Violence:Impact on Nursing

Robert T. RossoRobert T. Rosso

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Healthy People 2010Healthy People 2010

Healthy People 2010 lists 28 Focus Areas.Healthy People 2010 lists 28 Focus Areas.

Injury and Violence Prevention is listed.Injury and Violence Prevention is listed.

Healthy People 2010 lists 10 Leading Healthy People 2010 lists 10 Leading Health Indicators.Health Indicators.

Injury and Violence is listed.Injury and Violence is listed.

Types of ViolenceTypes of Violence

Firearm Firearm Domestic Domestic

Workplace ChildWorkplace Child

Firearm ViolenceFirearm ViolenceEvery 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.

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.

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?

Levels of Prevention

Primary PreventionPrimary Prevention::

Education on stress coping techniques

Attention to personality development

Secondary PreventionSecondary Prevention::

Arresting injury process and preventing death

Tertiary PreventionTertiary Prevention::

Restoration and rehabilitation of body after wound is stabilized/healing

Firearm ViolenceFirearm Violence

Intimate Partner ViolenceIntimate Partner ViolenceOf persons first injured by domestic violence, 75% Of persons first injured by domestic violence, 75% continue to experience abuse.continue to experience abuse.

Half of battered women who attempt suicide try Half of battered women who attempt suicide try again.again.

Eighty-nine percent of victims reported previous Eighty-nine percent of victims reported previous assaults by their current assailants, with 35% assaults by their current assailants, with 35% experiencing violence on a daily basis.experiencing violence on a daily basis.

The ultimate result of domestic violence may be The ultimate result of domestic violence may be death from suicide or homicide.death from suicide or homicide.

Intimate Partner ViolenceIntimate Partner ViolenceWomen in abusive relationships have Women in abusive relationships have similar patterns of thought about their similar patterns of thought about their

situations. situations.

A group of nurses researched women A group of nurses researched women who were in, or who had left abusive who were in, or who had left abusive

relationships.relationships.

Their findings bring to light the similar Their findings bring to light the similar feelings of abused women.feelings of abused women.

Intimate Partner ViolenceIntimate Partner ViolenceThe nurses researching the women in the study found The nurses researching the women in the study found similar attitudes in 4 areas:similar attitudes in 4 areas:

Living an Unnatural Life, The Experience of Telling, The Living an Unnatural Life, The Experience of Telling, The Leaving Experience, and Reducing BarriersLeaving Experience, and Reducing Barriers

Nurses can educate themselves on how hard it is to Nurses can educate themselves on how hard it is to understand the plight of these women, how difficult it understand the plight of these women, how difficult it can be to tell others and ask for help, and how they are can be to tell others and ask for help, and how they are treated by uncaring medical professionals.treated by uncaring medical professionals.

Understanding and a willingness to help these victims Understanding and a willingness to help these victims can be the difference!!! can be the difference!!!

We Must Treat The We Must Treat The CausesCauses, Not Just The , Not Just The Injuries!!Injuries!!

Intimate Partner ViolenceIntimate Partner Violence

Levels of Prevention

Primary PreventionPrimary Prevention::

Education on stress coping techniques

Marriage/Partner Counseling

Secondary PreventionSecondary Prevention::

Arresting injury process and preventing death

Tertiary PreventionTertiary Prevention::

Use of sheltered colony – leaving abusive situation

Workplace ViolenceWorkplace Violence

Workplace violence -- including assaults Workplace violence -- including assaults and suicides -- accounted for 16% of all and suicides -- accounted for 16% of all work-related fatal occupational injuries work-related fatal occupational injuries

in 2003. in 2003.

Homicides are perennially among the top Homicides are perennially among the top three causes of workplace fatalities for three causes of workplace fatalities for

all workersall workers.

Workplace ViolenceWorkplace Violence

Understanding Predispositions and Understanding Predispositions and Additional Factors Leading toAdditional Factors Leading to

Workplace Violence:Workplace Violence:

Predispositions:Predispositions: Additional Factors:Additional Factors:Poor Interpersonal SkillsPoor Interpersonal Skills Lack of Privacy Lack of PrivacyPoor Employment HistoryPoor Employment History Loss of Control Loss of ControlWithdrawn/LonerWithdrawn/Loner Loss of Dignity Loss of DignityProblems with AuthorityProblems with Authority Loss of Identity Loss of IdentityShunned by CoworkersShunned by Coworkers Loss of Independence Loss of IndependenceViews World as HostileViews World as Hostile Frustration with System Frustration with System

Levels of Prevention

Primary PreventionPrimary Prevention::

Education on stress coping techniques

Provision of agreeable working conditions

Secondary PreventionSecondary Prevention::

Arresting injury process and preventing death

Tertiary PreventionTertiary Prevention::

Selective placement – may involve changing jobs

Workplace ViolenceWorkplace Violence

Maltreatment of Children

According to the HHS study, the number of total According to the HHS study, the number of total child maltreatment instances that were child maltreatment instances that were

investigated by state agencies remained investigated by state agencies remained constant from 1986 to 1993; however, the constant from 1986 to 1993; however, the percentage of cases investigated declined percentage of cases investigated declined

dramatically.dramatically.

An estimated 1,500 children were confirmed to An estimated 1,500 children were confirmed to have died from maltreatment; 36% of these have died from maltreatment; 36% of these

deaths were from neglect, 28% from physical deaths were from neglect, 28% from physical abuse, and 29% from multiple maltreatment abuse, and 29% from multiple maltreatment

types. types.

Maltreatment of Children

What can nurses do to help??What can nurses do to help??

One research study indicated that 40% of One research study indicated that 40% of medical staff have never cared for an medical staff have never cared for an

abused child, yet 60% assumed they could abused child, yet 60% assumed they could identify one.identify one.

Educating our nursing staff on the signs of an Educating our nursing staff on the signs of an abused child can stop the pattern of abused child can stop the pattern of

maltreatment.maltreatment.

Maltreatment of ChildrenLevels of Prevention

Primary PreventionPrimary Prevention::

Education on stress coping techniques

Agression Counseling

Secondary PreventionSecondary Prevention::

Arresting injury process and preventing death

Tertiary PreventionTertiary Prevention::

Selective Placement – Child Protective Services

ConfidentialityConfidentiality

Tarasoff v. RegentsTarasoff v. Regents

of University of California, 1976of University of California, 1976

Case to explain high risk and breach of Case to explain high risk and breach of confidentiality.confidentiality.

When is it ethical to break confidentiality?When is it ethical to break confidentiality?

According to the court, once a According to the court, once a therapist determines, or under therapist determines, or under

professional standards should have professional standards should have determined, "that a patient poses a determined, "that a patient poses a

serious danger of violence to others, serious danger of violence to others, he bears a duty to exercise reasonable he bears a duty to exercise reasonable care to protect the foreseeable victim care to protect the foreseeable victim

of that danger.”of that danger.”

ConfidentialityConfidentiality

What can a nurse do to break the cycle What can a nurse do to break the cycle of violence without breaking of violence without breaking

confidentiality??confidentiality??

Patients need to believe that their care Patients need to believe that their care givers will not break their trust.givers will not break their trust.

We must protect our ethical practice, We must protect our ethical practice, but but alsoalso protect the patient. protect the patient.

ConfidentialityConfidentiality

EducationEducation

Abused persons do not readily seek Abused persons do not readily seek out assistance for their problems.out assistance for their problems.

Healthcare workers need to be awareHealthcare workers need to be aware

of possible signs of abuse and be non-of possible signs of abuse and be non-judgmental in offering assistance and judgmental in offering assistance and

options for the victim.options for the victim.

ReferencesCenter 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/workplaceviolence.pdf

Goods for Guns of Alleghany County, Inc (n.d.) National Gun Violence Statistics. Retrieved July 15, 2006, from http://goodsforguns.org/nationalfacts/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), 551–557.

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

VirtualPsycheCentre.com (n.d.) Retrieved July 15, 2006, from http://www.virtualpsychcentre.com/diseases.asp?did=478

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