Hi, I'm Sarah Lavonne and I'm so glad you're here. Here at Bundle Birth, we believe that your life has the potential to make a deep, meaningful impact on the world around you. You, as a nurse, have the ability to add value to every person and patient you touch. We want to inspire you with the resources, education, and stories to support you to live your absolute best life both in and outside of work. But don't expect perfection over here. We're just here to have some conversations about anything birth, work, and life. Trying to add some happy to your hour as we all grow together. Bye nurses for nurses. This is Happy Hour with Bundle Birth Nurses. Welcome back to Happy Hour with Bundle Birth Nurses. I have Morgan here and if you have not listened to episode 1 of this now series, uh please pause this episode and go back to episode 1 because we are literally picking up exactly where we left off with that episode specifically talking about near fatal strangulation. And right now we are getting into the nursing assessment side even more so. And so the resource that you just heard about is a resource that is in your show notes down below. You can check it out yourself, download it, bring it to your unit, have it in your resources list, wherever you keep the resources that you're referencing on the regular. As we all continue to be better and continue to be, I'm going to say more thoughtful, more thorough, more equipped nurses in our specialty. um in ways that maybe we when you got into nursing you never thought that you would actually have to be. And so we left off our last conversation specifically talking about what we as nurses may recognize at the bedside in the case of a near fatal strangulation. So you talked about some of those like physical symptoms and we we can you can reference the the resource down below and that to be honest like the pictures and all that is like so helpful for my brain as well. So you can reference that. Some of the other things that you mentioned as far as just things that they would say potentially. Is there anything else that you want nurses to know about the signs that we are looking for as nurses? Again, sometimes they are very subtle. They are very subtle. Um you know it's sometimes it's in their hair, sometimes it's behind their ears. um you know but if if they have shared with you anything that has happened right if something looks off you know our assessment skills are so important and it's the follow-up question right because we're not going to assume we never assume right so sometimes and again you build that rapport and you look down like hey girl what happened to that nail and if you immediately see them do like they put their head down they don't want to talk about it they make oh you know I broke it on something like girl, how'd you break it? You know, um, find out. It might be just as simple as, oh, I was trying to open a can, you know, and then it might be something more, you know. The other thing is, um, trying to connect with them and ask those questions because sometimes I think sometimes we don't want the answer. We don't want to know. And it's probably because I don't want to know because I don't know how to help. And if I know now I now I got to do something about it, right? And I know that mandatory reporting can be scary. I know all these things can be scary. I'm not asking labor and delivery nurses to be forensic nurses. All I'm asking is that when they come in, you do your intimate partner violence screening. Do it right. Do it right, please. I know it can be hard. And we're going to talk more about how to do it right. And um if your spidey senses are tingling, let's escalate. Let's bring in a forensic nurse. Let's do a thing. So speaking of Spidey sense, based on last episode, we learned that one in four Mhm. women experience domestic violence in their lifetime. Yes. Right. And we know that the instance goes up in pregnancy. And so when we're asking those questions, it's easy to blow over and be like, "Oh, well, there there's no way, no chance." It's ignorance is bliss, denial, call it whatever it is. But the reality is that one in four at some point in their life, whether they're experiencing it actively with their current partner or not, have experienced domestic violence. And so, talk me through you as a forensic nurse and as somebody who specializes in this. What are your suggestions for us slash what do you do? Talk me through how you approach those the questions in our intake which are do you feel safe at home like you know and they're like they're they they to me it's almost like I feel awkward to be honest for one and I feel like oh no one's going to tell me this. Um, right. So, the first thing, um, again, your assessment skills, using your eyes, right? Look at your patient. Look at their demeanor, how they're holding themselves. Now, if she's, you know, 9 cm and doing the things and we're about to rocket out a baby, this is not the time for this, right? Yeah. Um, but you know what's going on? What's happening in the moment? if they're coming in or if they're with me and something feels off or just in general like with everyone because I'm going to ask everyone this question. I if if the other partner is carrying the bags, right, I might get mom into the room and like, you know, walk her to the bathroom and be like, "Here's the cup that I need you to pee in and here's a gown and hey, I just want to ask with like a very soft voice." And I ask everyone, you know, and I'm gonna use my normal voice because obviously we're recording, but you know, right? Are do you feel safe at home, is everything okay? And and I'm like, you know, and if they they'll look me in the eye and I' I've had someone shake their head like no before. And I said, okay, go ahead and just pee in the cup and change for me. And what I ended up doing is, you know, so she's now safely in there. And I was like, "Thank you so much for bringing the the bags in and you can put stuff here. I've got to get the doctor and we've got to do some stuff with mom. It's going to be boring. And on top of that, just kind of getting her settled. Why don't you go ahead and head down and you send them to the cafeteria? You It's all about them. It's going to be boring stuff. We got to get her all checked in, hook her up. She's not going to be able to walk around." And I I try to get that person out of the room. If that doesn't work, most units have either an ultrasound room or a triage space or like a separate space where you can make an excuse like, "Hey, we're just going to take mom down the hall, run a quick test, run a run a thing, do a thing. You know, we can't I'm sorry, the room's not big enough." Like, you know, the space is not big enough. So, just hang here. She'll take her phone. She'll take her phone. You'll be fine. And then I'll separate them like that. and I am the partner and I'm like, "No, I have to go." I understand that you want to go. It's exciting. We're We're having a baby. This is exciting. I just can't take you down there. I'm sorry. Like, they're not going to let me take someone and I have had someone insist and then we get to the space and they have to stay outside the room. Like, you literally take them into like an area and then they're separate because, you know, the answer is no. I'm sorry. Right. And I mean, if it if it escalates beyond that, then I already know as a nurse caring for this patient that my safety is going to be in question and like something's going on clearly, like you've been slightly confirmed, you know? So, if we get to that point where you're already trying to push against me, and again, I'm very mindful of the other person. I don't know what's going on, but hey, real simple. It's normal in hospitals for us to need to separate our patient to do an ultrasound, do a scan, do a something. Not everyone can come with you and hold your hand 24/7. And I remind the partner, we're going to take the phone. She's got her phone. You've got access to her the whole time. I'm sure you're going to watch the the tracking dot as I move her through the hospital. It'll be fine, you know. Um, but you try to keep everyone calm and you let them know as soon as you can have her back, you will have her back. Um, we will I'll also share with you there is a a recommendation for um specifically a pregnant adult patient that has experienced nonfatal strangulation. So, we can give that to your um viewers that comes from the training institute and it's the like essentially the dear doctor letter or the what happens when they present to the emergency department. So, if they um come through like an office, like if any of your nurses work in um an OB office versus in the hospital, this is what you would give them. And a lot of times what we do at the sexual assault center at the center is I will take this sheet and I will circle the things that I personally have assessed on my patient. So if it was, you know, piti or swelling or voice changes or I circle all the things so that when they and I give them a paper copy of it when they get to the hospital and they're like, I need at the ER this CTA, this this thing, it I've made sure that so the patient doesn't have to remember any of that if they just come with this, you know, and it's the same now if you work in the hospital and you're you're doing this the moment I've identified these things. So, this is still a good resource to have in the hospital. The only difference is you're not sending them to the emergency room, they're already there with you. I would then be calling my provider and I would be pulling this up going, "Hey, my patient." And you can start showing them these are all the symptoms and the signs and things that point to based on evidence-based resources. This is how we should be caring for her in while she's pregnant. Because I know as soon as we start talking about CTS and radiation and pregnancy, everybody gets like, "Ah, what do you mean?" Well, and I'm like, "Are doctors trained on this?" Like, is this a part of their standard training that they would have a a walk through of what to do? Literally, I've never heard of any like this is so This is not really what I think. So, it's it's mentioned, right? Like so at some point they they talk about trauma when they're in doctor school, you know, when they're in medical school, when they're becoming the the doctor, right? Um once they specialize, so an OB, cuz we're talking to labor nurses right now. Um so where I'm going with this is in the emergency room, think about how many people have tried to hang themselves or have, you know, been in a car accident where like, you know, the the seat belt got around their neck or this or that. These are all other forms of strangulation. So those doctors tend to know how to deal with those injuries a little bit more because they see it in trauma, right? Think about little kids being closed or this or that or their clothes getting around their necks like um so pediatric ER doctors they're going to have. But it's because they see the same kind of injury in different ways. Yeah. But how often are we sitting down with the obetric doctor going, "Hey, your patient population is at the highest risk of this and the number one manner of death is homicide and d and here you go." So, no, I I I think we've missed that piece. But I think it's because when we first started getting these little crumbs and started realizing like and we followed the path, right, and we realized what what's happening. Now, we're going, okay, this is this is how we start solving this problem. And the first step is disseminating this evidence-based research. And we be bring awareness. We talked about the, you know, in nursing school the levels of prevention, disease prevention, right? We're in level three where we already have the disease and we're managing it. This is this is a disease our society already has and we're we're learning how to manage it. Um, but the I want to get into better screening and better awareness so that we're not all I I I want to do less of these where I'm recognizing signs and symptoms and more we're doing early screenings and before we get to the strangulation part, we've already got the safety plans in place and we're doing better identification of problems and supporting these these women out of these situations. Yeah. Um but there are tools, there are things and I want these things for um every hospital, every nurse um at least to know where to access them. Yep. So they come in and in triage I'm almost like thinking because again my systems brain goes crazy and I'm like okay like a culture change and this is like a workflow change too. Especially those of you in triage, you are like, "Hello, this should be like red alert, red alert." like all the resources downloaded and start having these conversations on your units of like what are we going to do and what and like pull the policy and there might not be anything actually and if there is there needs to be and so you know it's almost like but I think about one of my okay so my very first hospital we it was a it was like a big room with a bunch of triage beds that had curtains and initi when I first got there we would keep the partner ner outside for the triage assessment. Like they were alone in triage. And so from this vantage point, I'm like, that's fabulous. That's great. You get them alone, you build rapport, you can kind of ease your way into the questions cuz I'm like how awkward. You're like, here, pee in a cup. Do you feel safe at home? you know, and and it's sort of like which I want you to address as far as like just I like the whole like I ask everybody this and while I have you alone, I would, you know, I I would love to know and make sure that you feel safe at home, you know, or whatever. Um, but also like in my head and I'm writing story here which I should not and I need to hold back so that I'm not like making assumptions that no one's going to disclose, but I'm like I literally just met you lady. like you're going to ask me and I'm going to disclose to you that I like I feel unsafe at home and unless it's like they've been thinking about getting out and they're there to get help and they want someone to ask those questions so that it opens up the door maybe and we need to give that benefit of the doubt but otherwise it's so incredibly awkward and so when I think about triage I'm like get them alone great start the the assessment always alone that in theory could be a quick fix and you also have three4s of the population that will never experienced this and it's labor and birth and they want to be with their partner and like me as the doula I'm like don't kick me out she needs support you know and as a doula whom like I know that their situation is safe so how do we navigate that like what's your suggestion for us okay so from my own research my nurses responded to me um thank you to all the nurses that participated in my dissertation research uh 58.47% of them said my unit does not have a protocol for this for near fatal strangulation. Okay, so that's a lot. And then um 34.43% said I don't know. I don't know. Like does it exist? Does it not exist? I don't know. Um however, 2% of you said yes and I'm familiar with it. And the 4% were like yeah it exists fa I'm not familiar with it. So interesting. Yeah. So, um that being said, um there's 58% out there. We have got to get you guys some protocols. Okay. Um even if they're not used as often as you need, we need them there. All right. Um I think nurses and especially our newer generation of nurses um while I don't want them to be task driven they do well with you know checklist with protocols with tasks with and I need a checklist and I need a policy because unless I'm going to go become a forensic nurse that specializes in all this like I need support. So again, um they're coming into you whether it's to have a baby, seek help for a problem in their pregnancy, whatever the case may be. Again, separating them, asking and and building rapport. So before I even get to that question, right? So a lot of times it's the transition to the room. My name is Morgan. How are you? Oh, are you from here? Tell me, are you have a little boy or a little girl? start talking, asking them about them. Oh, that's so exciting. Have you had a chance, like if they're early in their pregnancy, have you already had a chance to paint the room and do the things? No. No. Oh, okay. Do I get it? I'm busy, too. You know, start connecting with them, however you do it, so that by the time you've made it to the room or whatever you're doing, right, because you've already shown genuine interest. It's not that you're not genuinely interest, but show your patient that you are genuinely interested in who they are. They're like, "Tell me about the name you picked. Oh, how did you come up with that? That's such a great name. Wow, I love that." Because they're you're showing them in little ways that you're hearing them asking why they picked the name or how they came up with that. They're heard. You're paying attention. So, you're not just asking questions to make small talk. You are hearing them. You're validating what they're saying. you know, if they're talking, maybe they're there for a problem, right? And you're like, "Oh, I am so sorry that you're experiencing this. We're going to figure out some way to get you some comfort or we're going to figure out like how to alleviate some of these symptoms, whatever it is, showing that like I hear you and dude, those symptoms suck because then they they start connecting with you because she heard me." So then when you have that moment, and like I said, sometimes it's as simple as just walking them to the bathroom to get the urine sample or something just to start the induction or to start the whatever we're doing. Yeah. And you just very quietly, very quickly and and I always look them in the face. I look them in the face and I look them in the eyes and I'm very like soft. I've I learned something at move and I still do it and now I teach it to people and it is I stop at the door and I take a deep breath. I pause at the door and I take a deep breath and I settle myself before I go in because all of the things that are I carry all of my emotions, my feelings, I'm going to transfer that into this person. And so I need to, you know, release anything bad, release all my assumptions and come in there with open arms, right? And an open heart so that when I'm looking at her in that moment, my face, my body language, it's not rushed. It's not tense. It is nothing but pure care and empathy and love in that moment, in that one question. And that's all it is. It's one question. Yeah. And it really depends on your tone and how you present it. And like I said that I it makes such a big difference in your practice or like you let them go in the room, you get to the door, you kind of hold your hand out and the patient's walking into the room and I take my deep breath and then I come in and we start the process. I remember that episode by the way because it was a podcast episode. We'll link that down below. It's like we reference it in almost every episode and everything we do. And I remember talking to Justine and being like, "This is such a simple practice that would make the biggest difference in what we do on all fronts, on safety, on judgment, on, you know, all the respectful, all of it. So, I'm it's like so heartwarming to me to hear and also like the reflections from the live colorfully class are like everyone was reflecting on pause at the door, which I think is so cool. Now there's a class on it." So, anyway, continue. It's so nice. No, I just um but if you can connect, right, like that's what we do. And if if you get the answer, right, if you get the no or if you get the Yeah, I Yeah, but you can tell they're really struggling to get it out, right? And you go, "Okay, just give me the urine sample, do the thing, smile, and then, you know, escalate per policy, right? Don't ask questions. Just don't put them on the spot in front of that person, right? Do the things that you need to do, okay? We're not there to ruin the experience of having a baby or whatever they're there to do. Okay? But you as the nurse know like we we ha we have a problem. We have something, right? And we are going to look for the appropriate time to ask questions to get into some of these resources. Sometimes it might be that the partner has left to go get food or whatever. You've already glanced at the material and you've got just a little window to ask some more probing questions, right? Think about if it was anything else like, oh, you've got this wound on your foot. How did you get this wound? Did you trip? Did you fall? Did you step on something? Does it hurt when I touch it? You know, does it have it, you know, is it warm? Is it does it blanch? Does it this? This is the same concept. The only difference is that they're questions cuz I'm I'm asking about hurt that I can't see necessarily. That's an interesting frame that I don't know that I've ever thought about is like the do you feel safe at home question is the screener and then you get a you get a oh yeah I feel great at home. you move on, but you get a hesitant yes, you get a no, you get a something in between where there's more to explore that then that's when you create an environment and andor you watch for a moment that then you can you can ask more questions and provide the opportunity to open up that conversation. I tell my patients often I am like the cruise director of their labor, but the baby steers the ship. So as a cruise director, I can curate moments at times and I will look to curate that moment where I can have some alone time with my patient, right? Just like, you know, we can do different things with, you know, peanut balls or birth balls or different things and we eb and flow, right? And I'm gonna I'm going to use my skills, the things that I've learned. I'm going to read the room emotionally and I'm going to find the right time and I'm going to create that moment if I can. Mhm. And it might come later as long as we're safe in the moment. Safety in in the moment is paramount, right? Sure. How they present. Yeah. And if it's labor, it's going to be much less likely to be like the the primary concern. Yep. Because that imminent birth, that labor is priority. Remember, as nurses, we prioritize. but I can't let her go home unchecked. And so, let's say you're the nurse that's leaving, right? You're the nurse that's coming off. All right? And you have had the the I don't know with the screening and the things in my report to my next nurse. I'm going to be, hey, this is what I've documented. I'm going to put a nursing note in. You know, safety questions asked. Patient hesitantly gave a yes. um at this time my nursing priority you know safe we are safe in the room however delivery is imminent. So I would place a care consult I would also notify the OB and then I would also go ahead and see what other resources you have because once the baby is here like once the baby has been born and we are now in that less urgent because that delivery is definitely a health priority because that's coming and I'm not stopping that. The other thing is I don't want to change her hormones by asking these questions because that will affect her labor. Okay? So when I see in my patient's chart that she has suffered a sexual assault, I don't tend to bring that up. But what I will bring up is is there anything that I can do to make these checks more comfortable? are there things that I can do to make this a better experience for you? And usually when you say like checks and stuff, they're like, "Oh, okay. Yeah, yeah." You know, and they they know without actually saying, "Oh, because you've experienced sexual assault because of this, you know, like I don't even want to say that word while they're there." Yeah. For labor, you know, specifically. Yes. For labor. Because specifically, I am like when they are in labor, this baby is imminent. It is coming. I am very mindful of the physiological process and the hormones and the things, but I'm not going to forget and I'm not going to let them fall through the track the cracks because I need to make sure and I know sometimes like I might not be there at the delivery. So, I'm going to make sure all the other things are in place so that when I step away, I'm telling in my ESBAR to my next nurse, I have done these things and I need in the next ESBAR to the next nurse, we need care consult. Let's get a forensic nurse. Let's get a thing cuz it's okay. It's not our wheelhouse, but let's make sure before she leaves one comes up here. Yeah. Somebody somebody sits and talks with her. Exactly. And there there are advocates in the hospitals. Almost every hospital should have advocates and it wouldn't be necessarily OB specific. It would be a forensic nurse from like another unit. Correct. Unless you have somebody like So some some hospitals do have forensic nurses. So I'm over here in Georgia. So for example, Grady actually keeps sexual assault forensic nurses on staff. Not every hospital does. A lot of children's hospitals do. Um but if they don't, guess what? Your ER at some point has dealt with this. And there is uh when I say this, a sexual assault patient, somebody's come in and said, "This has happened to me." And they're going to have a protocol on how to get a nurse or someone who does this. Yeah. So, if you're in labor and delivery and you're like, "Okay, I have it. Here it is." Or, "This needs a better interview. It needs more. It needs something more." Call the ER, find out what your protocol is. And if they don't know, there's going to be a non-emergent line. Um, almost every police station, whatnot, where you would do your mandatory reporting, they've got a protocol and access to a forensic nurse. And your mandatory reporting is if you have a patient um that's experienced a violent crime, gunshots, the strangulation is a violent crime. Um if they've been hit, assaulted, anything like that. Um, at 16, we have age of consent. So, if you have a 16-year-old that comes in and has a baby, I remind all of my nurses, you have to do the math. Was she 15 when she conceived? Because if she was 15, she couldn't consent and you have to report. Um, now you'll go looking through their chart and make sure somebody if they've already if mandatory reporting has already taken place. It only has to happen once, but there should be a clear note in the chart with a case number that it's been reported so that they're not getting a call every time this minor comes into triage. Mhm. So, I'm like, whoa, our whole nursing practice just opened up a whole lot of like cranial nerves. I'm like, I haven't done a cranial nerve assessment since nursing school practically. Oh my gosh. If someone comes in and they've got slurred speech and you, you know, you're thinking they're drunk or high like but they're like no no like I'm not like what do you do, right? So, um, this is this is how you know and and a strangulation assessment and this is like truly like if and if you can't get a hold of a forensic nurse or if you something's going on, that's what these resources are for. And the thing is as a nurse, we learned all of this in nursing school. You learned every bit of this. Yeah. And that's what I'm saying as I'm like asking you these I'm like thinking back to my my like what was it? health assessment or whatever class and I'm like, "Oh, yeah, that I was so good at that." Yeah. Yeah. You did every bit of it, you know, in nursing school. So, this is not some crazy thing. Yeah. That you just, you know, are now having to figure out like, nope, you That's why we went to school. Yep. Exactly. How do you stay non-judgmental? Because I I I mean, I want to address and then we're going to get into your research. I I think Okay. There's, you know, one of my dreams for us as nurses and the especially the Bundleberg nurses community. You've heard me address it in a million different ways across all sorts of classes and podcasts and social media and all of that, but like we can be a judgy bunch and especially how we speak like you talk about nurses eating their young, but not even that like workplace bullying um is extremely prevalent. We all know that this happens. I've talked very openly about that it's happened at both of my facilities and that it contributes to people leaving the profession, leaving their units. It's contributes to high levels of stress and anxiety and alosatic load and all the things for us. And so, you know, I think for all of us to just pause for a second and think about the culture on your unit of how we talk about people and it's talk about each other, it's talk about doctors, it's talk about our patients, it's talk about their patient scenarios, it's how we pass report. And you know, and then you think about society of just like you know, we we talk openly or use the word stigma, right? that like we're, you know, we're so, you know, don't be stigmatized for mental health or substance use or, you know, domestic violence or sexual assault or whatever these like big issues are. And it's easy to say don't stigmatize it. And yet we see it all the time subtly um at the bedside or not. And so, you know, I think one, I mentioned this last time. I think for me, one of the things that's been really helpful is this like come to Jesus of I do not and will never know what it's like to be in their shoes. And people will say just put yourself in their shoes. And I'm just like I I kind of hate that phrase because I will never know. and I can empathize a lot and I try and I'm like listen and I apply myself but I will genuinely never know what it's like to be in your shoes. And so that for me has been really helpful in the in my process of growing to be more curious not judgmental and you know and now teaching on this stuff in the live colorfully class particularly but inner thread throughout all and so when you've specialized in all this stuff you know and in episode three we're going to come back and talk about the sane nursing side of things and forensic nursing as a whole. Um, what are the tools that have helped you become so and I feel it from you. I felt it from you from the start of just like this like I I I do not judge you and like this lack of shaming each other that and especially as women we are so hard on each other and you know and we're especially judgy on each other because we say like well I would have never done that you know and yet again like we don't you don't know unless you've been there and so um talk to me about that in particular and if you have any suggestions and tools for how we continue to grow in this because I want to say that like first thought second thought like there's there's some of it that's been just built into the culture culture as a whole and culture on your potential unit and it's so easy to get caught up in it the gossip and the the again for lack of a better word judgment. So, um, tell me, it's it's hard at times. I'm not going to lie, right? We're all human. Um, but here's the thing. I remember being a child and I was experiencing things that I was ashamed of because I was around people with loving parents and, you know, happy everything was great and I felt shame and I couldn't talk about it. I was scared of being ridiculed or or feeling different, right? So, I never got help when I was a kid for this situation. And then now as an adult, you know, I still carry shame around that, like talking about like childhood and the things that happened and um I'm like, you know what? No. Um whether it's, you know, being cheated on by your husband, you're not alone. It having a bad childhood, being hit, you're not alone. It doesn't make you a bad person. It doesn't make you less. It doesn't make you like um it made you who you are. And I'm here to listen and let you sometimes, you know, people as adults still need to heal the child inside of them. And if in that moment you're ready to share a little tidbit or let it out and it's going to help you heal, let me have it. You know, because I get it. I get it. And I there I am a human being and there are definitely times where I'm doing like a sexual assault case or something. I don't need to shame them because they're busy beating themselves up and shaming themselves more than enough. And they know they know they made a mistake and they don't need someone else to tell them they made a mistake. What they need is compassion. What they need is someone to go, I know it's a the mistake is done, but how do we move forward? Let's be solutionoriented. Y um Yeah. No, there's definitely times that I look bad and I'm like, uh, what was she thinking? You know, but I don't tell her that, you know, like I I think about it to myself and that's a normal human reaction and then I go, no, she was being a child, you know, she was being a young woman. her brain is not developing done developing like you know she was under the influence of alcohol whatever the case may be she was not making and it doesn't make them a bad person for going out and having a drink or this and that like I we're all human beings and until we start treating each other with that level of compassion then we're never going to get better if I'm too scared to take the journey to heal because someone's going to judge me or shame me or ridicule me then I can't heal and then I can't be a better person in society then I can't produce better people right like if you have kids sharing that you know generational trauma and all the things like no that's I need to I need to heal and I need to make space for those around me to feel safe to heal their problems and burdens are not my burdens and I have to remember that at times so there is a box that I put them in so there's a lot of self-care um I was talking to a friend about this the other day I was like I sleep um not an abnormal amount, but I sleep what my body needs. And that is honestly very important for my healing and the ability to do this. So, you know, it might take me a little longer to get something done, a craft or a thing in the house or a project or whatever, because when it's time for bed, we go to bed. Yeah. When I'm tired, I sleep. So, listening to my body is um definitely part of it. And not everybody is going to be responsive. If someone does share a judgmental thought or a thing, I'm I I remind them again, we frame everything positively. I hear you. I know that that's how you feel. However, this person is here now trying to heal. Let's support that. That's good. It's simple and just to the point and it it's not invalidating what they're saying or feeling because chances are they're right. you know, their their feelings are are valid and but we're not going to get anywhere with that. Yes. It's not going to fix our patient. It's not going to help our B. It's not going to help you. It's not going to help society. You're allowed to think at the moment. Get it out. I let them get it out. And I'm like, "Okay, cool. Now, let's go be nurses and fix it." Yep. Well, and I'm thinking about the nurses who are listening to this and they're like, "Ooh, this is a sexy new thing." You know, and I and I just what my fear is is that unless you are super duper self-aware of your motivation for maybe, you know, asking the questions and getting the information that like we all need to be extra self-aware that like we're not here to know the tea and have a good story or to Um, this is usually tea you don't want. This is the dark tea. Somebody that I worked with, they like called me in to look at something and it was like call and I still have shame about this that like she was like come see like and just act like you're coming in to whatever like come see. Oh my gosh. And it was like a rampant STD um or STI and Oh my gosh. Yeah. And but she was like, "Oh my god, you it was like this it was exploitation." And I was like, "Oh, I you know, in my curiosity, of course, I was like, "Yeah, I want to see. Like, come on." And she was there getting checked and like prepping for pushing. And I came in to literally look at this woman's vulva. This was year one as a nurse. I still am like, "Ew, ew." And the the medical side of me, I separated in that moment. I'm not like thinking like the vagina component of it or the vulva part of it like we've seen a million but also like I think back and I'm like oo my curiosity about the story and about my learning and about like wow this really happens like some of this stuff as dark as it is it's also somewhat sexy if we want to call a spade a spade and so so how like what I want to just pull and like say and then if you have anything to say and contribute fine but that let's roll it back and let's be really really mindful in these scenarios that these are human beings and that we're not exploiting their story and coming to the nurses station and going dude I got tea you want to hear about this one she doesn't feel safe at home like you know she was strangled y'all she was strangled you know like whoa whoa whoa if and here's the other thing sometimes with as nurses when we're doing this there's a reason we have advocates okay so if you don't have if you need to ask questions or if you want to have these questions asked. Um if sometimes like when people are coming into the hospital, we'll tag team like one person's putting on monitors and one person's asking questions and right. So if if you have uh two two nurses that have some already established facetime and you don't want to go in alone to ask questions, right? Maybe you as the nurse do want a a buddy. Buddy system feels safe, right? So, we're not talking about exploitation. We're talking buddy system for for hey, I you know, I brought so and so, they were here with me earlier. Um, we want to ask some questions. Can we sit down? or you know if I'm at the computer like charting and asking having that other person sit there next to them and honestly sometimes even offer a hand to hold like or if you see that the patient's getting emotional having someone there and that is an advocate so instead of making it sexy right um because I know that's the other thing too is if you the first time you have to ask these questions or you have to do this bringing emotional support and that's what an advocate is and sometimes having another nurse be emotional support for both of you is appropriate and um but doing it the right way um there's nothing fun or sexy or exciting about it and a lot of times there's drugs or alcohol involved so you have to check your personal beliefs at the door I treat this a lot like when we ask them do you want smoking sessation and they say no and we give them a nicotine patch or do you want help, you know, to stop drinking. They say no and they get their order for their beer or wine with their um abusive relationships are no different. We, you know, and it's the same with drugs, like, you know, do you want help getting off of your fentanyl or whatever if they say no, we're we can't give you fentanyl necessarily, like dirty street fentanyl while you're in the hospital, but we're going to give you methodone or suboxin or something to keep you from withdrawals until you check out. Um, so you know, when when you're asking these emotional questions, offering emotional support, having a social worker, an advocate, a therapist, or somebody, you know, um, and guys, I know that um, y'all are overworked and underpaid as nurses. We work in a very high stress. And, um, I loved Christa's work at MOO and talking about PTSD and nurses and vicarious trauma. And I was like, uh, yes, speak to my soul. Which, by the way, is the healing trauma and the birth professional class online. So, it is available for everyone. It's 30 bucks. It's the best self-care investment you could make on understanding all of that because and like and honestly like supporting you in maintaining your work. So, FYI, it is available. Mhm. you need to be um ready for when they do answer the question and give you the tea because if if they've they they're ready like you're the person they have chosen you that is a moment and you don't want to squander it. Yeah. And you don't want to make a mockery of them because it's an honor. They have chosen you. Yeah. and they are looking to you for help and this is your moment. This is your moment to actually make a difference. This is your starfish. Reach out and pick her up because there she is. Um tell us about your research. So when I started my PhD process, I was looking at so many different things. The the first thing I wanted to do, and they were like absolutely not, is I wanted to do qualitative research talking to sexual assault survivors that had delivered a baby afterwards, either from a consensual partner or some somewhere down the road. And I wanted to look at the words used by labor and delivery health care professionals that retraumatized sexual assault victims. So, I really want to So, my next project is going to be to dive into that, but they were like, "No, that is a protected group. You cannot talk to sexual assault survivors about going through labor and delivery. Um, you know, yeah, that it was I work with a very I I love my school, very conservative school, uh, IRB process. Um, and it's to protect people, right? Yeah, for sure. For sure. We love that. So, I was like, h, I want to do something in this realm that I love like, and I want to do something that's going to make a difference. So, what is something that we're not talking about? Everybody's talking about strangulation and near fatal strangulation and there's great great research. There are some wonderful health care professionals out there that um you know Dr. Dr. Bill Smok, Diana Fagno, there's just so many that are doing really good work and there's protocols, there's checklists, there's assessments, all this, okay, this is all the tools are there. How do I get them to the nurses? Right? What do nurses know? Where where are the nurses at in all this? And so I started going down the rabbit hole of like, well, okay, I know all of this exists and you know, like when I got your reaction at move, this plethora smorgish board of stuff is here, but nurses don't, it's not even that they don't have access. They don't know it's there. We're not training nurses. Um, we always talk about that gap between evidence-based research and getting it into practice. And I'm like, this can't wait. This can't wait. So, um, I decided to do a survey of nurses to ask them how to rate their own self-efficacy. So, for all of the steps of the strangulation exam, how well do they think they can perform these steps? So it's everything from the actual like asking the questions to performing the individual functions you know like measuring you know different things or you know do you know where to how to look for petique eye or where to look for peti like can you perform these steps um oddly enough like I'm still um doing synthesis on the data right the nurses in general rated their ability to perform like the assess ment tasks fairly high. Where I saw things starting to waver is collaborative care or things outside of what would be like, okay, I can do the headtotoe assessment. I can assess what's abnormal. What do I do now? Totally. And I thought that that was really interesting because um and it it was funny you mentioned the cranial nerves. That's also where people started falling off a little bit and they were like and and and keep in mind like um I I'm specifically asking nurses in labor and delivery uh obed um you know labor triage and so you know my ER nurses are like yeah I got cranial nerves ever time in a neuro unit or I see yeah but asking labor nurses like you know can you do a check um and concise precisely document using exact words of you know the patient in near fatal strangulation and like 49% of nurses were like yes I can document using the exact patients words and I'm like really do you know how hard that is like um and it it I I was very curious about that one because that's one of the hardest tasks for me as a sexual assault nurse is you know I'm not a stenographer so when they're I'm having to type down their their story in their exact words. That's really difficult. And I was like, "Huh, okay." So, I I was really surprised. Um, but the nursing pieces, I was like part of me, the inside was like, "Yeah, go nurses go." Like, we're comfortable doing assessments. Some of the things like the delayed complications, the anoxic brain injury, people started falling off. Um so now that I have all this data and now I have all this in place the goal is to so I created a standardized tool um that you know and now I have the data behind the tool to say this is significant it's statistically relevant the tool will be made for free after the dissertation is done going through the publishing process um which is happening right now so yeping um and then the idea is it would go to like an educator in a unit, she it's um just a few questions nurses score themselves and it allows for the unit educators to go, okay, this right here is what I need to do more education on. Maybe it's documentation, maybe it's documenting injuries, maybe it's symptom recognition, but that means we can now do targeted education within the units on what we need. And some of it too is just do you know where to find the policy? Yeah. Yeah. And I know like everybody's like when Jacob gets here and they ask you make sure you know the the the magical binder of policies is here or there or it's on policy tech or whatever they use, you know, but this this is important, right? So that was the goal. So um from the early bits of crunching the data I have a statistically significant tool and it's a tool that can be used and it can and it will be made free and available to all healthcare workers. So, I have to say this especially because now I'm working more with hospital leaders and researchers and like not I work so much with staff nurses too, but I have way more exposure now in this role than I ever did in the hospital to like other subsp specialties of nursing and medicine. And so, I want to just say that like these tools are essential to us continuing to move the dial. If ever, for instance, I I'm thinking about HCAPS because HCAPS is like a survey, right? I don't know if you would call it a tool, but basically like you would you would give an HCAP survey and then that would give an HCAPS number to for related to patient satisfaction for for patients. And so what I was when I'm talking about this data with hospital leaders, I talk about how HCAPS doesn't actually give us the next step. It tells us where we're not doing so hot and where we're doing great in the realm of patient satisfaction, but it doesn't actually specifically rate or give suggestions for or identify the issues in your unit. And so the literally and luckily like I had this data, but it stands out to me because on my first call with hospital leaders, I had the Mory mothers on something index and then the uh child birth experience questionnaire as vetted tools that actually do give that information. And so when we actually do use a tool like this, we find that these things lead to better patient satisfaction than just an hcaps. And HCAPS is like a check-in point, but if you're actually wanting to know what to do about it or what actually contributes, these are vetted tools. And I remember like when I mentioned this Mory and child CEQ, like people were taking notes of like, oh, and then I had another another nursing statistic about nursing retention. And the one question that I had on this entire call, which this was not the point of the call, what tool did they use to measure nurse satisfaction? And I was like, "Let me get that for you." And I knew I'd read it, but I just didn't have it on my slides. And so this like from a pullback standpoint because I did not get this until I was doing my own synthesis of research and reading these articles constantly and like deep in it that these tools are the gateway to evidence-based practice that like when you know and I think it's easy to be like oh you put together a survey but like this survey has so much potential for actually being something that like gives data about a unit's practices and your nurses that then can become actionable. So, I like I think it's so exciting and so cool and also like for all of us nurses to know that like nursing should and can be a part of research that can be a part of leading change in this way and like this is the way I mean we know data is the thing that moves the dial and in medicine you know like nothing happens without data. We love our data, right? And but and here's the thing, once you have the data, what do you do with it? Right? So if I were to like just show up to your hospital, I'm like, "Hey, we got to do this, right?" And everybody's like, "Okay, but why?" Right? And I can show you the why. And then but then there's questions about implementation and education. And then um because a lot of this, like I said, nurses had these skills. These are not new skills. It's just a matter of showing them how to appropriately apply these skills, right? And you know, I think every hospital is going to have different needs. Every hospital's got its own thing. So this tool would allow hospitals to identify the needs of their nurses and their educational stance like where where is everybody at and do some more targeted things. The other thing too is like in as an educator, I can't just sit and talk for three hours and expect you to absorb all of it, right? being able to provide good bite-size um interactive material so that we can retain this is how I'm going to move things from your short-term to your long-term memory and it's going to stick and it's going to become wrote and part of your practice and these are the things that are going to change healthc care and that my dear is how we're going to move that number. I don't want homicide to be the number one anymore. Like that's how we're going to change this. Beyond that, what's your hope for the future? Truly, what I hope for the future is that when my daughter, if she were to decide, cuz she tells me she wants to have a kid all the time, I don't want to have to worry. I want her to go into a healthy, safe, sound environment with good, confident nurses and a hospital that supports them. And so she's supported. And I like that's what I want. Like I want I want us all to be able to go get health care in, you know, a good a good way. Mhm. So, not everything in the world is good. I'm not going to fix the world. I'm not going to save the world, but I'm looking to save a couple starfishes along the way. If you were to ask the nurses listening to do one thing in their practice that like after listening to this now do this instead or add this. What do you feel like that would be? ask that intimate partner violence question and like ask it in a way that your patient knows that you mean it and truly care. Thank you for being here and for sharing. There's so much more that we could talk about. And so if you are I'm going to not say too much, but if you are like really into this and want more, need more, uh, etc., etc., Uh there is a list that I'm going to strongly encourage you to add yourself to in the show notes down below and that will be obvious just to be notified of future related things. And so yeah, um check that out down below and then also check out the show notes down below. And I think um for all of us, I want to thank you from this community for the work that you're doing and for bringing this to light and being so open and excited to share with us and and I think this community is like there's no better community than the Bundleberg nurses community because these are the nurses who are out there like, "Okay, I'm going to go read it and I'm going to go do the thing and I'm going to do my best and you don't have to do it perfectly, but I'm going to apply myself and at bare minimum ask that question, let alone learn about a safety plan or maybe you also are like sparked to be like wait I could do this too and I have a passion for it that like looking into forensic nursing etc. which is where we are coming back for one more episode where we are going to talk about forensic nursing specifically related to sane nurses and dealing with sexual assault. I'm going to ask some tips on things to say, things not to say, your approach, what that means. And so, make sure you subscribe down below. If you want more from us, you can head to bundleberg nurses.com, follow us on Instagram, or subscribe to our educational newsletter. And then now it's your turn to take what you learned today, apply it to your life, and then on your next shift, when you are doing your intake questions, pause at the door prior to meeting your patient and commit to learning how to approach the question, quote unquote, do you feel safe at home in a way that is sensitive that and it provides an environment where a patient could disclose to you what's going on after you've built rapport. We'll see you next time.