1
Q
assault
A
an attempt to attack a person by a show of physical force or the act proves that an assault is imminent
drawing blood without consent is assault
2
Q
misdemeanor
A
arguement without injury
assault with injury that requires some medical attention
assault with a deadly weapon (but without a serious injury)
domestic violence
sexual battery
3
Q
felony
A
assault that requires “serious” medical attention or by strangulation
assault with a weapon with injury the require medical attention
sexual assault
domestic violence with the above categories
4
Q
restraints
A
1987 OBRA designed to reduce dependence on restraints
JCAHO and CMS are very strict on limiting the use of restraints
are dehumanizing and ethically “muddy”
are considered a form of elder abuse
have regulatory, civil, and even criminal implications
document, document, document
5
Q
when to report assault
A
gun shot injury (federal and state law)
assault on someone under 18
assault on someone 65 or older
murder
invovle
-BB gun
-blackjacts
-air rifle/pistol
-metal knuckle
-bowie knife
-dirk/switchblade
-dagger
-slingshot
-leaded cane
-razor blade
-fireworks
-any sharp pointed instrument
6
Q
priorities during assault
A
treat life threatening injuries
provide safety
follow policy for reporting
notify law enforcement (if patient consent)
7
Q
short term affects of assault
A
scrapes
bruises
cuts
emotions (in the moment)
8
Q
moderate affects of assault
A
fractures
sutures
hospitalization
mental health impacted (sleep)
relationship impacted
9
Q
life long impact on assault
A
prolonged medical stay
severe disability
PTSD
occupational change
relocation
lost of relationship
10
Q
violence
A
intentional use of physical force or power, threatened, or actual against oneself, another person, or a group or community that either results in or has a likelihood of resulting in injury, death, psychological harm, maldevelopment, or deprivation
11
Q
What is interpersonal violence?
A
a violent act occurs between persons
-family/partner
-community
12
Q
two types of violence
A
patriarchal terrorism: domination and control
situational violence: response to conflict
13
Q
types of interpersonal violence (IPV)
A
abuse and neglect
-chld abuse and neglect
-elder abuse and neglect
youth violence
bullying
sexual violence
14
Q
population at greatest risk for IPV
A
infants and children
older adults
gender and identity
15
Q
individual risk factors
A
substance use disorder
mental health condition
neurobiology and genetics
exposure to violence in childhood
sociocultural factors
16
Q
S/S of person at risk for IPV
A
story is inconsistent injuries
afraid to provide events
may not be able to recollect events
17
Q
common comorbidity conditions and injuries
A
TBI>1 y/o
Shaken baby syndrome
learning disabilities, blindness, seizures,
paralysis
Abdominal injuries may include internal
bleeding
burn from scalding water
burns with a stocking or circular pattern
18
Q
interprofessional team
A
provider(s)
nurse
social worker
psychologist or counselor
chaplain
19
Q
intervention
A
treat underlying injury or injuries
report suspected IPV
refer victim to a safe house
provide emotional support
collaborative practice referrals
decrease stigma
20
Q
de-escalation
A
method to prevent potential violence
-purposeful action
-verbal communications
-body language
maintan safe distance
avoid being alone with an individual who is
combative or potentially violent
know limitation and seek additonal help
move yourself to a safe location
21
Q
verbal de-escalation
A
using potentially dangerous or threatening situations in an attempt to prevent a person from causing harm to us, themselves, or others
tactics to help limit the number of staff who might be injured on the job
never use physical force unless trained
22
Q
physical force
A
use as a last resort
results in some (you) getting hurt
23
Q
verbal de-escalation tatics
A
listening
distracting person
re-focusing person on something esle
changing subject
use humor (sparingly)
motivating the other person
empathizing with person
giving choices
setting limits
24
Q
listening technique
A
attending: giving your physical (mental) attention to another person
following: making sure you are engaged by using eye contact (nodding, saying okay, or asking an infrequent question)
reflecting: paraphrasing and reflecting, using the feeling of the other person (empathy)
25
rape
penetration, no matter how slight, of the vagina or anus with any body part or object, or oral penetration by a sex organ of another person, without the consent of the victim
26
types of rape
marital rape
-illegal in all 50 states
aquaintance rape
-date rape
-club drug/alcohol
stranger
27
cause of sexual assault
100% perpetrator
28
factors involving rape
can include physically violent elements
know their attacker
planned and not spontaneous
psychological element
-this is your fault
-berating names
-threatened with harm to a loved one if
reported
29
culture most likely to be raped
american indians
30
risk factors for rape
-females
-being under influence
-being under 20 as a female
-being at or near home, a realtive or
friend's home
-homeless or diabled
-males age 18-24 who are college student
31
factors for rapist
use of drug or alcohol
emotions such as anger/revenge or sense of entitlement
self-delusions
32
risk factors for perpetration of sexual violence
-acceptance of violence
-early sexual initiation
-prior sexual victimization
-childhood history of abuse
-poverty
-lackof employment
-general tolerance of sexual violence in
the community
-higher crime areas
33
sign of sexual activity in children
STI
sexual vocabulary
withdrawn/deperssed
poor self-esteem/hygiene
bed-wetting after being potty trained
do not interview child
assess life threatening injuries and treat
provide comfort and safety
34
rape-trauma syndrome
relates to PTSD but is more specifice to sexual assault
describes trauma including disruption to normal physical, emotional, and cognitive and interpersonal behaviors
patient's resonse to this act of violence
35
immediate response of rape victim
shock, denial, and/or disbelief
fear and/or anger
guild and/or embrassment
helplessness and/or loss of control
confusion, anxiety, and or nervousness
36
symptoms of RTS
-re-experiencing the trauma: nightmares,
flashbacks, or inability to stop
remembering the rape
-social withdrawal: "psychic numbing"; not
expering feeling of any kind
-avoidance behavior: desire to avoid any feelings or thought that might recall the mind events about the rape
-increased physiological arousal characteristics: exaggerated startle response, hypervigilance, sleep disorder, or difficulty concentrating
37
acute stage of RTS
begins days or weeks after a sexual assault and generally last a few day to a few weeks
72 hours after assault
38
outward adjustment stage
begins when acute stage ends
can last for few months and several years if not interrupted
serious inner turmoil
39
underground stage
work to return to their more "normal" lives.
may last for years
pretend nothing happened
blocking thoughts of assault out
40
reorganzation stage
external trigger returns suvivor to previous stages
41
renormalization stage
sexual assault is no longer the central focus
feeling of guilt and shame resolved
end stage
42
43
nursing diagnosis
risk for infection
RTS
fear
acute panic
powerlessness
ineffective coping
situational low self-esteem
risk for self harm
44
planning
it is critical for the victim to have control over the planning process
-help prevent patient perception of revictimization
45
implementation
provide comfort
treat physical inuries/facilitate evidence
empower the patient
46
evaluation
patient will express emotions regarding the rape
patient is empowered to take control of the situation
the patietn acknowledge the rape was not their fault
47
risk factors for trafficking
-recent migration or relocation
-substance use
-mental health concerns
-involvement with child welfare system
-being a runaway or homeless youth
48
what do traffickers use as leverage
love (powerful explitation)
49
recognize trafficking victim
-don't speak english
-speak english but someone else is speaking for them
-no travel documents or someone else is holding onto the document
-has no spending money
-under control and supervision of someone who won't leave them alone
-malnutrition, dehydration, drug use or addiction, poor general health or poor personal hygeiene
50
physical signs of traffic victim
-scars, bruises, burns, tatoo that raise suspicion
-depressed, frighten, anxious or otherwise distressed
-story about being here makes no sense
-lives with employer or place of business
-person who brought them is resistant to you speak to patient alone
51
trauma
experiences that overwhelm an individual's capacity to cope
52
what cause trauma?
-accidents and natural disaster
-childhood abuse and neglect
-sexual violence
-medical intervention
-witness violence
-sudden loss
-war and intergeneraltional trauma
53
positive stress
moderate and short lived
normal part of development
-first day of a new job
-getting married
-competing in sports
54
tolerable stress
-more intensed but time limited
-buffered by support relationship
death of a loved one
serious illness or injury
job loss
55
toxic stress
prolong activation of stress response
lack adequate adult support
can damage brain architecture
-ongoing discrimination
-exposure to domestic violence
-caring for a sick family member w/o
support
-unresolved trauma from past abuse and
neglect
56
core of trauma informed care
-safety
-trustworthiness and transparency
-peer suport
-collboration and mutual support
- empowerment (voice and choice)
-cultural and historical sensitivity
57
physical effects of trauma
eating and sleep disturbances
chronic pain
low energy
headaches
panic symptoms
58
emotional affect of trauma
deperssion
anxiety
extreme vulnerability
emotional numbness
difficulty in relationship
59
behavior effect of trauma
self-harm
substance abuse
isolation
hypervigilance
risk-taking behaviors
60
cognitive effect of trauma
memory lapse
difficulty concentrating
decision making challenge
intrusive thoughts
decreased focus
61
in-the-moment trauma response
rapid breathing or breath-holding
muscle tension
increased HR
startle response
disconnection from present
difficulty speaking
loss of focus
physical freezing
62
creating safety
-introduce yourself and explain role
-use non-threatening body language
-ask permission before touching
-explain procedure before doing them
-provide choice when possible
-ensure private space
-allow patient t have support person -
present
63
grounding technique
-present-moment awareness excercise
-deep breathing
-physical grounding (feeling feet on floor)
-sensory awareness (using 5 senses)
-self-soothing statement
-environmental organization
-body-based technique (walking, tense and
release hands)
64
environment consideration for trauma patient
-calm, welcoming space
-clear signage
-good lighting
-comforatble seating
-private area
-noise control
-easy exits
-safe movement paths
65
building trust with trauma patient
-consistent care approach
-clear communication
-maintain boundaries
-following through on commitment
-respecting privacy
-acknowledging patient expertise
-collaborative decision-making
66
prevent retraumatizing patient
-universal screening protocol
-patient-centered approach
-choice in treatment option
-clear informed consent
-predictable environment
-trauma-specific services
-regular safety assessment
67
adverse childhood experiences
something happened between infancy and adulthood to create a lifetime of addictions, abuse, and mental health problems
68
childhood trauma
developmental delays
explusions
69
adolescent trauma
dilinquency
mental health
sexual activity
drugs and alcohol
violence
70
adulthood trauma
-psychiatric problems
-drug abuse
-alcohol
-crime
71
trauma stress
-overhelming experience
-involves a threatoverwhelming
-results in vulnerability and loss of control
-leave people feeling helpless and fearful
-intensify with realtionships and beliefs
72
Source of trauma stress
-loss of loved one
-accidents
-homelessness
-community/school violence
-domestic violence
-neglect
-physical abuse
-sexual abuse
-man-made or natural disasters
-terrorism
73
chemical stress response
prepares the body for action when threat is detected
helps the body respond to stress effectively
74
fight, flight, freeze
-protect the body
-body uses increased energy to respond to danger in 1 of 3 ways: fight, flight, or freeze
75
stress response and trauma
-overwhelm a person's usual ability to cope
-all who experience trauma have varied response
-most recovered
-some develop more severe difficulties
76
toxic stress
from exposure to violence can impair healthy development
77
Triggers of trauma victim
-seeing, feeling, or hearing something that reminds us of past trauma
-Triggers activate the alarm system
-When the alarm system is activated, but
there is no danger; it is a false alarm
-The response is as if there is a current
danger
78
development and trauma
childhood exposure to trauma invest energy into survival instead of developmental mastery
development in adulthood may continue to be impacted
79
secure attachment
-secure "container"
-provides for basic needs and safety
-has the freedom to explore and learn
80
disrupted attachment
-lack of availability and predictability
-lack of safety and security
-diminished ability to develop trusting relationships and coping skills
81
self regulation
the growth of self-regulation is a converstone of early childhood development that cuts across all domains of behaviors
the ability to balance self-control with self-expression
82
example of self regulation
establishing sleep-wake pattern
increasing attention span
focusing on goals
managing emotions appropriately and in context
expressing feelings constructively
83
trauma, self-regulation, and coping skills
biology of trauma impacts abilite to regulate
impacts caregiver-child relationship
to heal child must feel safe in their bodies and they mahve have supportieve relationships with loving caregiver who they can trust
if coping skills are more developed, a child is much better equipped to handle stress
84
resilient child
A resilient child is one who bounces back from adversity and continues to function reasonably well, despite continued exposure to risk
self-esteem and self-resilience
sense of self-efficacy--belief in their ability to affect their own lives
a range of social, problem solving approaches
one significant adult
external support system
85
why leadership matters in nursing
guide and coordinate interdisciplinary teams
effective leadership directly correlates with patient safety, morale, and workflow efficiency
Leadership theory provides structured approaches for managing conflict, delegating tasks, and improving outcomes
understanding leadership helps nurses evolve from task-focused roles to professional advocacy and influence
86
Trait theory
leaders possess inherent traits such as confidence, intelligence, and decisiveness
rooted in the belief that leadership qualities are innate and not learned
strengths help identify potential leadership early; emphasize consistency of behaviors
limitation does not account for environmental or situational factors
example: a charge nurse remains calm and assertive during rapid response activity
87
transactional relationship
leadership is based on defined tasks, performance expectations, rewards, and corrective actions
motivation occurs through structured incentives such as bonuses, reconition, or disciplinary steps
best suited for settings requiring routine consistency and efficiency
limitation: may reduce creativity and can lead to burnout if overemphasized
example: nurse manager sets patient-satisfaction goals and reward teams who meet target
88
behavioral theory
suggest leadership is developed through learned behaviors rather than inherent traits
authoritarian: direct, controlling, fast decisions, useful in emergencies
democratic: encourages participation, collaboration, shared decision-making, ideal for policy development
laizzez-fire: minimal control, effictive with highly experience team
example: a unit manager incorporates staff nurese in revising clinical, workflow protocol
89
socratic leadership
center on inquiry-based guidance, facilitating reflective thinking and deeper understanding
leaders use probing questions rather than directive
encourage development of clinical reasoning and autonomy
ideal in an educational or debriefing setting
example: nurse preceptor asks, "what cues led you to coose that intervention?" during reflective practice
90
laissez-Faire leadership
hands-off approach allowing team members to self direct
works wbest with competent, autonomous, and motivated staff
risk: can to to confusion or lack of direction if the team lack experience
example: senior ICU nurses collaborateively managing workflow without constant oversight
91
situational leadership
leaders adapt style based on team readiness, skill level, and motivation
telling: for inexpereince staff
selling: explains decisions used when staff need motivation
participating: shares decision making, ideal for moderately experience staff
delegating: high independence; for expert staff
example: preceptor transitions from hands-on guidance to full autonomy as new RN progresses
92
transformational leadership
focus on inspiring, motivating, and empowering staff to exceed expectation
encourages innovation, evidence-based practice and continuous improvement
build strong team culture through communication and vision
example: CNO leads a hospital-wide initiative reducing errors through shared governance
93
servant relationship
leader prioritizes the needs and well-being of the team before their own
emphasize empathy, listening, ethical decision making, and stewardship
strengthens trust and reduces burnout
example: nurse leader adjusts staffing to protect work-life balance and ensure equitable workload
94
contingency theory
there is no universal leadership style; effectiveness depends on context
leadership success varies with environment, task demands and team needs
example: during a severe staffing shortage, a normally, democractic leader applies a more authoritative style to maintain safety
95
leadership in practice
leading change, implementing new charting system, care models, or safety protocol
resolving conflicts, mediating disagreements between team members or department
advocating: pushing for policy changes, staffing improvements, or patient-safety measures
mentoring: support new nurses through precepting, coaching, and professional development planning
collorbation: working with interdisciplinary teams to coordinate complex care
96
type of organizations
regulating bodies
accrediting agencies
professional organization
97
regulating bodies
US constitution grants state the authority to govern slected professional such as nursing, medicine, and pharmacy
national council of state boards of nursing (SBON)
US DHHS
state health departments
local health departments
international agencies
98
accrediting agencies
recognition through peer review process that evaluates the quality of an organization on the basis of standards and criteria ofthe accreditation organizaiton
Joint Commision-Independent, nonprofit organization
COA, NCQA, CCNE, ACNE, AHA, CCNE
99
professional organization
each organization define standards of practice for their specialty
requiredd education and mastery of skills
establish a code of ethics for thier members
authority recognized by society and the clientele of the profession
approval of authority sanctioned by broader community or society
give a voice to the profession
ENA-emergency nurse association
Wound ostom and continence nurse society
ANA
Forensic nurse
Nanda
Infusion Nurse society
100
medicare
strict criteria for SNF placement
limited coverge long-term care
documentation affects eligibility for post-acute services
101
medicaid
have difficulty accessing specialty care or placements
discharge planning can be complex and delayed
medicaid patients have higher social and health complexity
102
VA/CHampus/Tricare
covers veterans, active-duty service members, retirees, and eligible dependents
federal military-associated payors
care may be delivered within VA systems or civilian facilities
authorization rules are common
patients need referral or authorization before services
veterans have access to unique benefits adn resources
understanding benefits helps connect patients to appropriate systems
103
private insuracne
insured through employers or private plans
wider variety of coverage
often requires prior authorization
usually higher reimbersement rates
depends on plan rules, not clinical need alone
higher deductible or copays
authorization delays can affect procedure adn discharge timing
104
Health insurance exhange (Affordable care act/Obamacare)
insurance through federal or state market
private insurance plan with standardied coverage tier
income based subsidies may apply
coverage can change annually
patients may misunderstand coverage limit
formularies and networks vary significantly
loss or change of coverage can disrupt continuity of care
105
charity Care/Self pay
uninsured or underinsured patient meeting institutional criteria
hospital-based financial assistance
often require application and documentation
limited to criteria service
patient may delay care to fear of cost
social involvement is critical
early identification supports safer discharge planning
106
nurse role in education
responsibility to ensure caregivers understand and can demostrate essential care skills to promote optimal health and safety
107
communication skills
starts with active listening
-paying full attention, having eye contact and using words and body language
speak with empathy
-show empathy toward caretaker by acknowledging their emotions
handling difficult situations
-Use "I" statement instead of "you" to reduce defensiveness
108
what needs to be determined first before starting to teach caregiver anything
determine what we need to teach in order to determine their best learning style for them to understand
109
determining caregiver learning style
ask them open-ended questions
110
vark questionaires
test visual, auditory, reading/writing kinesthetic
111
Kolb's Learning Style inventory
test if a person learns best through accommodating, diverging, convering, assimilating
NUR 212
flashcards
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