The EMR can facilitate interviews and a template can be created to ensure all of the above pertinent information is obtained. Make sure the patient knows how to access their records, and also that the patient Documenting abuse with photographs In addition to complete written records, photographs can be of particular value as evidence. Additional imaging studies may be useful, depending on the clinical situation. The physician should obtain written consent for photographic documentation from the patient prior to taking photographs. Digital images should be dated and signed by the physician (freehand or electronic signature), and accompanied by a statement that indicates that the images are authentic and unaltered. Techniques for optimal photographic documentation include: ● Whenever possible, take photographs before medical treatment is provided. ● Photograph from different angles, full body, and closeup. ● Hold up a coin, ruler, or another easily identifiable object to illustrate the size of an injury.
knows the document is confidential, thus requiring their permission or a subpoena for the partner or anyone else to view it.
● Include a date marker on the photograph. If not available from within the camera, that day’s newspaper or other dated material may be used. ● Include the patient's face in at least one picture and some identifiable part of the patient in all photographs. ● Take at least two pictures of every major trauma area. ● Mark photographs precisely as soon as possible with the patient's name, location of injury, names of the photographer and others present, and the date and time of the photograph. ● To maintain chain of custody and confidentiality, be consistent as to where photographs are filed and who has responsibility for and access to photographs. ● Arrange for the patient to return in two or three days for additional photographs to document the progression (and healing) of visible injuries. departments use the services of Sexual Assault Nurse Examiners (SANE nurses) who have specific training in forensic nursing, evidence collection, and crisis counseling. If a patient calls your office before presenting to the emergency department, he or she should be told to refrain from showering, bathing, or douching before arriving at the hospital. Victims of sexual assault should be instructed to put all clothes worn during the assault in a paper bag to bring to the hospital as additional evidence.
Sexual assault forensic documentation and evidence collection Documentary evidence of an attempted or completed rape can be collected up to five days after the crime occurs. Physical evidence that can be used for medical assessment and possible criminal prosecution should be obtained using a Sexual Assault Forensic Evidence (SAFE) kit, which can be found in most hospital emergency departments. Unless the patient is unwilling or unable to present to the emergency department, the examination and evidence collection
should be conducted in the emergency setting. An increasing number of hospital emergency
STRATEGIES FOR IMPROVING CARE FOR IPV VICTIMS
Effective communication strategies As important as it is to ask the right questions, it is equally important to refrain from asking questions in a manner that might frighten or intimidate your patient, increase the sense of humiliation and shame about the violence, or be interpreted as blaming the survivor for the situation. Here are some pitfalls to avoid: 30 ● Do not inquire about abuse in the presence of the partner, friends, or family members. Children older than three should not be present while discussing IPV. ● Discussing IPV can be very difficult and can leave patients feeling vulnerable. Do not inquire about abuse until the patient is fully clothed. ● Do not break patient confidentiality by disclosing any information or discussing your concerns with the patient’s partner. The Trauma-Informed Care Model As potentially valuable as they may be, medical encounters can also be stressful for abused patients. Because of this, healthcare providers should care for
● Most survivors do not identify themselves as abused because of the perception of shame and worthlessness associated with that term. Therefore, avoid using the words “victim,” “abused,” or “battered” when speaking with the survivor. Instead, use words like “hurt,” “frightened,” or “treated badly.” ● Assure the survivor that everyone deserves to feel safe and no one deserves to be abused. Never ask your patient what they did to bring on the violence. ● Do not ask your patient why they have not left their partner. ● A survivor may leave a partner only to later return. If this is the case with your patient, avoid asking why they have returned.
all patients in a trauma-informed manner. The nine principles of trauma-informed care are: 31
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Book Code: CT24CME
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