Table of Contents
Introduction
Section I: Definitions and Anatomic Review
Section II: Case Study Chapters
1. 32-Year-Old Female Strangulation Patient with Hyoid Bone Fracture and Suicidal Ideation
2. 21-Year-Old Male Patient Assaulted by an Acquaintance
3. 66-Year-Old Female Patient Assaulted by Her Son
4. 17-Year-Old Female Patient Assaulted by an Acquaintance
5. 26-Year-Old Female Patient Assaulted by a Former Intimate Partner
6. 15-Year-Old Female Patient Assaulted by a Stranger
7. 24-Year-Old Female Patient Assaulted by a Former Intimate Partner
8. 65-Year-Old Female Patient Assaulted by a Former Intimate Partner
9. 31-Year-Old Female Patient Assaulted by a Former Intimate Partner
10. 22-Year-Old Female Patient Assaulted by a Former Intimate Partner
11. 70-Year-Old Male Patient Assaulted by an Employee
12. 56-Year-Old Female Patient Assaulted by an Ex-Husband
13. 30-Year-Old Female Patient Assaulted and Strangled by an Intimate Partner
14. 25-Year-Old Female Patient Assaulted by a Stranger
15. 46-Year-old Female Patient Assaulted and Strangled by her Husband
Section III: Appendix
Section IV: Recommended Reading
Section V: Answer Key
Domestic Violence and Nonfatal Strangulation Assessment is a valuable tool to educate first responders, SAFE/SANE nurses, and medical providers on how to assess, document, and treat victims of nonfatal strangulation. It starts by standardizing basic definitions and moves on to discuss the anatomy, signs and symptoms, and injuries seen in victims of strangulation. Information on the various imaging modalities and what each specific technique visualizes is provided. The multiple case studies, along with the resources in the appendices and the recommended readings, serve to standardize our documentation. This book provides invaluable, evidence-based information to both novice providers and experienced providers alike.
Rosalyn Berkowitz, BSN, RN, FNE A/P
Forensic Nurse Examiner
SAFE and Domestic Violence Program
Greater Baltimore Medical Center
Towson, Maryland
Strangulation victims most often do not have signs or symptoms of strangulation. The Domestic Violence and Nonfatal Strangulation Assessment is very important to implement in every health care provider’s practice. This guide does a great job presenting case studies from everyday practice and gives you the knowledge you will need to assess the strangulation victim while using the best evidence-based practices and tools. Photos are used to discuss the anatomic location of common injuries and proper documentation of those injuries. Safety and proper discharge planning are essential in these patients and are discussed in the guide with great resource recommendations for the victims. Overall, this an excellent guide from a very knowledgeable group of expert authors.
Natalie Calow, MSN, RN, CEN
Forensic Nurse
IUH Methodist Hospital
Indianapolis, Indiana
The case studies used in this comprehensive guide can be extremely helpful for newer forensic nurses or for those working in rural areas that may not have seen the volume of forensic examinations a busier metropolitan area has. The pictures and activities at the end of each chapter will help prepare these nurses for the injuries they might see during a strangulation examination.
Kristin Hall, BSN, RN, CEN
Clinical Director
Family Justice Center SANE
The Domestic Violence and Nonfatal Strangulation Assessment for Health Care Providers and First Responders will be a tremendous asset for those that encounter a victim of strangulation. Often, first responders may not be trained on the signs and symptoms of a strangulation assault and may overlook some important information and assessments. The use of case studies and imaging in this guidebook will assist first responders and health care providers in recognizing some of the physical signs that may be present, but also the verbal identifiers the victim may report. This guide will provide a quick and easily accessible reference to understand the uniqueness of this form of violence and provide the necessary steps to provide the best practice initial care and compassion these individuals will need upon first contact with health care or law enforcement.
Lori Combs, BS, RN, LNC
Forensic Nurse Expert/Forensic Consultant
Critical Analysis Consulting RN
Fort Myers/Cape Coral, Florida
Domestic Violence and Nonfatal Strangulation Assessment for Health Care Providers and First Responders is a collection of case studies that presents relevant discussions and activities to enhance the user’s knowledge base surrounding nonfatal strangulation. Leaders in the field have compiled pertinent case studies, including photographs, which promote discussion of the challenges surrounding nonfatal strangulation cases and provide best practice recommendations for these cases. We keep this workbook in our “library.” It is used as a teaching aid and reference for SANEs.
Each case study provides an anatomic skill review that reinforces areas of interest or concern when caring for victims of nonfatal strangulation. An injury identification activity for each case study provides visual cues for photodocumentation and can bolster the provider’s documentation skills by incorporating key descriptive words to use when describing findings. Case studies also provide activities to enhance the user’s assessment and evidence collection skills. Activities are designed to encourage the user to outline appropriate care and referrals for each patient.
Jennifer Knowlton, RN, SANE-A
Chief Executive Officer
Chesapeake Forensic Specialists
Chesapeake, Virginia
This workbook lays the foundation of fundamental concepts necessary for evidence-based clinical and medical-forensic assessment and care of the strangulation patient. It addresses key information that underlies the background and dynamics of domestic violence and applies it toward a holistic care approach. Each case study looks at the unique medical and psychosocial implications. A literature-based discussion is provided, which drives clinical decision making, safety planning, and mental and behavioral health guidance. Health care providers can rely on this resource to enhance their care plans to meet the comprehensive set of needs of the strangulation patient.
Amber O’Malley, MSN, RN, SANE-A, SANE-P
Forensic Nurse Examiner
NWA Forensic Nurses
Bentonville, Arkansas
The Domestic Violence and Nonfatal Strangulation Assessment is an outstanding guide for those who provide care to victims of domestic and intimate partner violence affected by strangulation. This workbook is all-encompassing and addresses the physical, mental, emotional, social, and legal challenges victims and providers experience when providing care to those impacted by violence. It highlights evidence-based practice screening tools, diagnostic testing, assessment pearls, evidence collection, and resources, enhancing a provider’s ability to deliver safe, quality, comprehensive medical-forensic treatment and care. This workbook is not only a must-read for forensic nurses, but for all health care providers.
Jennifer Barrett, MSN, RN, CNS, SANE-A, SANE-P
Sexual Assault Nurse Examiner,
Forensic Clinical Nurse Specialist
Denver Health Medical Center
Denver, Colorado
