ABUSE AND VIOLENCE

Abuse

is the wrongful use and maltreatment of another personcan be child, spouse, partner, or elder parent
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Victims of abuse and trauma can have both physical and psychological injuries, including:  Agitation anxiety, silence  Suppressed anger or resentment  Shame and guilt  Feelings of being degraded or dehumanized; low self-esteem self Relationship problems; mistrust of authority figures

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Characteristics of Violent Families

    

Social isolation Power and control by abusive person Alcohol and other drug abuse Intergenerational transmission process Domestic violence occurs in families of all ages and from all ethnic, racial, religious, socioeconomic, and sexual orientation backgrounds Battered immigrant women face increased legal, social, and economic barriers
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RAPE

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RAPE


Is a crime of violence and humiliation of the victim expressed through sexual means Rape is the penetration of an act of sexual intercourse with a female against her will and without her consent, whether her will is consent, overcome by force, fear of force, drugs, or intoxicants

It is also considered rape if the woman is incapable of exercising rational judgment because of mental deficiency or when she is below the age of consent. consent. 8/24/2011 diZkARTe 5

RAPE


According to Republic Act 8353, it refers to the 8353, insertion of the penis into the mouth, vagina, anus of a victim Insertion of any object into the mouth or anus It is generally considered as an act of hostility, anger or violence

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ESSENTIAL ELEMENTS NECESSARY TO DEFINE AN ACT OF RAPE



Use of threat / force Lack of consent of the victim Actual penetration of the penis into the vagina

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DIFFERENT KINDS OF RAPE



Anger Rape Power Rape Sadistic Rape

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ANGER RAPE


Distinguished by physical violence and cruelty to the victim Rapist believes he is the victim of an unjust society and takes revenge on others by raping He uses extreme force and viciousness to overcome the victim This is done as a means of retaliation
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POWER RAPE


The intent of the rapist is not to injure the victim but to command and master another person sexually The rapist has an insecure self-image and selffeelings of incompetence and inadequacy The rape is the vehicle for expressing power, potency and might is done to provediZkARTe masculinity ones

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SADISTIC RAPE


Involves brutality The use of bandage and torture is not an expression of anger but necessary for the rapists sexual excitement The assault is often eroticized and is sexually stimulating This is done to express erotic feelings
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WARNING SIGNS OF RELATIONSHIP VIOLENCE



Emotionally abuses you (insults, makes belittling comments, acts sulky or angry when you initiate an idea or activity) Tell you with whom you may be friends or how you should dress, or ties to control other elements of your life Talks negatively about women in general
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WARNING SIGNS OF RELATIONSHIP VIOLENCE



Acts in an intimidating way by invading your personal space such as standing too close or touching you when you do not want him to Cannot handle sexual or emotional frustration without becoming angry Does not view you as an equal; sees himself as equal; smarter or socially superior
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WARNING SIGNS OF RELATIONSHIP VIOLENCE



Guards his masculinity by acting tough Is angry or threatening to the point that you have changed your life or yourself so you wont anger him

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RAPE TRAUMA SYNDROME



It refers to a group of signs and symptoms experienced by a victim in reaction to a rape

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PHASES OF THE RAPE TRAUMA SYNDROME



Acute Phase  Characterized disbelief

by

shock,

numbness

and

Denial Phase  Characterized by the victims refusal to talk about the event

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tension,

and
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NURSING CARE FOR RAPE VICTIMS



In the emergency setting, provide immediate emotional support The nurse should allow the woman to proceed at her own pace and not rush her through any interview or examination

Give as much control back to the victim as possible by allowing her to make decisions, decisions, when possible, about whom to call, what to do next, what she woulddiZkARTedone, etc. like etc. 8/24/2011 17

NURSING CARE FOR RAPE VICTIMS



It is the victims decision about whether or not to file charges and testify against the perpetrator and the victim must sign consent forms before any photographs of hair and nail samples are taken for future evidence The priority in the care of a rape victim is the preservation of evidence

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NURSING CARE FOR RAPE VICTIMS



Prophylactic treatment for STDs is offered Prophylaxis can be offered to prevent pregnancy In some areas, encouraged HIV testing is strongly

Referrals to rape crisis centers are encouraged

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SPOUSE OR PARTNER ABUSE

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SPOUSE OR PARTNER ABUSE



Is the mistreatment or misuse of one person by another in the context of an intimate relationship The abuse can be emotional or psychological, psychological, physical, physical, sexual or a combination (which is common)

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SPOUSE OR PARTNER ABUSE



Emotional or psychological abuse includes:

      

NameName-calling Belittling Screaming Yelling Destroying property Making threats Refusing to speak to or ignoring the victim
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SPOUSE OR PARTNER ABUSE



Physical abuse includes the following:



Shoving Pushing Severe battering and choking and may involve broken limbs and ribs, internal bleeding, brain damage, even homicide
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SPOUSE OR PARTNER ABUSE



Sexual abuse include the following assaults during sexual relations such as:


Biting nipples Pulling hair Slapping and biting Rape

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BATTERED WIFE SYNDROME



Cycle of domestic violence characterized by wifewife-beating by the husband, humiliation and other forms of aggression The most common trait of abusive men is low selfself-esteem The most common trait of the abused woman is dependence
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CHARACTERISTICS OF ABUSIVE HUSBANDS



They usually come from violent families They are assertive immature, dependent and nonnon-

They have strong feelings of inadequacy

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PHASES OF SPOUSE OR PARTNER ABUSE



Tension Building Phase  Involves minor battering incidents Acute Battering Phase  More serious form of battering occurs Aftermath / Honeymoon Phase  The husband becomes loving and gives the wife hope
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Cycle of Abuse and Violence

 Initial

episode of violence  Honeymoon period: abuser promises it will never happen again, gives gifts and flowers, is affectionate  Tensions begins to build with arguments, silence, complaints  Violence occurs again  This cycle repeats over and over
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Assessment
 It

is necessary to identify victims of abuse in all settings, since they often do not seek treatment directly  SAFE questions can be used to assess:
   

Stress/Safety tress/S Afraid/Abused fraid/A Friends/Family riends/F Emergency plan

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PRIORITY IN NURSING CARE FOR THE ABUSED SPOUSE OR PARTNER

Provision

of shelter

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DOs IN WORKING WITH VICTIMS OF PARTNER ABUSE



Do ensure confidentiality

and

maintain

the

clients

Do listen, affirm, and say I am sorry you have been hurt. hurt. Do express: I am concerned for your safety. express: safety. Do tell the victim: You have the right to be safe victim: and respected. respected.
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DOs IN WORKING WITH VICTIMS OF PARTNER ABUSE



Do recommend a support group or individual counseling Do identify community resources and encourage the client to develop a safety plan Offer to help the client contact a shelter, the police, or other resources

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DONTs IN WORKING WITH VICTIMS OF PARTNER ABUSE



Dont disclose client communications without the clients consent Dont preach, moralize, or imply that you doubt the client Dont minimize the impact of the violence Dont express outrage with the perpetrator
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DONTs IN WORKING WITH VICTIMS OF PARTNER ABUSE



Dont imply that the client is responsible for the abuse Dont recommend couples counseling Dont direct the client to leave the relationship Dont take charge and do everything for the client
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Treatment and Intervention

 

 

Domestic violence laws vary among states and are not always followed Women may stay in abusive relationships for fear of violence to children, fear of increased violence or death, financial dependence Identifying women in violent situations is a priority. More health care agencies are beginning to ask routine screening questions of all women Providing women with information about shelters, services, and so forth is essential The nurse must never indicate that he or she thinks the woman should leave the relationship; need to keep the door open for further communication
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CHILD ABUSE

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CHILD ABUSE


Child abuse or mistreatment is generally defined as the intentional injury of a child

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CHILD ABUSE


It can include any of the following: following:

  

  

Physical abuse or injuries Neglect or failure to prevent harm Failure to provide adequate physical or emotional care or supervision Abandonment Sexual assault or intrusion Overt torture or maiming
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TYPES OF CHILD ABUSE



Physical Abuse Sexual Abuse Neglect Psychological Abuse

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TYPES OF CHILD ABUSE PHYSICAL ABUSE



Physical abuse of children often results from unreasonably severe corporal punishment or unjustifiable punishment such as hitting an infant for crying or soiling his diapers deliberate assaults on children

Intentional include: include:  Burning  Biting  Cutting 8/24/2011  Poking

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TYPES OF CHILD ABUSE PHYSICAL ABUSE



The victim often has evidence of old injuries (e.g., scars, untreated fractures, multiple bruises (e. of various ages) that the history given by parents does not explain adequately

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TYPES OF CHILD ABUSE SEXUAL ABUSE



Sexual abuse involves sexual acts performed by an adult on a child younger than 18 years of age

Examples include: include:  Incest  Rape  Sodomy performed directly by the person or with an object  Oral-genital contact Oral Acts of molestations such as rubbing, 8/24/2011fondling, or exposing the adults genitals diZkARTe 42

TYPES OF CHILD ABUSE SEXUAL ABUSE



Sexual abuse includes:



Exploitation, such as:

Making, promoting, or selling pornography involving minors Coercion of minors to participate in obscene acts

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TYPES OF CHILD ABUSE NEGLECT



Neglect is malicious or ignorant withholding of physical, emotional, or educational necessities for the childs well-being well-

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TYPES OF CHILD ABUSE NEGLECT



Child abuse by neglect is the most prevalent type of maltreatment and includes: includes:  Refusal to seek health care or delay doing so; so;  Abandonment  Inadequate supervision  Reckless disregard for the childs safety  Punitive, exploitative, or abusive emotional treatment; treatment;  Spousal abuse in the childs presence  Giving the child permission to be truant (absent from school)  Failing to enroll the child in school
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TYPES OF CHILD ABUSE PSYCHOLOGICAL ABUSE



Psychological abuse (emotional abuse) includes  Verbal assaults



Blaming Screaming NameName-calling Using sarcasm

 

Constant family discord characterized by fighting, yelling, and chaos Emotional deprivation or withholding affection, nurturing Normal experiences that engender acceptance, love, security and self-worth self-

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CHARACTERISTICS OF ABUSIVE PARENTS

   

They come from violent families They were also abused by their parents They have inadequate parenting skills They are socially isolated because they dont trust anyone The are emotionally immature

 

They have negative attitude towards the management of 8/24/2011 abused diZkARTe 47 the

WARNING SIGNS OF ABUSED OR NEGLECTED CHILDREN



Serious injury such as fractures, burns, or lacerations with no reported history of trauma Delay in seeking treatment for a significant injury Child or parent gives a history inconsistent with severity of injury, such as a baby with contre injury, coup injuries to the brain (shaken baby syndrome) that the parent claim happened when the infant rolled off the sofa
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WARNING SIGNS OF ABUSED OR NEGLECTED CHILDREN



Inconsistencies or changes in the childs history during the evaluation by either the child or the adult Unusual injuries for the childs age and level of development, such as fractured femur on a 2 month old or a dislocated shoulder in a 2 year old

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WARNING SIGNS OF ABUSED OR NEGLECTED CHILDREN



High incidence of urinary tract infections; infections; bruised, red, or swollen genitalia; tears or genitalia; bruising of rectum or vagina Evidence of old injuries not yet reported, such as scars, fractures not treated, multiple bruises that parent cannot explain adequately

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COMMON INDICATORS OF CHILD ABUSE

     

Serious injuries in various stages of healing Healthy hair in various length Apathy, no reaction Depression Excessive knowledge of sex Self-esteem is low elf-

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PRIORITIES IN CHILD ABUSE



Republic Act 7610, the anti-child abuse law 7610, antirequires reporting of suspected cases to authorities


Remember that the nurse does not have to decide with certainty that abuse has occurred Nurses are responsible for reporting suspected child abuse with accurate and thorough documentation of assessment diZkARTe 52 data

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PRIORITIES IN CHILD ABUSE



The first part of treatment for child abuse or wellneglect is to ensure the childs safety and wellbeing Assistance of social service agencies may be tapped

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injuries such as scalding and cigarette burns  Delays in seeking treatment, inconsistent history, or illogical explanation for the injuries  Urinary tract infections; red, swollen, or bruised genitalia; tears of vagina or rectum  Old injuries that were not treated  Multiple, unexplained bruises
 Unusual
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Assessment Suspect child abuse when there are:

Treatment and Intervention

 Getting

the child to a safe place once abuse is identified  Family therapy  Individual therapy for the child  Intensive involvement of social service agencies  Treatment for parents for any substance abuse or psychiatric issues
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Elder Abuse

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Elder abuse is maltreatment of older adults by family members or caretakers, including:

 

Physical, sexual, or psychological abuse or neglect SelfSelf-neglect Financial exploitation

 Denial

of adequate medical treatment

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 60%

of perpetrators are spouses, 20% adult children, 20% others  People who abuse elders are almost always in a caretaker role  Elders are reluctant to report abuse because they fear the alternative (nursing home)  Not all states have mandatory elder abuse reporting laws
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Assessment
Possible indicators of physical abuse:  Malnourished, dehydrated  Rashes, sores, lice  Smell of urine, feces, dirt  Failure to keep needed medical appointments  Untreated medical condition
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Possible indicators of emotional or psychological abuse:

 Reluctance

to talk openly  Helplessness  Withdrawal or depression  Anger or agitation

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Possible indicators of self-neglect: self Inability

to manage own finances  Inability to perform activities of daily living  Inadequate clothing  Signs of malnutrition or dehydration  Rashes and sores

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Possible indicators of financial exploitation:

 Inability

to manage money  Unusual activity in bank accounts  Different signatures on checks  Recent changes in will that client could not make  Missing valuables
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Possible indicators of abuse by caregiver:

 Caregiver

speaks for the elderly person  Caregiver shows indifference or anger  Caregiver blames elderly person for physical problems  Caregiver shows defensiveness  Caregiver and client give conflicting accounts

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Treatment and Intervention

 Providing

adequate support and respite for the caregivers  Changing caregiving arrangements  Moving the elderly person to a safe environment

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Community Violence
Of great concern are homicides and suicides associated with schools.

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Solutions emphasize:
 Problem-solving Problem-

skills, anger management, and social skills development  Parenting programs that promote strong bonding between parents and children and conflict management in the home  Mentoring programs for young people

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A

history of violence, victimization, and witnessing of violence can lead to problems with aggression, depression, relationships, achievement, and abuse of drugs and alcohol

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Psychiatric Disorders Related to Abuse and Violence Posttraumatic stress disorder (PTSD)  Dissociative disorders


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PTSD Disturbing behavior resulting after a traumatic event at least 3 months after the trauma occurred Up to 60% of persons at risk (combat veterans, victims of violence and natural disasters) develop PTSD.
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Symptoms of PTSD include:

       

Persistent nightmares Memories Flashbacks Emotional numbness Insomnia Irritability Hypervigilance Angry outbursts
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Dissociation is a subconscious defense mechanism that helps a person protect the emotional self from recognizing the full impact of some horrific or traumatic event by allowing the mind to forget or remove itself from the painful situation or memory.
 Dissociative  Amnesia  Fugue  Dissociative

disorders include:

identity disorder (formerly multiple personality disorder)  Depersonalization disorder

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Treatment and Interventions

 Involvement

in group and/or individual therapy in the community  Clients with dissociative disorder or PTSD are seen in the acute setting for brief periods when symptoms are severe or there is concern for their safety

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Application of the Nursing Process

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Assessment
  

 

Includes history of trauma or abuse Client often appears hyperalert, anxious, or agitated Mood and affect: client is fearful and anxious; needs large personal space; has a wide range of emotions Thought processes and content: nightmares, flashbacks, destructive thoughts or impulses Sensorium and intellectual processes: disorientation (during flashbacks), memory gaps
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 Judgment

and insight: impaired decisiondecisionmaking and problem-solving abilities problem Self-concept: client has low self-esteem Selfself Roles and relationships: problems with relationships, work, authority figures  Physiologic considerations: difficulty sleeping, under- or overeating, use of underalcohol or drugs for self-medication self8/24/2011 diZkARTe 75

Data Analysis Nursing diagnoses include:

 Risk

for Self-Mutilation Self Ineffective Coping  Post-Trauma Response Post Chronic Low Self-Esteem Self Powerlessness

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Outcome Identification
The client will:  Be physically safe  Distinguish between self-harm ideas and selftaking action on those ideas  Learn healthy ways to deal with stress  Express emotions nondestructively  Establish social support network in the community
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Intervention
 Promoting

the clients safety  Helping the client cope with stress and emotions using grounding techniques  Helping to promote the clients self-esteem self Establishing social support

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Evaluation
Is the patient:  Learning to protecting him- or herself? him Learning to manage stress and emotions?  Able to function in their daily lives?

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SelfSelf-Awareness Issues
   

Becoming comfortable asking all women about abuse (SAFE questions) Listening to accounts of abuse from clients and families Recognizing clients strengths, not just problems Working with perpetrators of abuse; dealing with own feelings about abuse and violence

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THANK YOU
ABUSE AND VIOLENCE
ALLRIGHTS RESERVE

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