyes
because with a calendar, theycan actually look at how
frequently they are experiencingabuse.
And it might be more than theyThey really realize.
And also, the more yeses thereare tells us how bad the abuse
(23:33):
is.
And then what we can do is thatwe can basically set them up
with resources and informationand shelters and so forth that
can help them, one, stay alive,and then two, get to safety.
Now, whether or not they followthrough with those
recommendations, I feel likethat's more of the hard part.
(23:58):
I mean, you can offer theseresources, but ultimately this
is an adult and they can makethe decision to go back.
You just want to documentabsolutely everything that you
did with this person.
Now, unfortunately, more than70% of murder-suicide cases are
related to intimate partnerviolence.
And the majority of that, about94% of that, those victims are
(24:21):
female.
And if there is any type of gunpresent in the home, that risk
of homicide increases by 500%.
Those who are of minorities,they are at a very, very high
risk of experiencing homicidewith abuse.
(24:43):
And then failure to routinelyassess for intimate partner
violence, that is absolutely adisservice to the patient.
And then where we could havepossibly done a screening, like
the danger assessment, and wecould have allowed the patient
to have an opportunity for aneye-opening moment and possibly
(25:05):
save their life.
So there's that.
I know this is not like a funlecture, so I'm sorry.
So human trafficking, what areyour risk factors for human
trafficking?
It's those who are homeless,like they're kind of down on
their luck.
They have nowhere to go.
They're a runaway youth.
(25:25):
Those of the LBGTQ community areat a very high risk of human
trafficking.
Those who have no financialmeans and support.
lack of legal status rightyou're an illegal immigrant
you're more likely to be humantrafficked unfortunately and
those who are minority those whohave a history of abuse any type
(25:48):
of lack of family support you'reat a higher risk of human
trafficking and those who haveany type of substance abuse
regardless if that's drugs oralcohol or if there's some
mental health um issues you areat a higher risk of human
trafficking And some signs ofhuman trafficking could be, no,
(26:13):
key word is could be.
This is not like a given thingbecause this can be a number of
things too.
But signs that could indicatehuman trafficking is if the
patient delays medical care,their stories are absolutely
inconsistent with the injuriesand how they are presenting to
the doctor or whatever.
There's bruises of various typesof or other injuries of various
(26:41):
phases of healing.
The patient is completelywithdrawn.
There is some type ofself-mutilation.
There also could be brandinglike tattoo branding or even
like brand like you know likethat burning of like the the
cows and stuff like that canhappen as well they can be a
hyper sexualized that can alsobe a sign of human trafficking
(27:05):
they can be malnourished unawareof really where they are what
time it is um not be aware ofthe date Poor hygiene is also
something that we can see aswell, or even be hesitant to
answer any type of questions.
If a patient seems to have arehearsed answer or response,
(27:28):
this can be a indication ofeither human trafficking or
either any type of abuse,whether it's physical,
emotional, all that stuff.
So those are some of the signsthat can indicate that the
patient is not safe.
And what you would want to do isget that patient away from their
(27:51):
alleged abuser.
If they did come in withsomebody into the ER, hospital,
whatever, the best thing to dois really separate them from
whoever the other person is sothat we can get all the details
that we need and hopefully wecan follow through with what
this patient needs to be safe,right?
(28:12):
So this is your humantrafficking, episode.
I'm sorry, I know it's a prettyDebbie Downer episode, I know,
but these are very, veryimportant things to be very
aware of.
You can definitely see this inyour patients, and it's
important to know what yourresources are and what your
(28:33):
scope of practice is so that youcan safely help these patients.
So I hope you guys have a greatday.
I hope you were able to takesomething away with you today.
Please let me know if you haveany topics that you want me to
cover.
Please like, rate, subscribe,and comment.
(28:53):
That really does help.
And please share this with yourother nursing friends, whether
they're in the same school or adifferent school.
I would greatly appreciate it.
And I hope you have a great day.
Bye-bye.
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