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Community Health Final

Chapters 27, 28, 29, 30, 31, & 32

Chapter 27: Violence
Violence is a national public health problem.
Interpersonal violence
Homicide (15th leading cause of death in the united states)
o The united states ranks first in the industrial world in violent death rates
o Who is usually the perpetrator of a female homicide?
An intimate partner- 30% of female murder victims are killed by an
intimate partner
Homicide is the leading cause of death in pregnant women
Suicide is the 8th leading cause of death for all Americans. More people die from
suicide than from homicide in the united states.
Intimate partner violence (IPV)
o Ipv is the single greatest cause of injury to women between the ages of 15-24
o Rape is not about love or sex; its about power and control
o The most dangerous time for a victim is when the victim leaves or attempts
to leave the relationship, because it is seen as an erosion of the abusers
control. (The victim is most likely to be abused at this time more than any
other time in the relationship)
o Power & control wheel
Professional intervention is required to break the cycle of abuse. I
am legally required to report this.
Child abuse
o Most child abuse occurs within the family
Physical abuse
Shaken baby syndrome
o Violent shaking of an infant causes brain and spinal
cord trauma
o Leading cause of death from child abuse in the us
o In approximately 65-90% of shaken baby cases, the
father or mothers boyfriend is the perpetrator
o An 84 year olf woman lived with her youngest
daughter, the daughters live in boyfriend, and 1
child. On this visit, the nurse noted the woman
appeared depressed and dehydrated. Both wrists
were swollen and scabbed. When asked if she was all
right, the woman protested she was fine and her
daughter took good care of her. What action should
you take?
According to the text, working with victims of
elder abuse, the nurse must establish rapport
& trust first; remember that competent adults
have the right to make decisions about their
own care, including to stay in a abusive
situation; the nurse should discuss measures

to relieve stress and possible respite care

options with the daughter. The second goal is
to report the abuse.
Wisconsin has always had, and will generally retain, a
voluntary reporting system. Voluntary rather than mandatory
reporting was selected based on this states commitment to
an adults right to self-determination.

Community violence
o Workplace violence (what are most dangerous for health care staff)
In the health care field, the most frequent areas for the occurrence
of violence are the emergency departments, psych units, geriatric
units, and waiting rooms
o Gangs
Although gang problems declined in the 1990s, they have steadily
increased since that time
In 2007, there were estimated 788,000 youth gang members in
27,000 active gangs. By 2011 there were 30,000 gangs in the usan
ever-increasing problem!
o Hate Crimes
Often considered worse than other crimes involving violence
because the crime is personal, attacking the victims identity

Chapter 28: natural & man made disasters

Disaster vs emergency
Disaster: any event that causes a level of destruction, death, or injury that affects the
abilities of the community to respond to the incident using available resources
Emergencies differ from disasters in that the agency, community, family, or individual
can manage an emergency using their own resources.
Often times a disaster event may be beyond the ability of the community to respond to
and recover from the incident using its own resources
A disaster affects the whole community, whereas an emergency occurs at a personal
level and the person, family, community can manage the event with their own
Acts of terrorism
Terrorism is the use of force or violence against persons or property in violation of the
criminal laws of the united states for purposes of intimidation, coercion, or ransom
Threats of terrorism
o Assassinations
o Kidnapping
o Hijacking
o Bomb scares & bombings
o Computer based attacks
o Chemical, biological, nuclear, radiological weapons
Terrorists goal: to coerce and create fear to accomplish their goals

When should a disaster planned be developed?? Before the disaster occurs!

Local, state, & federal responsibilities
Remember! Agencies and disaster incidents are handled at the lowest possible
organizational and jurisdictional level
Local government
o Responsible for the safety and welfare of its citizens
o The local office of emergency management is responsible to develop a
community disaster plan, have emergency drills to test the plan, and
determine the proper response
Federal government
o Main goal: ensure continuity of essential federal functions during any
National incident management system (nims): integrates practices in disaster preparedness
and response into a comprehensive national framework for incident management.
Federal emergency management agency (fema): Mission= to lead the efforts to prepare the
nation for all hazards and to manage the federal response and recovery efforts following a
national incident
Fema also initiates proactive mitigation activities, trains first responders, and
manages the national flood insurance program and the us fire administration
American red cross (ARC): though chartered by congress to provide disaster relief, is not a
government agency. Primarily a volunteer organization.
Preparedness/planning State: Individual and family preparedness
Individual and family preparedness includes training in first aid, assembling a
disaster emergency kit, establishing a predetermined meeting place away from
home, and making a family communication plan.
Who should create a disaster plan including emergency supplies and where to
meet in case of emergency? Your family!
Community disaster planning
The plan should indicate who has the power to declare there is a disaster and has the
power to initiate the disaster plan.
Response stage
30-2 can do
o where 30 is the # of respirations, 2 is the # of seconds needed to check
perfusion, and can do relates to checking mental status
o to assess an individual within the 1 minute guideline, the system uses three
First, respirations are checked;

Second, perfusion by pinching the nail bed and observing the

Third, mental status, by asking simple questions beginning with,
who are you? Then where are you hurt?
o Remember! Before search and rescue begins, safety must be considered
Disaster triage
Start: Simple Triage And Rapid treatment
Red- life threatening; requires immediate care
Yellow- urgent, but can wait an hour, such as someone with an open fracture but
controlled bleeding
Green- walking wounded, can delay for three hours
Black- mortally wounded, no care required (dead)
The classic 4 phases of a communitys reaction to a disaster:
1. heroic phase
a. during this phase, nearly everyone feels the need to rush to help people
survive the disaster
b. medical personnel may work hours without sleep, under very dangerous
and life threatening conditions, in order to take care of their patients.
2. honeymoon phase
a. individuals who have survived the disaster father together with others who
have simultaneously experienced the same event.
b. Bonds are formed between victims, between health care workers, and
between victims and health care workers who have shared experiences.
3. disillusionment phase
a. when time has elapsed and a delay in receiving help or failure to receive the
promised aid has not occurred, feelings of despair occur. Depression may
set in.
4. reconstruction phase
a. once the community has restored some of the buildings, businesses, homes
and services, and some sense of normalcy is occurring, feelings of despair
will subside
b. counseling support for victims and helpers may need to be initiated to help
people recover.
On an individual level, common responses to a traumatic event include:

cognitive: poor concentration, disorientation, indecision, shortened attention span,

memory loss, unwanted memories, difficulty making decisions