Ending Domestic Violence Wheel

Domestic Violence

What is domestic violence?

It is a system of behaviors used by one person to control another’s actions and feelings. An abuser uses physical and sexual abuse, or the fear of it, to get and maintain control over his partner. Over time, the violence usually becomes more dangerous, and the attacks more frequent. The Power and Control Wheel below shows the many of the different tactics abusers use to exert their power. The Equality Wheel shows the same areas and how they are handled in a non-abusive relationship.

Download PDF here: wheel_both



Injury Prevention Webinar: Violent Injury Intervention–How Hospitals Can Support Our Children (Recording)

This was just sent to me by the Children’s Hospital Association. It is a pre-recorded webinar from April on violent injury interventions and speaks to how hospitals can best support children who have been in these situations. I wanted to pass it along to you all, as we, unfortunately, run into many of these cases. The write-up states:
Injury Prevention Webinar: Violent Injury Intervention–How Hospitals Can Support Our Children (Recording)
Children and adolescents victimized by violence are often treated in hospital emergency departments. Each year, emergency departments treat approximately 340,000 youth. In this webinar, learn about the impact of violence on youth, evidence-based violence intervention and prevention strategies within hospital systems and how to develop a violence intervention program in conjunction with your community.
  • Understand impact of violent injury on youth
  • Learn ways hospitals can provide support youth victims of violence and their families
  • Introduce National Network of Hospital-Based Violence Intervention Programs and their role in supporting hospitals interested in developing a violence intervention program

Webinar: https://www.childrenshospitals.org/events/2014/04/15/injury-prevention-webinar-violent-injury-interventionhow-hospitals-can-support-our-children


The Medical Cost of Abusive Head Trauma in the United States

Please find below an article summary featured in the July 11, 2014 edition of the Children’s Safety Network eNewsletter pertaining to TBI:
Children’s Safety Network eNewsletter
CSN Article Highlight:

The Medical Cost of Abusive Head Trauma in the United States
OBJECTIVES: Health consequences of shaken baby syndrome, or pediatric abusive head trauma (AHT), can be severe and long-lasting. We aimed to estimate the multiyear medical cost attributable to AHT.
METHODS: Using Truven Health MarketScan data, 2003–2011, we identified children 0 to 4 years old with commercial or Medicaid insurance and AHT diagnoses. We used exact case–control matching based on demographic and insurance characteristics such as age and health plan type to compare medical care between patients with and without AHT diagnoses. Using regression models, we assessed service use (ie, average annual number of inpatient visits per patient) and inpatient, outpatient (including emergency department), drug, and total medical costs attributable to an AHT diagnosis during the 4-year period after AHT diagnosis.
RESULTS: We assessed 1209 patients with AHT and 5895 matched controls. Approximately 48% of patients with AHT received inpatient care within 2 days of initial diagnosis, and 25% were treated in emergency departments. AHT diagnosis was associated with significantly greater medical service use and higher inpatient, outpatient, drug, and total costs for multiple years after the diagnosis. The estimated total medical cost attributable to AHT in the 4 years after diagnosis was $47 952 (95% confidence interval [CI], $40 219–$55 685) per patient with AHT (2012 US dollars) and differed for commercially insured ($38 231 [95% CI, $29 898–$46 564]) and Medicaid ($56 691 [95% CI, $4290–$69 092]) patients.
CONCLUSIONS: Children continue to have substantial excess medical costs for years after AHT. These estimates exclude related nonmedical costs such as special education and disability that also are attributable to AHT.

Link to the FULL FREE article: http://pediatrics.aappublications.org/content/early/2014/06/10/peds.2014-0117.full.pdf+html


FREE CEU for nurses

U of M FREE CEU Public Health

Free U of MN 1 hour course on PFA:www.sph.umn.edu/ce/perl/courses/?id=11783  


Medical Equipment brought in from Home (to hospital) Policy @ HCMC

Medical equipment brought in by patients from home will be evaluated for therapeutic use, electrical safety and cleanliness.
Continued use of patient supplied medical equipment requires an order by the patient’s
For CPAP, non-invasive BiPAP, or home ventilators, the patient’s nurse, upon admission to 2.
the patient care unit, is to call the Respiratory Therapy Department to evaluate the patient’s
If the Respiratory Therapist determines that the patient owned device is functional and clean, the Therapist will call the Bioelectronics Department to perform an electrical safety test. If it does not meet these requirements, the device will be replaced with hospital –owned equipment.
For any other electrical, patient supplied medical device, Bioelectronics Department is to be 
contacted for safety testing before being put into use.
For more details, please see info on call policies

HCMC Level of Care inpatient Cost

Level of care is also essential. Patients need to be charged the correct rate.
These are our current rates:
Level 1 $2,791
Level 2 $ 3,346
Level 3 $4,346
Level 4 $ 7,291
Level 5 $7,291

Pediatric RAM Nasal Cannula

I have had some questions regarding the RAM nasal cannula in the PICU and why we are using it. I contacted the company and this is what I found…
-It has a unique 15mm adaptor on the cannula so we are able to “plug it in” to the CPAP machine whereas other cannulas don’t have this so we are not able to hook it up to anything other than the wall or the high flow
– It has wider bore tubing and wider bore nasal prongs so it is able to tolerate the higher flows and higher pressure
-The current sizes are only rated to be used on kids up to age one. However, next year they will be trialing their pediatric sizes and these will work on kids up to the age of 18
-This is, currently, the only way to deliver CPAP without a mask
PDF from the Company that does a great job explaining:

HCMC: Pediatric Standards for a Suicide Precaution Patient

Pediatric Standards for a Suicide Precaution Patient 
RN: Review the standards below with HCA at the start of every shift.
HCA: Remain one arm’s length away from the patient at all times.  This includes while the patient is voiding or showering. If the patient is showering, they are able to have the bath curtain drawn but the HCA will be in the bathroom with the patient. If the patient is voiding, the HCA will stand in the bathroom doorway to observe the patient.   
The HCA should make all efforts to engage patient by suggesting and participating in activities along with patient. The HCA should attempt to get the patient out of the room, have the lights on, have the patient eat meals in a chair (not in bed), and adhere to the daily schedule below. Some suggested activities include:   
·         Art activities 
·         Board games/puzzles
·         Read books/magazines
·         Video games outside of room 
·         Computer use
·         Listening to music
·         Exercise (walking around the unit, Wii games)
·         Doing hair, painting nails, etc.  
The HCA is not permitted to be on their phone, on the computer, or distracted by other means while watching the 1:1. If the family is in the room, the HCA still needs to remain in the room. The only time they are able to leave the room is if psychology is interviewing the patient and deems it is safe to have the HCA outside the room.  
If possible, we will request a same sex HCA 
For each patient, the child life specialist will connect with and provide therapeutic distractions. 
If the patient has been here for three days, with an anticipated long term stay, please contact social work to reach out to school to get homework sent and/or tutor services set up.  
Patient’s personal belongings must be collected and locked in the medication room. This includes:
·         Cell phones and chargers
·         Clothes/Shoes
·         Makeup and personal hygiene items (including mirrors/compacts) 
Place patient in spice colored scrubs.
All visitors need to be approved by parent or legal guardian. If none present, family must be contacted to obtain a list of approved visitors. 
Set personal recovery goals with patient (e.g. What does the patient want to work on during this hospital stay?)
Patient is to be woken up at 0900 for rounds. At that point, the lights in the room will be on and the shades will be open. 
Shower, change of clothes, and linen change should be completed every morning.
Patient will be sitting up in a chair and offered three meals a day.
Vital signs to be completed as ordered. 
The patient’s schedule will be written up on the white board and changed daily.
The patient will be in bed with the lights off at 10:00 pm. 
Supervised cell phone use permitted as a reward to meeting set expectations.