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Vulnerablepopulation
| Question | Answer |
|---|---|
| What is a Vulnerable person? | Vulnerable populations are groups of people at higher risk for poor physical, psychological, or social health. |
| What is a Vulnerable person? | These barriers can be intensified by social, economic, political, and environmental factors, as well as limitations due to illness or disability. |
| What is a Vulnerable person? | Reasons for Vulnerability: -Inherent risk factors are innate, meaning individuals are born with these characteristics . -Acquired risk factors are extrinsic or exposure- related. |
| Sexual Assault | Sexual violence is unwanted sexual experiences, unwanted sexual contact, and sexual coercion. Sexual violence crimes include rape, sexual assault, and sexual harassment. One-third of females and 1 in 9 males report being sexually harassed in public |
| Sexual Assault | In 2021, fewer than 22% of rape and sexual assault survivors reported the crime to the police. Nurses are mandated reporters, and it is the responsibility of the nurse to know the reporting requirements in their state. |
| Sexual Assault | Ideally, a sexual assault examination should take place within 72 hours. Often nurses certified as SANE (Sexual Assault Nurse Evaluation) nurses examine patients. |
| Sexual Assault | SANE nurses have specialized training in interviewing and collecting evidence after a sexual assault. |
| Sexual Assault | In New York state, nurses are required to report suspected or actual sexual abuse to the SCR (Sexual Crimes Registry). Reports must include the date of the incident, the gender of the victim, and whether it took place within certain time frames. |
| Sexual Assault | Sexual violence or assault involves a range of acts on all types of people |
| Sexual Assault: Patient History | Patient history topics to address after an assault: Personal hygiene activities since the assault (e.g., showering) Circumstances of the assault Loss of consciousness or memory Physical description of the assault |
| Sexual Assault: Patient History | Specifics of the assault (oral, anal, or vaginal contact; ejaculation; and condom use) Other areas of trauma Bleeding by the victim or assailant Recent consensual sex |
| Sexual Assault: Patient History | The interviewer must take great care to avoid any type of victim blaming or judgment. |
| Sexual Assault: Prophylactic Care #1 | After an assault, individuals are tested for sexually transmitted infections and pregnancy. Positive results are not likely a result of the assault due to incubation periods. |
| Sexual Assault: Prophylactic Care #1 | Treatment is usually given at the time of the assault, prior to receiving a positive result. Emergency contraception is indicated as soon as possible after an assault. |
| Sexual Assault: Prophylactic Care #1 | A pregnancy test should be taken if the patient misses a period 2 to 3 weeks after an assault. |
| Forensic Examination Samples | Pt. should be in their clothing for the interview and placed on a clean sheet before disrobing |
| Forensic Examination Samples | Clothing Swabs of tissue from the buccal mucosa, vagina, rectum, and other areas highlighted by ultraviolet light Combed specimens from the scalp and pubic hair |
| Forensic Examination Samples | Fingernail scrapings and clippings Control samples of the victim’s scalp and pubic hair to compare against other hair collected Whole blood sample Saliva sample |
| Sexual Assault: Prophylactic Care #2 | Because of the high risk of exposure and infrequent follow-up visits, individuals are often treated for gonorrhea, chlamydia, and trichomoniasis after an assault. |
| Sexual Assault: Prophylactic Care #2 | Individuals are often tested for hepatitis B immunity, started on the vaccine series, or received hepatitis B immune globulin if the perpetrator is known to have hepatitis B. |
| Sexual Assault: Prophylactic Care #2 | HIV nonoccupational postexposure prophylaxis (nPEP) is most effective if started 4 hours after exposure and not effective if started after 72 hours. |
| Sexual Assault: Prophylactic Care #2 | Treatment with nPEP lasts for 28 days and consists of medications used to treat HIV. HIV and syphilis testing should be done at 4 to 6 weeks and 3 months after an assault. |
| Sexual Assault: Prophylactic Care #3 | Survivors of sexual assault between the ages of 9 and 26 should receive the human papillomavirus vaccine (HPV), unless previously received. Nurses should offer mental health services to all survivors of sexual assault. |
| Sexual Assault: Prophylactic Care #3 | Survivors of sexual assault are at risk for: Posttraumatic stress disorder Depression Insomnia Anorexia Suicidality |
| Intimate Partner Violence (IPV) #1 | IPV is any actual or threatened psychological, sexual, or physical harm of one current or past partner by the other. Approximately 1 in 10 males and 1 in four females experience IPV in their lifetimes. |
| Intimate Partner Violence (IPV) #1 | Approximately one in five homicides is of one intimate partner by another, and half of the female victims of homicide are killed by a current or former intimate partner (CDC, 2021). A feature of IPV includes power of one partner over another. |
| Intimate Partner Violence (IPV) #1 | Trust is critical in the nurse/patient relationship. It often takes several encounters before a person discloses IPV. Most victims of IPV are not in immediate danger, but safety must be assessed. |
| Intimate Partner Violence (IPV) #1 | Safety planning is an attempt to reduce the risk of escalating violence and may include a signal to alert others to contact emergency services (an emergency kit, information for shelters). |
| Principles of Clinician Intervention (Ganley, A. (1988) | Safety: Maximize safety and reduce risk of harm to victims and their children Empowerment: Facilitate self-determination Abuser accountability: Hold the perpetrator responsible for the violence and resolution, NOT the victim |
| Principles of Clinician Intervention (Ganley, A. (1988) | Advocacy: Advocate within and beyond the healthcare setting for political, legal and social change Change: Continuously seek ways to improve the delivery of care to victims |
| Intimate Partner Violence #2 | Mandated reporting requirements vary by state and situation. Documentation of the abuse is important and should include physical examination findings and the patient’s report of the abuse. |
| Intimate Partner Violence #2 | IPV victims may have long-term consequences such as posttraumatic stress syndrome, anxiety, suicidality, eating disorders, or chronic pain. |
| Intimate Partner Violence #2 | Risk factors for the escalation of IPV When the victim seeks to leave the relationship, seeks help, or is afraid for one’s life. When the victim is suicidal or homicidal. |
| Intimate Partner Violence #2 | When the perpetrator threatens to kill oneself, victim, or children. When the perpetrator is violent outside the home, uses drugs, or owns weapons. |
| Intimate Partner Violence #3 | Helpful statements: “I am so sorry this is happening.” “This is not your fault.” “I can help connect you with people and resources that can help you when and if you’re ready.” “This is not an uncommon problem. You are not alone.” |
| Intimate Partner Violence #3 | Unhelpful statements: “What do you think is wrong with you that you get into these situations?.” “If it is so bad, why do you stay?.” “I would never let anyone hurt me like that.” |
| Human Trafficking | Human trafficking is the recruitment, transportation, transfer, harboring or receipt of people through force, fraud or deception, with the aim of exploiting them for profit. |
| Human Trafficking | In 2016, it was estimated that 24.9 million people were forced into unpaid labor and 4.8 million of these were forced sex workers. In 2023= 1 million. |
| Human Trafficking | Human trafficking victims face frequent health problems and report seeking the use of healthcare services. Some victims may not recognize themselves as human trafficking victims. |
| Human Trafficking | Victims of human trafficking and those who care for them are at risk for harm from traffickers. Care should be taken to maintain confidentiality and clinic security. Careful documentation is required. |
| Human Trafficking | Patients are not always able to leave once identified. Resources given to them should be memorized if possible. |
| Human Trafficking: Red Flags | Shares a scripted or inconsistent history Is unwilling or hesitant to answer questions about the injury or illness |
| Human Trafficking: Red Flags | Is accompanied by an individual who does not let the patient speak for themselves; refuses to let the patient have privacy, or interprets for the patient |
| Human Trafficking: Red Flags | Exhibits signs of being in controlling or dominating relationships (excessive concerns about pleasing a family member, romantic partner, or employer) Demonstrates fearful or nervous behavior or avoids eye contact |
| Human Trafficking: Red Flags | Is resistant to assistance or demonstrates hostile behavior Is unable to provide their address or is not in possession of their identification documents |
| Human Trafficking: Red Flags | Is not aware of their location, the current date, or time Is not in control of their own money or is not being paid or has wages withheld |
| Incarcerated Patients #1 | As of 2020, almost 80,000 females were incarcerated in the United States. All females who are incarcerated should be tested for pregnancy at the time of incarceration. |
| Incarcerated Patients #1 | The expectation is that the pregnancy/postpartum care of females who are incarcerated is the same as for females who are not incarcerated. |
| Incarcerated Patients #1 | Logistics can be a barrier to care (e.g., transportation, follow-up, and care of the newborn). Females who are incarcerated have higher risk for pregnancy complications. |
| Incarcerated Patients #2 | Intrapartum care should include: Nurses should be aware that shackles increase the risk of a fall. A corrections officer may be required in the room. |
| Incarcerated Patients #2 | Postpartum care should include: Few facilities having available accommodations for infants on site. Infants often given to family, foster care, or adoption. |
| Incarcerated Patients #2 | Contraception should be discussed and initiated. About half of females released from incarceration become pregnant within 3 months. |
| Incarcerated Patients #2 | Care after incarceration should include: Most sentences for females are brief, follow-up appointments should be made prior to release to avoid a gap in treatment. |
| Patients With Eating Disorders: Anorexia Nervosa | Diagnosis of anorexia nervosa is made when: Calorie restriction below requirement for weight maintenance |
| Patients With Eating Disorders: Anorexia Nervosa | Profound fear and anxiety about being overweight Distorted and disproportionally important perception of body weight |
| Patients With Eating Disorders: Anorexia Nervosa | Treatment for anorexia nervosa includes: Psychotherapy Nutritional rehabilitation |
| Patients With Eating Disorders: Binge Eating Disorder | Binge eating disorder is frequent bouts of overeating without inappropriate compensatory behaviors such as purging or excessive exercise. |
| Patients With Eating Disorders: Binge Eating Disorder | Binging is generally considered to be consuming the equivalent of two or more meals or 2,000 calories or more within a given period of time (such as 2 hours) at least once a week for at least 3 months. |
| Patients With Eating Disorders: Binge Eating Disorder | Often associated with mental health diagnosis such as substance abuse, stress, anxiety, PTSD, borderline personality, or mood disorder. Treatment goals include reducing the number of binge eating episodes and weight loss. |
| Patients With Eating Disorders: Binge Eating Disorder | Often treated with psychotherapy and pharmacotherapy (such as selective serotonin reuptake inhibitors). |
| Caring for Sexual Minority Women (SMW) #1 | SMW may be used to describe a female who identifies as lesbian, bisexual, pansexual, transgender, gay, or polyamorous. |
| Caring for Sexual Minority Women (SMW) #1 | SMW are at increased risk for STIs, substance abuse, and mental health problems. Health disparities in SMW are due to discrimination, stigma, and civil and human rights violation. |
| Caring for Sexual Minority Women (SMW) #1 | Lack of disclosure of gender or sexual orientation is associated with higher risk for depression or suicidality. |
| Caring for Sexual Minority Women #2 | When working with SMW, effective communication is important to all care. Avoid making judgments, assumptions, gossip, or stereotypes about SMW. |
| Caring for Sexual Minority Women #2 | Avoid using gendered terms or phrases that pertain to sexual orientation when possible (e.g., use the term partner instead of husband, wife, girlfriend, or boyfriend). |
| Caring for Sexual Minority Women #2 | Use the term patient, instead of he or she until or unless the patient’s gender identity and preferred pronoun use is clear. Legal documents may not have a transgender individual’s preferred name or gender identity. |
| Caring for Sexual Minority Women #2 | Use preferred gender pronouns (he/she/ze). Respectfully apologize if the wrong pronoun is used. |
| Caring for Sexual Minority Women #2 | Hormone Therapy Goal= to induce physical change in keeping with gender identity Pt. must be able to communicate persistent gender dysphoria & capacity for informed decision-making about therapy |
| Caring for Sexual Minority Women #2 | Hormone Therapy Can decrease but not eliminate fertility |
| Caring for Sexual Minority Women #2 | Surgery Pt. desiring gender confirmation surgery are generally required to have tolerated six months of gender affirming hormone therapy. Types of surgery are decided based on what the pt. goals and preferences are |
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