1. NOTE: To change the image on this slide, select the picture and delete it. Then click the Pictures icon in the placeholder to insert your own image. CH. 28 CHILD, OLDER ADULT, AND INTIMATE PARTNER VIOLENCE Natalie Starkey, BSN, RN, CA/CP SANE

2. Types of Abuse  Family Violence  Physical Abuse  Sexual Abuse  Emotional Abuse  Neglect  Economic Abuse Retrieved from: thewomenscenterinc.org

3. Statistics  Child Abuse  3.3 million referrals annually  Neglect 78%  Physical 17%  Sexual 9%  Emotional 8%  Intimate Partner Abuse  1 in 3 women  1 in 4 men  Elder Abuse  2 million referrals annually Retrieved from calvcp.blogspot.com(Varcarolis, E., 2010)

4. State Laws  Elder/Disabled Person Abuse  Texas Department of Human Resources  Code 48.052  >65 years of age-Report Abuse, Neglect, and Exploitation “cause to believe”  Child Abuse  Texas Family Code 261.101  Persons required to report-licensed by the state  “cause to believe”  Institutional Responsibility to report: a professional may not delegate to or rely on another person to report  Report within 48 hours  Local or State Law Enforcement, Department, State Agency  Failure to Report: Class A Misdemeanor Retrieved from giveasyouget.com

5. Who is at Risk?  Women  Pregnancy  Leave the relationship  Children  <3 years of age  Handicaps  Adolescents  Older Adults  Mental/Physical Health Retrieved from: seniorhealthpolicy.blogpost.com Retrieved from motherhoodthetruth.com Retrieved from kamilagoria.com (Varcarolis, E., 2010)

6. Cycle of Violence Retrieved from voicesempowered.org

7. Long Term Effects  Box28-1 p. 533  Depression  Suicidal Feelings  Self-Contempt  Inability to Trust  Poor Self-Esteem  PTSD  Somatic Complaints  Abuse Retrieved from medical express.com (Varcarolis, E., 2010)

8. Presenting problems of Victims of Abuse  Physical  Injuries that don’t add up  Poor hygiene/clothing  Malnutrition/Failure to Thrive  Unattended medical/physical needs  Behavioral  Sleep disturbances  Regressive behaviors  Anxiety/Fearfulness/Suicidal  Withdrawal  Extreme dependence  Pediatric Specific Indicators  Hematomas/Lacerations  Pain/Irritation/Injury /Discharge to genital area  Running away  Hostile/Disruptive Behavior  Sexual promiscuity  Withdrawal Retrieved from floliblog.wordpress.com (Varcarolis, E., 2010)

9. Nursing Role

10. Chapter 28 Review  Types of abuse  Box 28-1 p. 533  Box 28-1 p. 534  Cycle of Violence  Vulnerable Populations  Table 28-2 p. 539  Table 28-3 p. 541  Table 28-4 p. 542  Role of Nurse  Prevention of Abuse

11. CH. 29 SEXUAL ASSAULT Natalie Starkey BSN, RN, CA/CP SANE Retrieved from studentlife.umich.edu

12. Sexual Assault Statistics Every 2 minutes someone is sexually assaulted 1 in 6 women and 1 in 33 men are sexually assaulted in their lifetime 60% of sexual assault are not reported to the police Approximately 70% of rape victims know their assailant Only 6% of rapist will ever spend a day in jail Retrieved from rainn.org (www.rainn.org)

13. What is Sexual Assault?  Sexual assault generally meets three criteria  1. Vaginal, anal, or oral penetration by a penis, object, or body part  2. Lack of consent  Can be verbal and/or physical signs  Incapacitation by age, disability, or drug/alcohol intoxication  3. Threat or actual use of force or manipulation  Most common recognized forms of Sexual Abuse  Genital fondling  Oral-genital  Genital-genital  Anal-genital (Giardino, A, (n.d.))

14. Different Types of Rape  Confidence Rape  Stress Sex  Date Rape  Marital Rape  Stranger Rape  Drug Facilitated Rape  Human Sex Trafficking  Genital Female Mutilation Retrieved from pinterest.com

15. State Laws  Texas Family Code 261.101  Texas Penal Code 22.011  Lack of Consent  Romeo and Juliet Clause  Karnes vs State  Penetration  Senate Bill 1191  Texas BON  Emergency Room Nurses must obtain 2 hours of forensic evidence collection CEU  Non-Reporting  Garland Crime Lab  Billing  Texas OAG  Crime Victims Application Retrieved from safevic.org

16. Pediatric Sexual Abuse  Sexually abused children do not have set profiles  Delayed Outcry  Diagnosis of sexual abuse usually relies solely on the history given by the child  Warning Signs  Most consistent indicator: age inappropriate sexual language and behavior  Physical  Behavior  Psychiatric Retrieved from miera31.blogspot.com (Giardino, A, (n.d.))

17. Adolescent/Adult Sexual Assault There is not a typical sexual assault victim Do not stereotype Immediate Reactions after Sexual Assault No normal or abnormal response Most Do not seek immediate attention Fear of Death is the most intense fear after an assault Immediate Reactions may be: Shock Disbelief Self-blame Anger Outward Behaviors: Crying Sobbing Quiet Anxious Grief Retrieved from philipaverbuck.com Retrieved from legalfundsnow.com (Giardino, A, (n.d.))

18. Rape Trauma Syndrome  Behavioral/Somatic/Psychological  Disorganization Phase (Acute)  Reorganization Phase  Delayed Reactions  PTSD  Depression  Suicidal Ideations  Substance Abuse  Physical Complaints  Abdominal pain, pelvic pain, headaches Retrieved from blogs.psychcentral.com (Giardino, A., (n.d.))

19. What is a SANE A Sexual Assault Nurse Examiner is a nurse who has specifically been trained to:  Provide comprehensive care to sexual assault survivors  Conduct medical/forensic exams for evidence collection  Show compassion and sensitivity to survivors of sexual assault  Provide effective courtroom testimony Retrieved from orsane.orgeonsatf.org www.texasattorneygeneral.gov

20. SANE Training Didactic training consists of: Adult, adolescent, and pediatric population of sexual assault Advocacy, survivor symptomology, documentation, history taking skills, collection of forensic evidence, use of sexual assault kit, and courtroom testimony 80 hours Clinical Training consists of: Well-woman exams, well-child exams, sexual assault exams with collection kit on adults, adolescents, and children, courtroom observation Typically takes up to one year Retrieved from orsane.orgeonsatf.org (www.texasattorneygeneral.gov)

21. Acute Exams  Acute Exams-Sexual assault that has occurred within 96 hours or child without a timeframe of the assault  Hospital Setting  Patient is triaged and has a medical screening exam performed by a physician, SANE exam ordered, Advocate called  History  Head to Toe Assessment  Collection of Evidence  Detailed Anogenital exam  Photo documentation  Nursing Diagnosis  Treatment

22. Non-Acute Exams  Non-Acute Exams-Sexual assault that has occurred >96 hours in pediatric and adolescent population  Non-acute setting  Patient is seen be SANE, Advocate available  History  Head to Toe Assessment  Detailed Anogenital exam  Nursing Diagnosis  Treatment Retrieved from childrensadvocacycenterofeasttexas.org

23. Why is there not injury?  Children have an immature anatomic concept of vaginal penetration  Use of lubricants  History of pain does not always correlate with injury  Nonspecific findings have multiple other causes  Most incidents don’t involve use of force and do not cause injury  Genital and anal tissue have elasticity-may stretch rather than tear  Small injuries heal quickly and completely (Kaufhold, M, n.d) Retrieved from medilor.b.com

24. Forensic Nursing-Sexual Assault Nurse Examiner Caption

25. Chapter 29 Review  Define Sexual Assault  Table 29-1 p. 554  Role of SANE  Signs/Symptoms Sexual Abuse/Assault  Table 29-2 p. 558  Rape Trauma Syndrome

26. References  Child Welfare Information Gateway. (2014). Mandatory reporters of child abuse and neglect. Washington, DC: U.S. Department of Health and Human Services, Children’s Bureau. Retrieved from https://www.childwelfare.gov/pub PDFs/manda.pdf #page =1&view=Introductionhttps://www.childwelfare.gov/pub PDFs/manda.pdf  Giardino, A., et al. (n.d.). Sexual assault quick reference guide for healthcare, social service, and law enforcement professionals. St. Louis, Mo: STM Learning, INC.  Kaufhold, M. (n.d.). Genital findings in acute and nonacute exams of prepubertal children. Retrieved from http://c.ymcdn.com/sites/www.is pcan.org/resource /resmgr/training_materials/4-prepubertal_findings.pdfhttp://c.ymcdn.com/sites/www.is pcan.org/resource /resmgr/training_materials/4-prepubertal_findings.pdf  Sexual assault nurse examiner (SANE): frequently asked questions. (n.d.) Retrieved from https://www.texasattorneygeneral.gov/victims/sane.shtml  Varcarolis, E. M., Halter, M. J., & Varcarolis, E. M. (2010). Foundations of psychiatric mental health nursing: A clinical approach. St. Louis, Mo: Saunders/Elsevier.