Understanding Abuse and Violence: Preventing Harm and Supporting Victims

1. Chapter 33Clients ExperiencingAbuse and Violence

2. Please, Mom and Dad My hands are small—I don’t mean to spill my milk. My legs are short—please slow down so I can keep up with you. Don’t slap my hands when I touch something bright and pretty—I don’t understand. Please look at me when I talk to you—it lets me know you are really listening. My feelings are tender—don’t nag me all day—let me make mistakes without feeling stupid.

3. Don’t expect the bed I make or the picture I draw to be perfect—just love me for trying. Remember I am a child not a small adult—sometimes I don’t understand what you are saying. I love you so much. Please love me just for being me—not just for the things I can do. —J. Richardson and J. Richardson (Poster Funded by Health and Rehabilitative Services, State of Florida)

4. Learning Objectives After studying this chapter, you should be able to • Identify risk factors that create an environment for child abuse • Differentiate between child abuse and child neglect, and cite an example of each • Recognize at least five common physical findings indicating physical abuse of a child • Differentiate among the terms sexual harassment, sexual assault, rape, and statutory rape • Articulate the dynamics of rape trauma syndrome • Illustrate how elderly persons are abused

5. Learning Objectives (cont.) • Explain at least four causative factors related to domestic violence • Discuss the dynamics ofintimate partner or spousal abuse • Construct a profile of an individual who may become violent in the work setting • Describe the emotional and behavioral reactions of the following victims of physical abuse or domestic violence: children, women, men, and the elderly • Develop an assessment tool for the following clients: a victim of child abuse, an elderly victim of domestic violence, and a teenaged victim of rape

6. Elements of Abuse • The abuser • Individuals who grew up in an abusive family • Low self-concept, immature, fear authority, lack skills to meet emotional needs, believe in harsh physical discipline, poor impulse control, lack of parenting or relationship skills, often use alcohol or other substances to cope with stress • The abused • Pattern of learned helplessness, low self-esteem, and shame and feelings of dependence, isolation, guilt, and entrapment • A crisis • The precipitating event that sets an abusive person into action

7. Child Abuse • Etiology of child abuse • Characteristics of potentially abusive parents • Characteristics of an abused child • Classifications of child abuse • Physical abuse of a child • Physical indicators • Munchausen’s syndrome by proxy • Shaken baby syndrome • Behavioral and environmental indicators

8. Examples of Child Abuse

9. Child Abuse (cont.) • Child neglect • Physical indicators • Behavioral and environmental indicators • Emotional abuse or neglect • Behavioral and environmental indicators • Child sexual abuse • Classifications of child sexual abuse • Terminology of child sexual abuse • Child abduction

10. Groups at risk Epidemiology Factors contributing to domestic violence Profiles of the abuser and the abused Forms of domestic violence Domestic or Intimate Partner Violence

11. Dynamics of domestic violence Tension-building phase Acute battering phase Loving phase Barriers to leaving a violent relationship Lack of resources Lack of institutional responses Traditional ideology Domestic or Intimate Partner Violence (cont.)

12. Adult Sexual Abuse • Sexual harassment, stalking, and sexual coercion • Rape • Essential elements of rape • Rape victim profile • Motives for rape • Subclassifications of rape • Emotional reactions to rape • Long-term reactions to rape • Adult survivors of childhood sexual abuse

13. Elder Abuse • Major types of elder abuse • Physical abuse • Sexual abuse • Emotional or psychological abuse • Abandonment • Financial or material exploitation • Self-neglect • Etiology • Emotional responses to elder abuse

14. Violence • Youth violence • Etiology • Emotional responses of youth violence victims • Workplace violence • Predictors of workplace violence • Classification of workplace violence incidents • Emotional responses of workplace violence victims • Hate crimes

15. The Nursing Process • Assessment • Nursing diagnoses • Outcome identification • Planning interventions • Implementation • Evaluation

16. Assessment • Assessment of abuse in children and adolescents – Biopsychosocial data – Documentation of the assessment • Assessment of adult victims of physical abuse or violence – Biopsychosocial data – Assessment tools – Documentation of data

17. Assessment (cont.) • Assessment of victims of sexual abuse or rape – Guidelines for data collection – Medical data – Behavioral and emotional responses – Collection and documentation of physical evidence • Transcultural considerations

18. Nursing Diagnoses • Anxiety • Impaired verbal communication • Ineffective denial • Disabled family coping • Interrupted family processes • Fear • Rape trauma syndrome • Risk for violence

19. Outcome Identification Outcomes focus on the following: • Reducing anxiety, fear, pain, and the potential for injury or violence • Improving communication, coping, self-esteem, or self-concept • Identifying members of support system(s) and the appropriate use of them • Assisting the victim in returning to a precrisis level of functioning

20. Planning Interventions Immediate care should focus on the following: • Meeting the client’s physical and emotional needs • Promoting homeostasis and comfort • Reducing fear

21. Implementation • Interventions for child abuse: • Multidisciplinary approach • Behavioral interventions • Continuum of care • Prevention of child abuse and neglect

22. Implementation (cont.) • Interventions for victims of physical abuse and violence: • Safe environment • Supportive therapies • Continuum of care

23. Implementation (cont.) • Interventions for victims of sexual abuse: • Crisis intervention • Continuum of care • Care of elderly survivors of sexual abuse

24. Implementation (cont.) • Interventions for victims of youth or workplace violence and hate crimes: • Developing awareness • Trauma/crisis counseling or critical-incident stress debriefing • Providing assistance

25. Evaluation Evaluation should focus on the following: • The client’s emotional and physical well-being • Efficacy of the medication • Effectiveness of interventions • Client progress

26. Abduction Abuse Attempted rape Child abuse Discipline Domestic violence Emotional abuse Emotional neglect Family violence Hate crime Incest Intimate partner violence Munchausen’s syndrome by proxy Key Terms

27. Neglect Rape Rape trauma syndrome Sexual abuse Sexual coercion Sexual harassment Sexual misuse of a child Shaken baby syndrome Silent rape syndrome Sodomy Stalking Statutory rape Violence Workplace violence Key Terms (cont.)

28. Reflect on the chapter-opening quote by Richardson and Richardson. In your own words, interpret the message that the authors are relating. In what situations would it be appropriate to use this poster? Explain the rationale for your answer. ? Reflection