Chapter Seven: Community Violence and Violence Prevention
Practical Application: Book Activity
Practical Application
Setting the Scene
Mary Lou: Intimate Partner Violence in Later Life
Watch this video by visiting https://youtu.be/B7N8CRorUvg
Think About It
Consider Mary Lou’s experience as showcased in the video.
- Were you surprised that Mary Lou was a victim of domestic violence?
- What from Mary Lou’s experience indicated she was in a domestic violence situation?
- Was Mary Lou exhibiting any risk factors for domestic violence?
- If you had a patient like Mary Lou, what would you do if they exhibited clues that they were experiencing domestic violence?
- What role does a therapist play in treating those who experience domestic violence? How can you, as a nurse, work with therapists in these situations?
Think About It: Other Examples
- You are working in the sexually transmitted infection (STI) department at the local health department. A 21-year-old transgender man comes in to be treated for syphilis. As a part of their visit, you interview the patient about their current relationship. They confide that their partner can be very controlling and, on more than one occasion, has hit him.
- What types of violence might you identify from their story?
- What steps would you take after learning about this violence?
- How does the patient’s transgender status impact your treatment?
- You are interviewing a 12-year-old at the pediatrician’s office, and after reviewing their record, you note that they have a history of being physically abused and neglected by their parents. You also know that their parents are divorced, and their mother is incarcerated.
- What types of violence might you identify from their story?
- What steps would you take after learning about this violence?
- How does the ACE study come into your evaluation?
- What adverse impacts might the child experience later in life, based on the ACE study?
Practical Application: Additional Guidance
Exercise Title
Understanding and Addressing Community Violence Application Practice
Objectives
- Promoting Awareness:
- Discuss the impact of community violence on public health.
- Recognize the role of nurses in violence prevention.
- Assessment Methods:
- Familiarize students with various assessment tools to evaluate community violence.
- Develop critical thinking skills by analyzing case scenarios.
- Collaboration:
- Understand the collaborative role of nurses and therapists in addressing violence.
Preparing for the Exercise
- Review the Chapter Material:
- Read Chapter Seven: Community Violence and Violence Prevention.
- Understand key concepts related to intimate partner violence, child abuse, and other forms of violence.
- Gather Resources:
- Collect relevant materials, including textbooks, articles, and online resources.
- Explore real-world examples (videos, case studies) to illustrate different forms of violence.
Exercise Components
- Introduction (15 minutes):
- Briefly introduce the purpose of the exercise.
- Discuss the relevance of community violence to nursing practice.
- Describe the concept of the community as a patient.
- Types of Violence Assessment (30 minutes):
- Present the following assessment methods:
- Census Data: Benefits and limitations.
- Health Impact Assessment (HIA): Application in evaluating potential health effects.
- Windshield Survey: Advantages and challenges.
- MAPP Survey: Community-driven approach.
- Hospital Needs Assessment: Role in identifying gaps.
- Present the following assessment methods:
- Group Activity (45 minutes):
- Divide students into groups.
- Assign each group a case scenario (e.g., Mary Lou, transgender man, abused child).
- Ask students to analyze data, identify violence indicators, and propose interventions.
- Discussion and Reflection (20 minutes):
- Have groups share findings and recommendations.
- Discuss the therapist’s role in treating victims of violence.
- Explore collaboration strategies between nurses and therapists.
Evaluation and Assessment
- Group Presentation: Assess students’ understanding of assessment methods, critical thinking skills, and ability to apply knowledge.
- Individual Reflection: Ask students to write a brief reflection on the exercise, highlighting key takeaways and areas for improvement.
Integration into Curriculum
- Alignment with Course Objectives: Ensure that the exercise aligns with course objectives related to public health.
- Sequencing: Determine the appropriate timing and sequencing of the exercise within the course curriculum to complement other content and activities.
- Integration of Theory and Practice:
- Incorporate violence prevention concepts into lectures and clinical scenarios.
- Encourage students to engage with local health departments and community organizations.
Resources and Support
- Learning Resources: Provide students with access to relevant literature, articles, and resources on community health assessment, including:
- Refer to the Community Health Assessment Toolkit and CDC’s CHANGE Tool.
- Explore local health department reports for community insights.
- Explore CDC’s violence prevention resources
- Faculty Support: Offer guidance, feedback, and support to students as they engage in the exercise, addressing any questions or concerns they may have about the scenario or related topics.
Conclusion
By following these guidelines, nurse educators can create an activity which can help empower nursing students to recognize and address community violence. By integrating these principles into their practice, they contribute to safer and healthier communities.
Additional Activities
Role-playing/Communication Exercise
Scenario Title
Addressing Community Violence
Objective
To enhance communication skills for effectively addressing and responding to community violence. This exercise aims to build empathy, improve active listening, and develop appropriate intervention strategies.
Roles
- Registered Nurse (RN)
- Community Member (role-played by participants)
- Observer
Materials Needed
- Role-play scenario cards
- Notepads and pens
- Guidelines for addressing community violence
- Feedback forms
Scenario Setting
A simulated community health clinic or a community meeting setting.
Role-Playing Activity
- Pre-Exercise Briefing
- Objective: Orient participants to the exercise, provide background information on community violence, and assign roles.
- Background on Community Violence:
- Definition of community violence (e.g., gang violence, domestic violence, youth violence).
- Impact of community violence on health and well-being.
- The role of nurses in identifying, addressing, and preventing community violence.
- Role Assignment:
- Assign participants to the roles of RN, Community Member, and Observer.
- Rotate roles if time permits to give each participant the chance to practice and observe.
- Role-Play Scenarios
- Objective: Practice communication skills in a safe and controlled environment.
- Scenario Cards:
- Create scenario cards with different situations involving community violence. Examples:
- A young mother seeking help after experiencing domestic violence.
- A teenager involved in gang activities and seeking advice on how to leave the gang.
- A community leader concerned about increasing youth violence and looking for preventive measures.
- A schoolteacher noticing signs of abuse in a student and seeking guidance on intervention.
- Create scenario cards with different situations involving community violence. Examples:
- Role-Playing:
- Registered Nurse (RN): Engage with the community member using active listening, empathy, and appropriate questioning techniques. Provide support and resources.
- Community Member: Role-play the given scenario, providing realistic responses and emotions based on the situation.
- Observer: Take notes on the communication skills demonstrated, including strengths and areas for improvement.
- Conducting the Role-Play
- Introduction:
- RN introduces themselves and explains their role.
- Establishes a safe and confidential environment for discussion.
- Active Listening and Empathy:
- RN listens attentively to the community member’s story without interrupting.
- Uses non-verbal cues (nodding, maintaining eye contact) to show understanding.
- Questioning and Clarification:
- RN asks open-ended questions to gather more information.
- Clarifies any ambiguities and repeats back key points to ensure understanding.
- Providing Support and Resources:
- RN offers emotional support and validates the community member’s feelings.
- Provides information on available resources (e.g., shelters, counseling services, hotlines).
- Discusses safety plans if applicable.
- Encouraging Further Communication:
- RN encourages the community member to ask questions and express any additional concerns.
- Sets up follow-up appointments or referrals if needed.
- Introduction:
Debriefing and Feedback
After the role-play, conduct a debriefing session where each participant reflects on their experience, provides feedback, and discusses lessons learned.
- Observer: Provides constructive feedback on the CHN’s communication skills, highlighting strengths and areas for improvement.
- Community Member: Shares their experience and feelings during the role-play, offering insights into what felt supportive and what could be improved.
- RN: Reflects on their own performance and identifies key takeaways.
Discussion Points:
- Importance of creating a safe and supportive environment for discussing community violence.
- Effective communication techniques for addressing sensitive and potentially traumatic topics.
- Strategies for providing appropriate resources and support.
- The role of cultural competence and understanding in addressing community violence.
Reflective Practice
This activity could occur on a discussion board or by uploading a video using Flip or Canvas Studio.
How can community health nurses effectively address and mitigate the impact of community violence while ensuring they provide compassionate and culturally sensitive care to affected individuals?
Interactive Module
Create an interactive escape room using Google Forms that challenges students to solve puzzles related to the chapter topic. These NCLEX-style questions can be a starting point.
- A community health nurse is conducting a home visit and notices signs of physical abuse on a client. The client denies any violence but exhibits fear when questioned privately. What is the nurse’s initial action?
- Document the findings and reassure the client of confidentiality.
- Confront the suspected abuser and inform them of the nurse’s observations.
- Immediately report the suspected abuse to local law enforcement.
- Offer the client resources for shelters and legal aid.
- When assessing a community for risk factors contributing to youth violence, which factor should the nurse prioritize?
- Availability of recreational facilities
- Educational attainment levels
- Access to mental health services
- Presence of community policing programs
- A nurse is developing a violence prevention program for a high-risk community. Which intervention should the nurse prioritize to address intimate partner violence?
- Providing self-defense classes for potential victims
- Establishing a hotline for reporting domestic abuse
- Conducting community workshops on healthy relationships
- Increasing police patrols in the neighborhood
- During a community health fair, a participant asks about risk factors for community violence. Which response by the nurse is most accurate?
- “Low socioeconomic status is the primary risk factor for community violence.”
- “Violence in the media has minimal impact on community violence rates.”
- “Community violence is most prevalent in rural areas compared to urban settings.”
- “Drug and alcohol use often contribute to community violence.”
- A nurse is providing education to a group of parents about preventing youth violence. Which statement by a parent indicates a need for further education?
- “I will limit my child’s exposure to violent video games and movies.”
- “I will encourage my child to join after-school programs and sports.”
- “I will teach my child effective conflict resolution skills.”
- “I will buy my child a weapon for self-defense.”
Case Study: Community Violence
Background
Brianna is a 32-year-old woman who resides in a densely populated urban neighborhood. She presents to the community health clinic with complaints of anxiety, insomnia, and recurring nightmares. Brianna is visibly distressed and hesitant to speak openly initially.
Scenario
- History: Brianna reveals that she has been in an abusive relationship with her partner for the past five years. She describes incidents of physical and emotional abuse, including being pushed, slapped, and verbally threatened. Brianna states that her partner often becomes aggressive after consuming alcohol, which occurs frequently.
- Assessment Findings: Upon further assessment, the nurse notes multiple bruises on Brianna’s arms and neck, which Brianna attributes to “accidents.” She appears anxious and hypervigilant and is constantly looking over her shoulder during the examination. Brianna discloses that she has never sought medical help before due to fear of retaliation from her partner.
- Psychosocial Assessment: Brianna reports feeling isolated from friends and family members, as her partner has restricted her interactions outside of the home. She expresses concerns about her safety and the well-being of her two young children, who witness the violence at home.
- Current Situation: Brianna is contemplating leaving her partner but is unsure where to seek help or how to ensure her safety and that of her children. She fears the consequences of leaving, as her partner has threatened to harm her if she tries to end the relationship.
- Nursing Care Plan:
- Diagnosis: Risk for injury related to ongoing domestic violence.
- Goals:
- Ensure Brianna’s safety and that of her children.
- Empower Brianna to make informed decisions regarding her relationship.
- Provide resources and support to help Brianna navigate her situation effectively.
- Interventions:
- Safety Assessment:
- Conduct a thorough safety assessment using the SAFE model (Safety, Ask, Future Planning, Empowerment).
- Develop a safety plan with Brianna, including identifying safe places to go in case of emergency and establishing a code word for help.
- Emotional Support:
- Offer emotional support and validate Brianna’s feelings of fear and anxiety.
- Utilize therapeutic communication techniques to build trust and rapport.
- Education and Counseling:
- Educate Brianna about the cycle of abuse and its impact on her and her children.
- Provide information about local domestic violence shelters, legal resources, and counseling services.
- Collaboration and Referral:
- Collaborate with social services and law enforcement to ensure Brianna’s safety.
- Facilitate referrals to a domestic violence advocate for ongoing support and legal advice.
- Follow-Up and Evaluation:
- Schedule regular follow-up visits to monitor Brianna’s progress and safety.
- Evaluate the effectiveness of interventions and adjust the care plan as needed.
- Safety Assessment:
- Outcome: Brianna agrees to develop a safety plan and seeks temporary shelter at a local domestic violence shelter. With ongoing support and counseling, she begins to regain a sense of control over her life and explores options for long-term safety and independence.
Questions for Reflection and Analysis
- Risk Assessment: What are the key factors that contribute to Brianna’s risk of injury in this case?
- Safety Planning: How can nurses effectively collaborate with other healthcare professionals and community resources to ensure the safety of patients experiencing domestic violence?
- Empowerment: Discuss strategies for empowering victims of domestic violence to make informed decisions about their safety and well-being.
Simulation
Scenario
Addressing Community Violence
Objective
To prepare nursing students to assess, intervene, and support individuals affected by community violence. It focuses on providing immediate care, assessing safety needs, and connecting individuals with appropriate resources in a community health setting.
Setting
A simulated community health clinic or outreach program.
Roles
- Registered Nurse (RN)
- Victim of Community Violence (role-played by a student
- Supportive Family Member/Friend (role-played by a student)
- Observer
Materials Needed
- Role-play scenario cards
- Notepads and pens
- Resources for community support services (simulated)
- Guidelines for managing community violence incidents
- Feedback forms
Simulation Outline
- Pre-Simulation Briefing
- Objective: Orient participants to the simulation, provide background on community violence, and assign roles.
- Background on Community Violence:
- Types of community violence (e.g., gang-related violence, domestic violence, youth violence).
- Impact of community violence on individuals’ physical, psychological, and social well-being.
- Role of community health nurses in identifying, assessing, and supporting individuals affected by community violence.
- Roles Assignment:
- Assign participants to roles such as RN, Victim of Community Violence, Supportive Family Member/Friend, and Observer.
- Discuss safety protocols, trauma-informed care principles, and resources available for victims of community violence.
- Role-Play Scenarios
- Objective: Practice nursing skills in a simulated environment focused on managing incidents of community violence and providing compassionate care.
- Scenario Cards:
- Develop scenario cards with different types of community violence incidents. Examples include:
- A victim of domestic violence seeking medical attention and support.
- A teenager involved in gang-related violence seeking guidance and resources to leave the gang.
- A community member experiencing trauma following a violent incident in the neighborhood.
- Role-Playing:
- Registered Nurse (RN): Assess the situation, provide immediate care, and initiate supportive interventions.
- Victim of Community Violence: Portray symptoms and responses realistically based on the scenario card.
- Supportive Family Member/Friend: Express concerns, provide information, and seek guidance on supporting their loved one.
- Observer: Take notes on the interactions, communication strategies, and actions of the participants.
- Conducting the Role-Play
- Assessment and Immediate Care:
- RN conducts a thorough assessment of the victim’s physical injuries and emotional state.
- Provides first aid as needed and addresses immediate safety concerns.
- Communication and Support:
- Utilize therapeutic communication techniques to build trust and rapport with the victim and family members.
- Offer emotional support, validate feelings, and provide information about available resources (e.g., shelters, counseling services).
- Safety Planning and Referral:
- Collaborate with the victim and family members to develop a safety plan tailored to their needs.
- Facilitate referrals to community resources, such as domestic violence shelters, legal aid services, and mental health professionals.
- Documentation and Follow-Up:
- Document the incident, assessment findings, interventions provided, and referrals made.
- Schedule follow-up appointments to monitor the victim’s progress and ensure continuity of care.
- Assessment and Immediate Care:
Debriefing and Feedback
After the simulation, conduct a debriefing session where each participant reflects on their experience, provides feedback, and discusses lessons learned.
Feedback Session:
- Observer: Provide constructive feedback on communication skills, trauma-informed care approaches, and collaboration demonstrated during the simulation.
- Participants: Reflect on their roles and actions, identifying effective strategies and areas for improvement.
- Discuss the emotional and ethical challenges of providing care to individuals affected by community violence.
Discussion Points:
- Importance of trauma-informed care principles in managing and supporting victims of community violence.
- Strategies for identifying and addressing social determinants of health contributing to community violence.
- Role of community partnerships and resources in promoting community safety and well-being.
Competency Assessment
Activity
Assessment and Screening
Demonstration
- Risk Assessment: Use standardized tools to assess the risk of violence in various community settings.
- Screening Protocols: Conduct routine screenings for signs of violence during patient interactions during simulation and clinical.
Clinical Activities/Opportunities
- School Health Programs: Participate in school-based health programs to address bullying, teen dating violence, and other forms of youth violence.
- Domestic Violence Shelters: Work with shelter staff to provide medical care, support, and safety planning for survivors of domestic violence.