Violence and Abuse

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Violence and Abuse

  1. 1. This material is the private property of Chesapeake Medical Staffing. Any duplication or use by anyone other than an employee of Chesapeake Medical Staffing is prohibited. Violence and Abuse JCAHO Mandatory Annual Competency Chesapeake Medical Staffing
  2. 2. This material is the private property of Chesapeake Medical Staffing. Any duplication or use by anyone other than an employee of Chesapeake Medical Staffing is prohibited. Content Domestic Violence Vulnerable Adult Abuse & Neglect Child Abuse Violence in the Workplace
  3. 3. This material is the private property of Chesapeake Medical Staffing. Any duplication or use by anyone other than an employee of Chesapeake Medical Staffing is prohibited. Domestic Violence Domestic violence is the use of physical abuse, verbal or emotional abuse, sexual abuse, or economic abuse (e.g. withholding money, lying about assets) to exert power or control over someone or to prevent someone from making a free choice. Three-fourths of domestic violence victims are women. Domestic violence is a major public health problem in the United States and around the world—even more prevalent than rape or assault by strangers or acquaintances.
  4. 4. This material is the private property of Chesapeake Medical Staffing. Any duplication or use by anyone other than an employee of Chesapeake Medical Staffing is prohibited. Prevalence The CDC reports that domestic violence affects more than 32 million Americans annually, causing more than 2 million injuries and approximately 1300 deaths (CDC, 2005). Domestic violence strikes all ages, cultural/ethnic/religious groups, and social classes. Rape, incest, and dating violence are all forms of domestic violence.
  5. 5. This material is the private property of Chesapeake Medical Staffing. Any duplication or use by anyone other than an employee of Chesapeake Medical Staffing is prohibited. National Domestic Violence Hotline “We have to be very careful when citing statistical reports that we don’t create the perception that anyone actually has a handle on the rate of domestic violence in America. The truth is, domestic violence is rampant and diverse, and it’s still something no one wants to talk about.” Sheryl Cates, Executive Director National Domestic Violence Hotline
  6. 6. This material is the private property of Chesapeake Medical Staffing. Any duplication or use by anyone other than an employee of Chesapeake Medical Staffing is prohibited. Categories of Sexual Violence Sexual violence can be categorized as: • Use of physical force to compel a person to engage in a sexual act against his or her will, even if the act is not completed. • Attempted or completed sex act involving a person who is unable to understand the nature or condition of the act, to decline participation, or to communicate unwillingness to engage in the sexual act because of illness, disability, or the influence of alcohol or other drugs, or because of intimidation or pressure. • Abusive sexual contact.
  7. 7. This material is the private property of Chesapeake Medical Staffing. Any duplication or use by anyone other than an employee of Chesapeake Medical Staffing is prohibited. Threats Threats of physical or sexual violence may include the use of “words, gestures, or weapons to communicate the intent to cause death, disability, injury, or physical harm.”
  8. 8. This material is the private property of Chesapeake Medical Staffing. Any duplication or use by anyone other than an employee of Chesapeake Medical Staffing is prohibited. Psychological/Emotional Violence • Psychological/emotional violence “involves trauma to the victim caused by acts, threats of acts, or coercive tactics.” • Psychological/emotional abuse can include, but is not limited to, humiliation; controlling what the victim can and cannot do; withholding information; deliberately embarrassing the victim; isolating the victim from family and friends; and denying access to money or other basic resources.
  9. 9. This material is the private property of Chesapeake Medical Staffing. Any duplication or use by anyone other than an employee of Chesapeake Medical Staffing is prohibited. Intimate Partner Violence • Intimate partner violence (IPV) is one of the most common and least reported crimes according to the National Violence Against Women Survey (National Institute of Justice, 2000). • Risk of becoming a victim of IPV is highest among American Indian and Alaskan Native women and men, African American women, Hispanic women, young women, and those below the poverty line.
  10. 10. This material is the private property of Chesapeake Medical Staffing. Any duplication or use by anyone other than an employee of Chesapeake Medical Staffing is prohibited. Stalking Stalking generally refers to repeated behavior, such as following someone, that evokes a high level of fear in the victim. Stalking is considered by some states as a type of intimate partner violence.
  11. 11. This material is the private property of Chesapeake Medical Staffing. Any duplication or use by anyone other than an employee of Chesapeake Medical Staffing is prohibited. Shame and Fear The shame and fear surrounding domestic violence silences many victims. Research shows that at least 4 out of 10 incidents of domestic violence are not reported to the police (Durose et al., 2005). Many abused women do not report IPV (Intimate Partner Violence) to their physicians or to anyone else.
  12. 12. This material is the private property of Chesapeake Medical Staffing. Any duplication or use by anyone other than an employee of Chesapeake Medical Staffing is prohibited. Risk Factors for Domestic Violence • Poverty • Family/Caregiver Stress • Pregnancy • Disability/Impairment
  13. 13. This material is the private property of Chesapeake Medical Staffing. Any duplication or use by anyone other than an employee of Chesapeake Medical Staffing is prohibited. Screening and Assessment Every healthcare facility serving women, children, and older adults needs to screen for potential domestic violence. This screening need not be lengthy. The screening can be part of the intake interview or included as part of the written history. The nurse admitting a patient to an inpatient unit, ER, L&D or primary care visit is responsible for completing the violence screening. A “yes” response is an automatic referral to a social worker or social services.
  14. 14. This material is the private property of Chesapeake Medical Staffing. Any duplication or use by anyone other than an employee of Chesapeake Medical Staffing is prohibited. Signs and Symptoms Related to IPV(Intimate Partner Violence) During the appointment, be aware of lack of eye contact and/or a husband or boyfriend who is reluctant to leave the woman alone with the healthcare provider. Suicide attempts may be directly related to IPV (Intimate Partner Violence). In addition, make note of: • delay in seeking care after physical injury • missed appointments • vague or inconsistent explanation of injuries • nonspecific somatic complaint • depression and social isolation • substance abuse • use of alcohol or drugs
  15. 15. This material is the private property of Chesapeake Medical Staffing. Any duplication or use by anyone other than an employee of Chesapeake Medical Staffing is prohibited. Documenting Suspected Domestic Violence Accurate, thorough documentation of the patient's injuries is essential in cases of suspected abuse because it can serve as objective, third-party evidence useful in legal proceedings. For example, medical records can help victims to obtain a restraining order, or to qualify for public housing, welfare, health and life insurance, and immigration relief.
  16. 16. This material is the private property of Chesapeake Medical Staffing. Any duplication or use by anyone other than an employee of Chesapeake Medical Staffing is prohibited. Phrases to Avoid Health professionals should avoid any phrases such as “patient claims” or “patient alleges” that cast doubt on the patient's reliability. Also avoid legal terms such as “alleged perpetrator” or “assailant.” Do not use conclusive terms such as “assault and battery” or “domestic violence” in documenting a case; let the factual information in the record speak for itself.
  17. 17. This material is the private property of Chesapeake Medical Staffing. Any duplication or use by anyone other than an employee of Chesapeake Medical Staffing is prohibited. ABCDES Framework A Assure the woman she is not alone. Isolation enforced by her abusive partner prevents her understanding that others are in a similar situation and that health care providers can help. B Express the belief that violence against the woman is unacceptable in any situation and that it is not her fault. C Ensure confidentiality. She may fear (justifiably) that the abuser will retaliate. D Document the case thoroughly (see above). E Educate the woman about the cycle of violence (Box 2), the likelihood of repeated violence, and her options for ending the abuse. S Safety. Help the woman formulate a plan of action for either leaving or remaining in the relationship, which some women do for a variety of reasons. Provide information about available resources such as hotline and shelter numbers. Suggest that a quick getaway bag packed with personal items be hidden or left with a neighbor.
  18. 18. This material is the private property of Chesapeake Medical Staffing. Any duplication or use by anyone other than an employee of Chesapeake Medical Staffing is prohibited. Patient and Family Interventions Begin intervention by believing any woman who admits being abused. She has shown trust and courage to disclose the facts. Skillful, nonjudgmental interviewing can help build trust and establish a therapeutic relationship. Patient safety, support and education are professional responsibilities of health care providers.
  19. 19. This material is the private property of Chesapeake Medical Staffing. Any duplication or use by anyone other than an employee of Chesapeake Medical Staffing is prohibited. Healthcare Setting "As the single most important and most accessed institution in the lives of women, the healthcare setting can provide a unique opportunity to intervene, making it one of the newest and most critical areas of the domestic violence movement today" (Family Violence Prevention Fund, 2001).
  20. 20. This material is the private property of Chesapeake Medical Staffing. Any duplication or use by anyone other than an employee of Chesapeake Medical Staffing is prohibited. Healthcare Implications Domestic violence has an enormous impact on the healthcare system. Homicide, injury, mental illness, substance abuse, and the legacy of violence from generation to generation may all be related to domestic violence. Women are the most frequent consumers of healthcare services and the most common victims of domestic violence. This puts healthcare providers in the best position to identify victims of domestic violence and make appropriate referrals to protect them against further harm.
  21. 21. This material is the private property of Chesapeake Medical Staffing. Any duplication or use by anyone other than an employee of Chesapeake Medical Staffing is prohibited. Vulnerable Adult Abuse or Neglect
  22. 22. This material is the private property of Chesapeake Medical Staffing. Any duplication or use by anyone other than an employee of Chesapeake Medical Staffing is prohibited. Vulnerable Abuse Abuse of the vulnerable elder has reached epidemic proportions in the United States. Elderly people may be more vulnerable to abuse than others because of social isolation and mental impairment.
  23. 23. This material is the private property of Chesapeake Medical Staffing. Any duplication or use by anyone other than an employee of Chesapeake Medical Staffing is prohibited. Vulnerable Adult Abuse ABUSE: the sustaining of physical injury by a vulnerable adult as a result of cruel or inhumane treatment or as a result of a malicious act by any person.
  24. 24. This material is the private property of Chesapeake Medical Staffing. Any duplication or use by anyone other than an employee of Chesapeake Medical Staffing is prohibited. Signs of Physical Abuse • Multiple injuries • Injuries that normally would not occur together • Bruises, welts or abrasions • The use of physical restraints, such as tying • Burns that could come from cigarettes or immersion to water that is too hot • A caregiver's refusal to allow visitors to see the person alone • Lab findings indicating over-medication
  25. 25. This material is the private property of Chesapeake Medical Staffing. Any duplication or use by anyone other than an employee of Chesapeake Medical Staffing is prohibited. Vulnerable Adult Neglect NEGLECT: the willful deprivation of adequate food, clothing, medical treatment, or rehabilitation therapy, shelter, or supervision from a vulnerable adult.
  26. 26. This material is the private property of Chesapeake Medical Staffing. Any duplication or use by anyone other than an employee of Chesapeake Medical Staffing is prohibited. Signs of Physical Neglect • Dehydration • Malnourishment without a cause related to illness • Failure to provide physical aids such as glasses, hearing aids, or false teeth • Pressure ulcers • Lack of compliance with medical care instructions
  27. 27. This material is the private property of Chesapeake Medical Staffing. Any duplication or use by anyone other than an employee of Chesapeake Medical Staffing is prohibited. Signs of Psychological Abuse • Statements about a caretaker that indicate fear • Threats or insults by caretaker • Caretaker talks of person as a burden • Person is withdrawn; gives short answers to questions, averts gaze • Person is not given opportunity to talk to others alone • Caregiver leaves person alone for long periods of time • Caregiver ignores person; gives "silent treatment" • Person shows signs of infantile behavior; antisocial behavior
  28. 28. This material is the private property of Chesapeake Medical Staffing. Any duplication or use by anyone other than an employee of Chesapeake Medical Staffing is prohibited. Self Neglect SELF-NEGLECT: the inability of a vulnerable adult to provide for his/her physical or mental health and well-being.
  29. 29. This material is the private property of Chesapeake Medical Staffing. Any duplication or use by anyone other than an employee of Chesapeake Medical Staffing is prohibited. Exploitation EXPLOITATION: any action which involves the misuse of a vulnerable adult's funds, property, or person.
  30. 30. This material is the private property of Chesapeake Medical Staffing. Any duplication or use by anyone other than an employee of Chesapeake Medical Staffing is prohibited. Signs of Financial Neglect or Exploitation • Someone has the person's mail sent to their own address • person is confused about his or her income and resources • possessions and quality of life seems substandard given the resources the person has • frequent or large gifts to a caregiver • frequent checks written to caregiver • unusual activity in bank accounts • personal belongings missing • person signs as surety or co-signer on loans • someone lives with the person and refuses to leave • numerous unpaid bills despite adequate income • other persons added to bank accounts
  31. 31. This material is the private property of Chesapeake Medical Staffing. Any duplication or use by anyone other than an employee of Chesapeake Medical Staffing is prohibited. Maryland Adult Protective Services This program serves persons aged 18 or over who lack the physical or mental capacity to provide for their daily needs. The purpose of the program is to prevent or remedy the abuse, neglect, self-neglect, or exploitation of adults who are unable to protect their own interests and are at risk of immediate harm to their own person or to others. The program provides professional services to protect the health, safety, and welfare of endangered, vulnerable adults.
  32. 32. This material is the private property of Chesapeake Medical Staffing. Any duplication or use by anyone other than an employee of Chesapeake Medical Staffing is prohibited. Reporting Adult Abuse or Neglect Under Section 14-309 of the Family Law Article, Annotated Code of Maryland, any health practitioner, police officer, or human service worker who has reason to believe that a Vulnerable adult is in danger is required to report that fact to the local department of social services. The law states "any person who in good faith makes or participates in making a report under this subtitle or participates in an investigation or a judicial proceeding resulting from a report under this subtitle is immune from any civil liability that would otherwise result."
  33. 33. This material is the private property of Chesapeake Medical Staffing. Any duplication or use by anyone other than an employee of Chesapeake Medical Staffing is prohibited. Toll Free Hot Line to Report Adult Abuse TOLL FREE ABUSE HOTLINE 1-800-91-PREVENT (1-800-917-7383) OR YOUR LOCAL DEPARTMENT OF SOCIAL SERVICES.
  34. 34. This material is the private property of Chesapeake Medical Staffing. Any duplication or use by anyone other than an employee of Chesapeake Medical Staffing is prohibited. Child Abuse
  35. 35. This material is the private property of Chesapeake Medical Staffing. Any duplication or use by anyone other than an employee of Chesapeake Medical Staffing is prohibited. Recognition Child abuse is both shocking and commonplace. Child abusers inflict physical, sexual, and emotional trauma on defenseless children every day. The scars can be deep and long-lasting. Unfortunately, the more subtle forms of child abuse such as neglect and emotional abuse can be even more traumatizing than violent physical abuse. The first step in helping abused or neglected children is learning to recognize the signs of child abuse and neglect.
  36. 36. This material is the private property of Chesapeake Medical Staffing. Any duplication or use by anyone other than an employee of Chesapeake Medical Staffing is prohibited. Difficult to Recognize It's not always easy to recognize when a child has been abused. Children who have been mistreated are often afraid to tell anyone because they think they will be blamed or that no one will believe them. Parents also tend to overlook symptoms because they don't want to face the truth. This is a serious mistake. A child who has been abused needs special support and treatment as early as possible. The longer he continues to be abused or is left to deal with the situation on his own, the less likely he is to make a full recovery.
  37. 37. This material is the private property of Chesapeake Medical Staffing. Any duplication or use by anyone other than an employee of Chesapeake Medical Staffing is prohibited. CAPTA (Child Abuse Prevention & Treatment Act) Child abuse and neglect are defined by both Federal and State law. The Child Abuse Prevention and Treatment Act (CAPTA) is the Federal legislation that provides minimum standards for the definition of child abuse and neglect that States must incorporate in their statutory definitions. Under CAPTA, child abuse and neglect means, at a minimum, any recent act or failure to act on the part of a parent or caretaker, which results in death, serious physical or emotional harm, sexual abuse, or exploitation, or an act or failure to act which presents an imminent risk of serious harm.
  38. 38. This material is the private property of Chesapeake Medical Staffing. Any duplication or use by anyone other than an employee of Chesapeake Medical Staffing is prohibited. Definition of Child Abuse Child abuse consists of any act, or failure to act, that endangers a child's physical or emotional health and development. Someone is abusive if he or she fails to nurture the child, physically injures the child, or relates sexually to the child.
  39. 39. This material is the private property of Chesapeake Medical Staffing. Any duplication or use by anyone other than an employee of Chesapeake Medical Staffing is prohibited. Types of Child Abuse The four major types of child abuse are: • physical abuse • sexual abuse • emotional abuse • neglect
  40. 40. This material is the private property of Chesapeake Medical Staffing. Any duplication or use by anyone other than an employee of Chesapeake Medical Staffing is prohibited. Physical Indicators of Child Abuse • Any injury (bruise, burn, fracture, abdominal or head injury) that cannot be explained • Multiple injuries (in various stages of healing) • Unexplained injuries (especially located in parts of the body not usually affected by normal childhood activity (i.e. eyes, mouth, neck, cheeks, lower back, genital area, buttocks, abdomen)
  41. 41. This material is the private property of Chesapeake Medical Staffing. Any duplication or use by anyone other than an employee of Chesapeake Medical Staffing is prohibited. Signs of Sexual Abuse • Fearful behavior (nightmares, depression, unusual fears, attempts to run away) • Abdominal pain, bedwetting, urinary tract infection, genital pain or bleeding, sexually transmitted disease • Extreme sexual behavior that seems inappropriate for the child's age
  42. 42. This material is the private property of Chesapeake Medical Staffing. Any duplication or use by anyone other than an employee of Chesapeake Medical Staffing is prohibited. Signs of Emotional Abuse • Sudden change in self-confidence • Headaches or stomachaches with no medical cause • Abnormal fears, increased nightmares • Attempts to run away
  43. 43. This material is the private property of Chesapeake Medical Staffing. Any duplication or use by anyone other than an employee of Chesapeake Medical Staffing is prohibited. Signs of Emotional Neglect • Failure to gain weight (especially in infants) • Desperately affectionate behavior • Voracious appetite and stealing of food
  44. 44. This material is the private property of Chesapeake Medical Staffing. Any duplication or use by anyone other than an employee of Chesapeake Medical Staffing is prohibited. Long-Term Consequences of Abuse and Neglect In most cases, children who are abused or neglected suffer greater emotional than physical damage. A child who is severely mistreated may become depressed or develop suicidal, withdrawn or violent behavior. As the child gets older, he/she may use drugs or alcohol, try to run away, refuse discipline or abuse others. As an adult, he/she may develop marital and sexual difficulties, depression or suicidal behavior.
  45. 45. This material is the private property of Chesapeake Medical Staffing. Any duplication or use by anyone other than an employee of Chesapeake Medical Staffing is prohibited. Reporting Suspected Child Abuse or Neglect CODE OF MARYLAND REGULATIONS, Section 07.02.07 requires reporting child abuse or neglect in the following manner: An individual shall immediately report suspected child abuse or neglect to the local department of social services, or report the suspected incident to a local law enforcement agency. Reports of abuse shall be made to the local departments of social services or the appropriate law enforcement agency. Reports of neglect shall be made to local departments of social services.
  46. 46. This material is the private property of Chesapeake Medical Staffing. Any duplication or use by anyone other than an employee of Chesapeake Medical Staffing is prohibited. It’s the Law Health practitioners, educators, human service workers, and police officers are required to report, both orally and in writing, any suspected child abuse or neglect, with oral report being made immediately and the written report being made within 48 hours of the contact which disclosed the suspected abuse or neglect.
  47. 47. Workplace Violence
  48. 48. This material is the private property of Chesapeake Medical Staffing. Any duplication or use by anyone other than an employee of Chesapeake Medical Staffing is prohibited. Violence : An Occupational Hazard Today more than 5 million U.S. hospital workers from many occupations perform a wide variety of duties. They are exposed to many safety and health hazards, including violence. Recent data indicate that hospital workers are at high risk for experiencing violence in the workplace. Several studies indicate that violence often takes place during times of high activity and interaction with patients, such as at meal times and during visiting hours and patient transportation. Assaults may occur when service is denied, when a patient is involuntarily admitted, or when a health care worker attempts to set limits on eating, drinking, or tobacco or alcohol use.
  49. 49. This material is the private property of Chesapeake Medical Staffing. Any duplication or use by anyone other than an employee of Chesapeake Medical Staffing is prohibited. What is workplace violence? Workplace violence ranges from offensive or threatening language to homicide. NIOSH (National Institute for Occupational Safety and Health) defines workplace violence as violent acts (including physical assaults and threats of assaults) directed toward persons at work or on duty.
  50. 50. This material is the private property of Chesapeake Medical Staffing. Any duplication or use by anyone other than an employee of Chesapeake Medical Staffing is prohibited. Examples of Violence • Threats: expressions of intent to cause harm, including verbal threats, threatening body language, and written threats. • Physical assaults: attacks ranging from slapping and beating to rape, homicide, and the use of weapons such as firearms, bombs, or knives. • Muggings: aggravated assaults, usually conducted by surprise and with intent to rob.
  51. 51. This material is the private property of Chesapeake Medical Staffing. Any duplication or use by anyone other than an employee of Chesapeake Medical Staffing is prohibited. High Risk Units Violence may occur anywhere in the hospital, but it is most frequent in the following areas: • Psychiatric units • Emergency departments • Waiting rooms • Geriatric units
  52. 52. This material is the private property of Chesapeake Medical Staffing. Any duplication or use by anyone other than an employee of Chesapeake Medical Staffing is prohibited. Risk Factors • Working directly with volatile people, especially, if they are under the influence of drugs or alcohol or have a history of violence or certain psychotic diagnoses • Working when understaffed-especially during meal times and visiting hours • Transporting patients • Long waits for service • Overcrowded, uncomfortable waiting rooms • Working alone • Poor environmental design
  53. 53. This material is the private property of Chesapeake Medical Staffing. Any duplication or use by anyone other than an employee of Chesapeake Medical Staffing is prohibited. Risk Factors (cont) • Inadequate security • Lack of staff training and policies for preventing and managing crises with potentially volatile patients • Drug and alcohol abuse • Access to firearms • Unrestricted movement of the public • Poorly lit corridors, rooms, parking lots, and other areas
  54. 54. This material is the private property of Chesapeake Medical Staffing. Any duplication or use by anyone other than an employee of Chesapeake Medical Staffing is prohibited. Prevention Strategies for Employers To prevent violence in hospitals, employers should develop a safety and health program that includes management commitment, employee participation, hazard identification, safety and health training, and hazard prevention, control, and reporting. Employers should evaluate this program periodically. Although risk factors for violence are specific for each hospital and its work scenarios, employers can follow general prevention strategies.
  55. 55. This material is the private property of Chesapeake Medical Staffing. Any duplication or use by anyone other than an employee of Chesapeake Medical Staffing is prohibited. Safety Tips for Hospital Workers Watch for signals that may be associated with impending violence: • verbally expressed anger and frustration • body language such as threatening gestures • signs of drug or alcohol use • presence of a weapon
  56. 56. This material is the private property of Chesapeake Medical Staffing. Any duplication or use by anyone other than an employee of Chesapeake Medical Staffing is prohibited. Maintain Behavior That Helps Diffuse Anger • Present a calm, caring attitude. • Don't match the threats. • Don't give orders. • Acknowledge the person's feelings (for example, "I know you are frustrated"). • Avoid any behavior that may be interpreted as aggressive (for example, moving rapidly, getting too close, touching, or speaking loudly).
  57. 57. This material is the private property of Chesapeake Medical Staffing. Any duplication or use by anyone other than an employee of Chesapeake Medical Staffing is prohibited. Be Alert • Evaluate each situation for potential violence when you enter a room or begin to relate to a patient or visitor. • Be vigilant throughout the encounter. • Don't isolate yourself with a potentially violent person. • Always keep an open path for exiting-don't let the potentially violent person stand between you and the door.
  58. 58. This material is the private property of Chesapeake Medical Staffing. Any duplication or use by anyone other than an employee of Chesapeake Medical Staffing is prohibited. Steps to Defuse An Escalating Situation • Remove yourself from the situation. • Call security for help. • Report any violent incidents to your management.
  59. 59. This material is the private property of Chesapeake Medical Staffing. Any duplication or use by anyone other than an employee of Chesapeake Medical Staffing is prohibited. Workplace Violence Prevention All hospitals should develop a comprehensive violence prevention program. No universal strategy exists to prevent violence. The risk factors vary from hospital to hospital and from unit to unit. All healthcare workers should be alert and cautious when interacting with patients and visitors. You should actively participate in safety training programs and be familiar with the hospital policies, procedures, and materials on violence prevention.
  60. 60. Summary: You Must Report Abuse or Neglect All health care providers are obligated by Maryland law to report cases of suspected child abuse or vulnerable adult abuse or neglect to either the police or local social service agencies.
  61. 61. This material is the private property of Chesapeake Medical Staffing. Any duplication or use by anyone other than an employee of Chesapeake Medical Staffing is prohibited. Healthcare Workers Can Make a Difference Healthy People 2010 named injury and violence as one of the ten leading health indicators that will be used to measure the health of the United States during the first ten years of the twenty- first century. Health professionals can make a critical difference in the progress toward ending this costly, destructive epidemic and halting the transmission of violence from generation to generation.

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