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Overview of Findings from the 2010 National Intimate Partner and Sexual Violence Survey Amy Martinez Garcie, DNP, APRN, ACNP-BC, CPNP, CEN, SANE-A, CFN.

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Presentation on theme: "Overview of Findings from the 2010 National Intimate Partner and Sexual Violence Survey Amy Martinez Garcie, DNP, APRN, ACNP-BC, CPNP, CEN, SANE-A, CFN."— Presentation transcript:

1 Overview of Findings from the 2010 National Intimate Partner and Sexual Violence Survey Amy Martinez Garcie, DNP, APRN, ACNP-BC, CPNP, CEN, SANE-A, CFN

2 National Intimate Partner and Sexual Violence Survey CDC’s National Center for Injury Prevention and Control CDC’s National Center for Injury Prevention and Control National Institute of Justice National Institute of Justice Department of Defense Department of Defense

3 Objectives Describe Describe Prevalence and characteristics of sexual violence, stalking, and IPV Prevalence and characteristics of sexual violence, stalking, and IPV Who is most likely to experience these types of violence Who is most likely to experience these types of violence The patterns and impact of the violence experienced by specific perpetrators The patterns and impact of the violence experienced by specific perpetrators The health consequences of these forms of violence The health consequences of these forms of violence

4 National Intimate Partner and Sexual Violence Survey Ongoing Ongoing Nationally-representative telephone survey Nationally-representative telephone survey 16,507 adults 16,507 adults 9,086 women 9,086 women 7,421 men 7,421 men Sexual violence Sexual violence Stalking Stalking Intimate Partner Violence (IPV) Intimate Partner Violence (IPV) 2010-first year, baseline 2010-first year, baseline

5 Sexual Violence

6 1.3 million women raped during the year preceding the survey 1.3 million women raped during the year preceding the survey 1:5 (18.3%) women raped in their lifetime 1:5 (18.3%) women raped in their lifetime 1:71 (1.4%) men raped in their lifetime 1:71 (1.4%) men raped in their lifetime Completed forced penetration, attempted forced penetration, or alcohol/drug facilitated completed penetration Completed forced penetration, attempted forced penetration, or alcohol/drug facilitated completed penetration

7 Sexual Violence 51.1% of female victims raped by intimate partner 51.1% of female victims raped by intimate partner 40% by an acquaintance 40% by an acquaintance 52.4% of male victims raped by intimate partner 52.4% of male victims raped by intimate partner 15.1% by a stranger 15.1% by a stranger

8 Sexual Violence 1:21 (4.8%) men 1:21 (4.8%) men Made to penetrate someone else during their lifetime Made to penetrate someone else during their lifetime Perpetrator was either an intimate partner (44.8%) or an acquaintance (44.7%) Perpetrator was either an intimate partner (44.8%) or an acquaintance (44.7%)

9 Sexual Violence Sexual coercion (unwanted sexual penetration after being pressured in a nonphysical way) in their lifetime Sexual coercion (unwanted sexual penetration after being pressured in a nonphysical way) in their lifetime ~13% women ~13% women 6% men 6% men Unwanted sexual contact Unwanted sexual contact 27.2% women 27.2% women 11.7% men 11.7% men

10 Sexual Violence Most female victims of completed rape (79.6%) experienced first rape before 25 yo Most female victims of completed rape (79.6%) experienced first rape before 25 yo 42.2% experienced first completed rape before 18 yo 42.2% experienced first completed rape before 18 yo Almost half of these before age 18 Almost half of these before age 18 30% between % between % < 10 yo 12% < 10 yo

11 Sexual Violence 27.8% of male victims of completed rape experienced before 10 yo 27.8% of male victims of completed rape experienced before 10 yo

12 Stalking

13 Stalking 1:6 (16.2%) women stalking victimization 1:6 (16.2%) women stalking victimization 1:19 (5.2%) men stalking victimization 1:19 (5.2%) men stalking victimization Felt very fearful or believed that they or someone close to them would be harmed or killed Felt very fearful or believed that they or someone close to them would be harmed or killed

14 Stalking 66.2% female victims stalked by current or former intimate partner 66.2% female victims stalked by current or former intimate partner 41.4% men stalked by an intimate partner 41.4% men stalked by an intimate partner 40.0% men stalked by an acquaintance 40.0% men stalked by an acquaintance

15 Stalking 78.8% women 78.8% women 75.9% men 75.9% men Repeatedly receiving unwanted telephone calls, voice, or text messages Repeatedly receiving unwanted telephone calls, voice, or text messages

16 Stalking Stalked before age 25 Stalked before age 25 >1/2 female victims >1/2 female victims >1/3 male victims >1/3 male victims Stalked between ages of 11 and 17 Stalked between ages of 11 and 17 1:5 female victims 1:5 female victims 1:14 male victims 1:14 male victims

17 Intimate Partner Violence

18 Rape, physical violence, and/or stalking by intimate partner in their lifetime Rape, physical violence, and/or stalking by intimate partner in their lifetime >1:3 (35.6%) women >1:3 (35.6%) women >1:4 (28.5%) men >1:4 (28.5%) men

19 Intimate Partner Violence 1:3 women experience multiple forms of rape, stalking, or physical violence 1:3 women experience multiple forms of rape, stalking, or physical violence 92% men experienced physical violence alone 92% men experienced physical violence alone 6.3% men experienced physical violence and stalking 6.3% men experienced physical violence and stalking

20 Intimate Partner Violence 1:10 (9.4%) women in US raped by intimate partner in lifetime 1:10 (9.4%) women in US raped by intimate partner in lifetime Estimated 16.9% of women and 8.0% men experienced sexual violence other than rape by an intimate partner at some point in their lifetime Estimated 16.9% of women and 8.0% men experienced sexual violence other than rape by an intimate partner at some point in their lifetime

21 Intimate Partner Violence 1:4 (24.3%) women 1:4 (24.3%) women 1:7 (13.8%) men 1:7 (13.8%) men Severe physical violence by an intimate partner Severe physical violence by an intimate partner Hit with a fist or something hard Hit with a fist or something hard Beaten Beaten Slammed against something Slammed against something

22 Intimate Partner Violence 10.7% women 10.7% women 2.1% men 2.1% men Stalked by an intimate partner during their lifetime Stalked by an intimate partner during their lifetime

23 Intimate Partner Violence 48.4% women 48.4% women 48.8% men 48.8% men Experienced psychological aggression by an intimate partner in their lifetime Experienced psychological aggression by an intimate partner in their lifetime

24 Intimate Partner Violence 69% women 69% women 53% men 53% men Experienced some form of IPV for first time before 25 yrs of age Experienced some form of IPV for first time before 25 yrs of age

25 Impact of IPV 3:10 women 3:10 women 1:10 men 1:10 men Being fearful Being fearful Concerned for safety Concerned for safety Post traumatic stress disorder (PTSD) Post traumatic stress disorder (PTSD) Need for health care Need for health care Injury Injury Contacting a crisis hotline Contacting a crisis hotline Need for housing services Need for housing services Need for victim’s advocate services Need for victim’s advocate services Need for legal services Need for legal services Missed at least 1 day of work or school Missed at least 1 day of work or school

26 Data 12 Months Prior to Survey

27 ~1% (1.3 million) women reported being raped by any perpetrator in the 12 months prior to taking the survey ~1% (1.3 million) women reported being raped by any perpetrator in the 12 months prior to taking the survey 1:20 (5.6%) women (5.3%) men 1:20 (5.6%) women (5.3%) men Sexual violence victimization other than rape in 12 months prior to taking the survey Sexual violence victimization other than rape in 12 months prior to taking the survey

28 4% women 4% women 1.3% men 1.3% men Stalked in the 12 months prior to survey Stalked in the 12 months prior to survey

29 1:17 (5.9%) women 1:17 (5.9%) women 1:20 (5.0%) men 1:20 (5.0%) men Experienced rape, physical violence, and/or stalking by an intimate partner in the 12 months prior to taking survey Experienced rape, physical violence, and/or stalking by an intimate partner in the 12 months prior to taking survey

30 Health Consequences

31 Men and Women Frequent headaches Frequent headaches Chronic pain Chronic pain Difficulty with sleeping Difficulty with sleeping Activity limitations Activity limitations Poor physical health Poor physical health Poor mental health Poor mental health

32 Women Asthma Asthma Irritable bowel syndrome Irritable bowel syndrome Diabetes Diabetes

33 Lifetime Prevalence of Rape by Any Perpetrator, Women Lifetime Prevalence of Rape by Any Perpetrator, Women United States18.3% United States18.3% Louisiana15.9% (280,000) Louisiana15.9% (280,000)

34 Lifetime Prevalence of Sexual Violence Other Than Rape by Any Perpetrator, Women Lifetime Prevalence of Sexual Violence Other Than Rape by Any Perpetrator, Women United States44.6% United States44.6% Louisiana 28.9% (509,000) Louisiana 28.9% (509,000)

35 Lifetime Prevalence of Sexual Violence Other Than Rape By Any Perpetrator, Men Lifetime Prevalence of Sexual Violence Other Than Rape By Any Perpetrator, Men United States22.2% United States22.2% Louisiana32.4% (523,000) Louisiana32.4% (523,000)

36 Lifetime Prevalence Stalking Victimization By Any Perpetrator, Women Lifetime Prevalence Stalking Victimization By Any Perpetrator, Women United States16.2% United States16.2% Louisiana13.5% (237,000) Louisiana13.5% (237,000)

37 Lifetime Prevalence Stalking Victimization By Any Perpetrator, Men Lifetime Prevalence Stalking Victimization By Any Perpetrator, Men United States28.5% United States28.5% Louisiana28.4% (457,000) Louisiana28.4% (457,000)

38 Implications

39 Violence begins at early age Violence begins at early age Commonly leads to negative health consequences across the lifetime Commonly leads to negative health consequences across the lifetime

40 Prevention Efforts Start early Start early Promote healthy, respectful relationships in families Promote healthy, respectful relationships in families Address the beliefs, attitudes and messages that are deeply embedded in our social structures Address the beliefs, attitudes and messages that are deeply embedded in our social structures Norms change Norms change Changing policies Changing policies Enforcing existing policies against violence Enforcing existing policies against violence Promoting bystander approaches Promoting bystander approaches

41 For victims For victims Coordinated services to ensure healing and prevent recurrence of victimization Coordinated services to ensure healing and prevent recurrence of victimization Strengthen and better coordinate healthcare system’s response Strengthen and better coordinate healthcare system’s response Ensure that legal, housing, mental health, and other services and resources are available and accessible Ensure that legal, housing, mental health, and other services and resources are available and accessible

42 Hold perpetrators accountable Hold perpetrators accountable Consistently enforce laws Consistently enforce laws Enhance training efforts within the criminal justice system Enhance training efforts within the criminal justice system

43 Implement strong data systems for monitoring and evaluating to understand trends, provide information to base development and evaluation of prevention and intervention programs, and to monitor and measure effectiveness of efforts Implement strong data systems for monitoring and evaluating to understand trends, provide information to base development and evaluation of prevention and intervention programs, and to monitor and measure effectiveness of efforts

44 Establish cost-efficient and timely systems for all states by using consistent definitions and uniform survey methods Establish cost-efficient and timely systems for all states by using consistent definitions and uniform survey methods

45 Ongoing data collection and monitoring through NISVS and other data sources at the local, state, and national level will further drive research to develop and evaluate strategies of prevention and monitor effectiveness Ongoing data collection and monitoring through NISVS and other data sources at the local, state, and national level will further drive research to develop and evaluate strategies of prevention and monitor effectiveness

46 Forensic Nursing

47 Forensic aspects of healthcare combined with the bio/psycho/social/spiritual education of the registered nurse Forensic aspects of healthcare combined with the bio/psycho/social/spiritual education of the registered nurse Scientific investigation and treatment of trauma and/or death of victims and perpetrators of violence, criminal activity and traumatic accidents. Scientific investigation and treatment of trauma and/or death of victims and perpetrators of violence, criminal activity and traumatic accidents.

48 Forensic Nursing Provides direct services to individual clients Provides direct services to individual clients Consultation services to nursing, medical and law-related agencies Consultation services to nursing, medical and law-related agencies Providing expert court testimony in areas dealing with questioned death investigative processes, adequacy of services delivery and specialized diagnoses of specific conditions as related to nursing (Lynch, 1991). Providing expert court testimony in areas dealing with questioned death investigative processes, adequacy of services delivery and specialized diagnoses of specific conditions as related to nursing (Lynch, 1991).

49 Forensic Nursing 1990s 1990s Forensic Specialist in Nursing Forensic Specialist in Nursing Forensic—pertaining to the law Forensic—pertaining to the law Focuses on areas where medicine, nursing, and human behavior intersect with the law and entails both living and deceased patients Focuses on areas where medicine, nursing, and human behavior intersect with the law and entails both living and deceased patients

50 Forensic Nursing All victims of violence All victims of violence Patients in police custody Patients in police custody Sexual assault Sexual assault Drug and alcohol abuse Drug and alcohol abuse Child maltreatment Child maltreatment Domestic violence Domestic violence Elder abuse Elder abuse Survivors of attempted suicide Survivors of attempted suicide Automobile trauma Automobile trauma Workers’ compensation Workers’ compensation Medical malpractice Medical malpractice Food and drug tampering Food and drug tampering Environmental hazards Environmental hazards Illegal abortion Illegal abortion Occult-related injury/death Occult-related injury/death Cults or religion abuses Cults or religion abuses

51 Standards of Practice for Forensic Nurses Standard 1. Assessment Standard 1. Assessment Standard 2. Diagnosis Standard 2. Diagnosis Standard 3. Outcomes Identification Standard 3. Outcomes Identification Standard 4. Planning Standard 4. Planning

52 Standards of Practice for Forensic Nurses Standard 5. Implementation Standard 5. Implementation Standard 5A. Coordination of Care Standard 5A. Coordination of Care Standard 5B. Health Teaching and Health Promotion Standard 5B. Health Teaching and Health Promotion Standard 5C. Consultation Standard 5C. Consultation Standard 5D. Prescriptive Authority and Treatment Standard 5D. Prescriptive Authority and Treatment

53 Standards of Practice for Forensic Nurses Standard 6. Evaluation Standard 6. Evaluation Standard 7. Quality of Practice Standard 7. Quality of Practice Standard 8. Education Standard 8. Education Standard 9. Professional Practice Evaluation Standard 9. Professional Practice Evaluation Standard 10. Collegiality Standard 10. Collegiality Standard 11. Collaboration Standard 11. Collaboration

54 Standards of Practice for Forensic Nurses Standard 12. Ethics Standard 12. Ethics Standard 13. Research Standard 13. Research Standard 14. Resource Utilization Standard 14. Resource Utilization Standard 15. Leadership Standard 15. Leadership American Nurses Association and International Association of Forensic Nurses (2009). Forensic Nursing: Scope and Standards of Practice. Silver Spring, MD: Nursesbooks.org American Nurses Association and International Association of Forensic Nurses (2009). Forensic Nursing: Scope and Standards of Practice. Silver Spring, MD: Nursesbooks.org

55 Facts

56 FACTS An American is assaulted every 2 minutes An American is assaulted every 2 minutes About 44% of rape victims are under age 18; about 15% are under age 12 About 44% of rape victims are under age 18; about 15% are under age 12 1:6 American women has been the victim of an attempted or completed rape 1:6 American women has been the victim of an attempted or completed rape About 10% of sexual assault victims are male About 10% of sexual assault victims are male About 2/3 of sexual assaults are committed by someone who is known to the victim About 2/3 of sexual assaults are committed by someone who is known to the victim Less that 39% of sexual assaults are reported to law enforcement Less that 39% of sexual assaults are reported to law enforcement

57 Offenders

58 Offenders Average age is 31 Average age is 31 52% are Caucasian 52% are Caucasian 22% of imprisoned rapists report they were married 22% of imprisoned rapists report they were married Juveniles accounted for 16% of forcible rape arrests in 1995 Juveniles accounted for 16% of forcible rape arrests in 1995 In 1:3 assaults, the perpetrator was intoxicated—the majority with alcohol In 1:3 assaults, the perpetrator was intoxicated—the majority with alcohol

59 Offenders In 2001, 11% of rapes involved the use of a weapon In 2001, 11% of rapes involved the use of a weapon Rapists are more likely to be a serial criminal than a serial rapist with 46% rearrested for another crime within 3 years of release from prison Rapists are more likely to be a serial criminal than a serial rapist with 46% rearrested for another crime within 3 years of release from prison

60 Sexual Assault Nurse Examiners (SANE)

61 What is a SANE? RN who has advanced education and clinical prep in the comprehensive medical forensic care of patients reporting a history of sexual assault RN who has advanced education and clinical prep in the comprehensive medical forensic care of patients reporting a history of sexual assault Provides non-judgmental, unbiased care Provides non-judgmental, unbiased care Provides a comprehensive medical/forensic/holistic exam Provides a comprehensive medical/forensic/holistic exam

62 SANE Training 40 hrs lecture 40 hrs lecture ~100 hrs community clinical time ~100 hrs community clinical time Supervised practice until competent Supervised practice until competent Recommendations and training approved by IAFN Recommendations and training approved by IAFN Published recommendations for training through Department of Justice Published recommendations for training through Department of Justice

63 Lecture Component Collaboration with related community agencies Collaboration with related community agencies Forensic history Forensic history Medical/forensic assessment and examination Medical/forensic assessment and examination Collection and chain of custody Collection and chain of custody Forensic photography Forensic photography Testing and treatment for STIs Testing and treatment for STIs

64 Lecture Component Evaluation and prevention of pregnancy Evaluation and prevention of pregnancy Chain of evidence Chain of evidence Judicial proceedings and expert witness testimony Judicial proceedings and expert witness testimony

65 SANE-A Certification IAFN established in 2002 IAFN established in 2002 RN with minimum of 2 years in practice RN with minimum of 2 years in practice Successful completion of adult/adolescent program Successful completion of adult/adolescent program Validated, supervised clinical practice Validated, supervised clinical practice

66 Pediatric SANE Training Pre-pubescent genital anatomy using the correct terminology. Pre-pubescent genital anatomy using the correct terminology. Child abuse advocacy center (CAC) and its purpose Child abuse advocacy center (CAC) and its purpose Specific growth and development for the prepubescent child. Specific growth and development for the prepubescent child. Open ended questions used in interviewing children Open ended questions used in interviewing children Roles and scope of work of the Child Protection Worker, Forensic Interviewer, District Attorney and Law Enforcement in the multidisciplinary team in dealing with child sexual assault. Roles and scope of work of the Child Protection Worker, Forensic Interviewer, District Attorney and Law Enforcement in the multidisciplinary team in dealing with child sexual assault.

67 SANE-P Certification IAFN established in 2007 IAFN established in 2007 RN with minimum of 2 years in practice RN with minimum of 2 years in practice Successful completion of pediatric program Successful completion of pediatric program Validated, supervised clinical practice Validated, supervised clinical practice Valid for 3 years Valid for 3 years

68 State of Louisiana Defines rape as an act of anal, oral, or vaginal intercourse with a male or female person committed without the person’s lawful consent Defines rape as an act of anal, oral, or vaginal intercourse with a male or female person committed without the person’s lawful consent Emission is not necessary and any sexual penetration, vaginal or anal, however slight, is sufficient to commit the crime Emission is not necessary and any sexual penetration, vaginal or anal, however slight, is sufficient to commit the crime

69 State of Louisiana Defines sexual assault as the unwanted contact and includes a wide range of victimizations, distinct from rape or attempted rape Defines sexual assault as the unwanted contact and includes a wide range of victimizations, distinct from rape or attempted rape Includes completed or attempted attacks generally involving unwanted sexual contact between the victim and offender Includes completed or attempted attacks generally involving unwanted sexual contact between the victim and offender

70 The Forensic Examination Collects evidence to aid in the prosecution of a crime Collects evidence to aid in the prosecution of a crime The body and clothing of a sexual assault victim are considered a “crime scene” in cases of sexual assault The body and clothing of a sexual assault victim are considered a “crime scene” in cases of sexual assault Should not be emotionally or physically traumatic Should not be emotionally or physically traumatic

71 The Forensic Examination Will not confirm or deny an allegation of sexual assault Will not confirm or deny an allegation of sexual assault Assists investigators in a determination of an allegation Assists investigators in a determination of an allegation Corroborates the victim’s story Corroborates the victim’s story

72 When to Obtain If the sexual assault occurred within 120 hours If the sexual assault occurred within 120 hours Beyond 120 hours if the victim reports Beyond 120 hours if the victim reports Pain or bleeding Pain or bleeding An unusual amount of force and injuries An unusual amount of force and injuries Ejaculation with clean-up Ejaculation with clean-up Vaginal ejaculation without condom Vaginal ejaculation without condom Child with vaginal/anal penetration Child with vaginal/anal penetration

73 Informed Consent Patient should be presented with relevant information regarding the forensic exam Patient should be presented with relevant information regarding the forensic exam Complete information allows the patient to make an informed decision regarding his/her desire to accept or decline the forensic examination Complete information allows the patient to make an informed decision regarding his/her desire to accept or decline the forensic examination

74 Informed Consent Patient may accept or decline any part of the medical evaluation and treatment and the forensic exam and evidence collection Patient may accept or decline any part of the medical evaluation and treatment and the forensic exam and evidence collection If a patient declines all or part of the exam, they must be made aware of the impact of declining a particular procedure in the criminal investigation If a patient declines all or part of the exam, they must be made aware of the impact of declining a particular procedure in the criminal investigation

75 Informed Consent Patients who are minors (under the age of 17), unconscious, intoxicated, or under the influence of drugs, are not able to give informed consent Patients who are minors (under the age of 17), unconscious, intoxicated, or under the influence of drugs, are not able to give informed consent If age 16 or younger, sexual assault is reportable to police and OCS If age 16 or younger, sexual assault is reportable to police and OCS ABOVE ALL: An exam should NEVER be done against the will of the patient! ABOVE ALL: An exam should NEVER be done against the will of the patient!

76 History of the Sexual Assault Complete history is critical to direct the SANE in the collection of forensic evidence Complete history is critical to direct the SANE in the collection of forensic evidence Specimens are collected only from the orifices or sites that the victim indicates were involved in the assault Specimens are collected only from the orifices or sites that the victim indicates were involved in the assault Exception: DFSA Exception: DFSA

77 Forensic History Coordinate with other responders Coordinate with other responders Allow for a quiet and private setting Allow for a quiet and private setting Advocacy should be allowed to remain with the patient for support during the history Advocacy should be allowed to remain with the patient for support during the history

78 Forensic History History should include: History should include: Date and time of assault Date and time of assault Pertinent medical history Pertinent medical history Recent consensual sexual activity Recent consensual sexual activity Post-assault activities Post-assault activities Assault related history Assault related history Suspect information Suspect information Nature of the physical assault Nature of the physical assault

79 Assessment of STI Risk Date and time of assault Date and time of assault Interval between assault and medical eval Interval between assault and medical eval Number of assailants Number of assailants If known, his/her HIV status If known, his/her HIV status Assailant’s history of STI and risk behaviors Assailant’s history of STI and risk behaviors Type of sexual content Type of sexual content

80 Assessment of STI Risk History of consensual sexual intercourse History of consensual sexual intercourse LMP and pregnancy status LMP and pregnancy status Use of contraception Use of contraception History of bathing, urinating, defecating, douching, changing clothes, or brushing teeth History of bathing, urinating, defecating, douching, changing clothes, or brushing teeth Victim history of STI Victim history of STI

81 Assessment of STI Risk History of previous sexual assault History of previous sexual assault Any symptoms Any symptoms History of prior or chronic medical conditions History of prior or chronic medical conditions Medication allergy Medication allergy

82 Sexually Transmitted Infections If <72 hrs, not time to incubate and be detected If <72 hrs, not time to incubate and be detected If Chlamydia trachomatis present in assailant’s semen, may be detected immediately after the assault If Chlamydia trachomatis present in assailant’s semen, may be detected immediately after the assault Before the assault or after? Before the assault or after? May carry important legal or emotional ramifications May carry important legal or emotional ramifications

83 STIs STI Confirmed Sexual Abuse Suggested Action GonorrheaDiagnosticReport SyphilisDiagnosticReport HIVDiagnosticReport ChlamydiaDiagnosticReport Trichomonas Highly Suspicious Report Condyloma accuminata SuspiciousReport HerpesSuspiciousReport Bacterial vaginosis Inconclusive Medical Follow-up

84 Factors predicting risk of acquiring STI Penile penetration Penile penetration Ejaculation Ejaculation Type of sexual assault Type of sexual assault Number of assailants Number of assailants Victim’s susceptibility to infection Victim’s susceptibility to infection Size of the inoculum for a given pathogen Size of the inoculum for a given pathogen Organism’s infectivity Organism’s infectivity

85 Others Chancroid Chancroid Mucupurulent cervicitis Mucupurulent cervicitis PID PID Proctitis and proctocolitis Proctitis and proctocolitis Pubic lice Pubic lice Scabies Scabies Viral Hepatitis Viral Hepatitis

86 Pregnancy 5% will become pregnant 5% will become pregnant Offer to all Offer to all Most effective when taken within 72 hrs Most effective when taken within 72 hrs Most common side effects Most common side effects Nausea/vomiting Nausea/vomiting Delayed return of menses Delayed return of menses Fatigue Fatigue Headaches Headaches Breast tenderness Breast tenderness Abdominal pain Abdominal pain

87 Prophylactic Treatment Rocephin 250 mg IM Rocephin 250 mg IM (Gonococcal Infections) (Gonococcal Infections) Zithromax 1 gm po Zithromax 1 gm po (Chlamydial Infections) (Chlamydial Infections) Flagyl 2 gm po Flagyl 2 gm po (Trichomoniasis) (Trichomoniasis) Plan B/Ella Plan B/Ella

88 Follow-up Td Td Hep B Hep B HIV HIV Baseline testing within 1 week Baseline testing within 1 week 1 month 1 month RPR, Gonorrhea, Chlamydia RPR, Gonorrhea, Chlamydia 3 months 3 months 6 months 6 months 1 year 1 year

89 Medical Exam Overriding priority must always be the health and welfare of the patient Overriding priority must always be the health and welfare of the patient Medical/forensic services of the SANE are of secondary importance Medical/forensic services of the SANE are of secondary importance

90 Blind Reporting Timely collection of forensic evidence is imperative to hold the perpetrator accountable for the sexual assault Timely collection of forensic evidence is imperative to hold the perpetrator accountable for the sexual assault Every effort should be made to facilitate treatment and evidence collection in a timely manner Every effort should be made to facilitate treatment and evidence collection in a timely manner Patients not ready to report a sexual assault to law enforcement may have a forensic examination completed as a “blind report” Patients not ready to report a sexual assault to law enforcement may have a forensic examination completed as a “blind report”

91 Confidentiality Medical record of the patient is confidential; protected by HIPAA Medical record of the patient is confidential; protected by HIPAA Information disclosed in the forensic record is discoverable by the defense and should the case go to court, part of the medical record Information disclosed in the forensic record is discoverable by the defense and should the case go to court, part of the medical record

92 Questions?

93 Websites ndex.html ndex.html ndex.html ndex.html

94 References American Nurses Association and International Association of Forensic Nurses (2009). Forensic Nursing: Scope and Standards of Practice. Silver Spring, MD: Nursesbooks.org American Nurses Association and International Association of Forensic Nurses (2009). Forensic Nursing: Scope and Standards of Practice. Silver Spring, MD: Nursesbooks.org Hammer, R.M., Moynehan, B., Pagliaro, E.M. (2006). Forensic nursing. A handbook for practice. Jones & Bartlett Publishers: Sudbury, MA. Hammer, R.M., Moynehan, B., Pagliaro, E.M. (2006). Forensic nursing. A handbook for practice. Jones & Bartlett Publishers: Sudbury, MA. Giaradin, B.W., Faugno, D.K., Seneski, P.C., Slaughter, L., & Whelan, M. (1997). Color atlas of sexual assault. Mosby: St. Louis, MO. Giaradin, B.W., Faugno, D.K., Seneski, P.C., Slaughter, L., & Whelan, M. (1997). Color atlas of sexual assault. Mosby: St. Louis, MO. Giardino, A.P., Datner, E.M., Asher, J.B., Girardin, B.W., Faugno, D.K., & Spencer, M.J. (2003). Quick reference sexual assault. G.W. Medical Publishing, Inc.: St. Louis, MO. Giardino, A.P., Datner, E.M., Asher, J.B., Girardin, B.W., Faugno, D.K., & Spencer, M.J. (2003). Quick reference sexual assault. G.W. Medical Publishing, Inc.: St. Louis, MO. Lynch, V. (2006). Forensic nursing. Elsevier Mosby: St. Louis, MO. Lynch, V. (2006). Forensic nursing. Elsevier Mosby: St. Louis, MO. National Intimate Partner and Sexual Violence Survey Summary Report. (2010). National Center for Injury Prevention and Control. Division of Violence Prevention. National Intimate Partner and Sexual Violence Survey Summary Report. (2010). National Center for Injury Prevention and Control. Division of Violence Prevention.

95 Amy Martinez Garcie


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