Nursing 204 West Coast University

1. Child, Older Adult, and Intimate Partner Abuse Chapter 26 Nursing 204 West Coast University

2. Types of Abuse • Physical abuse • Sexual abuse • Emotional abuse • Neglect • Economic abuse

3. People at Risk for Violence • Sexual abuse • 90+% of rape victims are women • Not age related • 18-20% of rape victims are teens • 50% of victims raped by spouse, partner, relative, or friend • 50% of rapes on college campuses are date rapes • 80+% of sexual assault involves alcohol

4. Cycle of Violence • Process of escalation/de-escalation • Tension-building stage • Attempts to reduce tension by both partners • Acute battering stage • Honeymoon stage • Tension builds and cycle continues

5. Epidemiologyand Comorbidity • Prevalence • Half of all Americans have experienced violence in their families • Comorbidity • Secondary effects of violence • Anxiety • Depression • Suicidal ideation

6. Actual Occurrence of Violence Requires: • Perpetrator • Vulnerable person • Crisis situation

7. Characteristics of Perpetrators • Consider their own needs more important than needs of others • Poor social skills • Extreme pathological jealousy • May control family finances • Likely to abuse alcohol or drugs

8. Characteristics of Vulnerable Persons: Women • Pregnancy may trigger or increase violence • Violence may escalate when wife makes move toward independence • Greatest risk for violence when attempts to leave relationship

9. Characteristics of Vulnerable Persons: Children • Younger than 3 years • Perceived as different • Remind parents of someone they do not like • Product of an unwanted pregnancy • Interference with emotional bonding between parent and child

10. Characteristics of Vulnerable Persons: Older Adults • Poor mental or physical health • Dependent on perpetrator • Female, older than 75 years, white, living with a relative • Elderly father cared for by a daughter he abused as a child • Elderly woman cared for by a husband who has abused her in the past

11. Theories of Domestic Violence • Neurobiologic theory • Role of serotonin (5-HT), corticotropin-releasing factor (CRF) • Intrapersonal theory • Experience of previous abuse a strong predictor for violence • Social learning theory • Family models, media models • Gender bias theory • Socioeconomic factors

12. Assessment: Interview Guidelines • Verbal approaches • Tell me about what happened to you. • Who takes care of you? (for children and dependent elders) • What happens if you do something wrong? • How do you and your partner resolve disagreements? • What do you do for fun? • Who helps you with your children/parent? • What time do you have for yourself?

13. Assessment: Interview GuidelinesContinued • Open-ended questions for parents • What arrangements do you make when you have to leave your child alone? • How do you discipline your child? • When your infant cries for a long time, how do you get him/her to stop? • What about your child’s behavior bothers you the most?

14. Assessment • Should include: • Violence indicators • Level of anxiety • Coping responses • Family coping patterns • Support systems • Suicide and/or homicide potential • Drug and alcohol use

15. Nursing Diagnoses • Risk for injury • Risk for violence (self- or other- directed) • Anxiety • Fear • Disabled family coping • Powerlessness • Caregiver role strain

16. Outcomes Identification • Evidence that the victim is no longer hurt or exploited • Physical abuse has ceased • Emotional abuse has ceased • Sexual abuse has ceased • Financial exploitation has ceased

17. Planning • Guidelines developed by • The Joint Commission on Accreditation of Healthcare Organizations • The Nursing Network on Violence Against Women • The general tolerance of violence in America must be addressed if long-lasting changes are to be made.

18. Implementation • Reporting abuse • Counseling – safety plan • Case management • Milieu management • Promotion of self-care activities • Health teaching and health promotion

19. Prevention of Abuse • Primary prevention • Measures taken to prevent the occurrence of abuse • Secondary prevention • Early intervention in abusive situations to minimize their disabling or long-term effects • Tertiary prevention • Facilitating healing and rehabilitative process • Providing support • Assisting survivors of violence to achieve their optimal level of safety, health, and well-being

20. Sexual Assault Chapter 27

21. Sexual Assault • Any type of sexual activity the victim does not want or agree to • From inappropriate touching to penetration • Verbal sexual assault can occur by phone or electronically online • Forced activities • Prostitution or posing for pornographic pictures or videos • Children, older adults, women, or men can be victims

22. Rape • Type of sexual assault • Nonconsensual vaginal, anal, or oral penetration, obtained by force or by threat of bodily harm or when a person is incapable of giving consent • Second most violent crime (FBI, 2008)

23. Epidemiology • People of lower socioeconomic classes more often victims • 80% of victims are white • 1/3 of all assaults occur inside home • Most of time, no weapon involved • Young females (12–19) at particular risk • 9% to 10% of all rapes are male victim

24. Profile of Sexual Perpetrators • Young • 30% under 21 • 23% under 30 • Under the influence of alcohol or drugs at time of offense • 61% acquainted with victim

25. Psychological Effects of Sexual Assault • Depression • Suicide • Anxiety • Fear • Difficulties with daily functioning • Low self-esteem • Sexual dysfunction • Somatic complaints

26. Responses to Rape • A variety of factors contribute to the response. • Depersonalization, denial are common defense mechanisms • Anxiety, agitation, nonpurposeful behaviors, shock, disbelief, fear are common emotional responses • The victim usually experiences extensive physical injuries.

27. Long-term Consequences • Post-trauma depression which may develop into a major depressive disorder • Disruption in daily functioning • Flashbacks, violent dreams, preoccupation with thoughts of future danger • Social withdrawal, concerns about safety • Sexual problems

28. History of Sexual Abuse in Psychiatric Patients Associated with a Characteristic Pattern • Depression • Anxiety disorders • Chemical dependency • Suicide attempts • Self-mutilation • Compulsive sexual behavior • Psychosis-like symptoms

29. Rape-Trauma Syndrome: Acute Phase • Occurs immediately after the assault • May last for a few weeks • Lifestyle disorganized • Somatic symptoms are common • Reaction to crisis includes disruptions in cognitive, affective, and behavioral functions

30. Rape-Trauma Syndrome: Long-Term Reorganization Phase Reactions likely to be experienced include: • Intrusive thoughts • Increased motor activity • Increased emotional lability • Fears and phobias

31. Theories of Sexual Abuse • Intrapersonal Theory • Guidelines for perpetrator assessment: • Low self-esteem • Emotionally deprived as children • Lack impulse control • Rigid, overcontrolling, aggressive • Family Systems Theory • Family system may be enmeshed, chaotic, with poor communication patterns

32. Nursing Process • Physical Assessment • Behavioral Assessment • Affective Assessment • Cognitive Assessment • Sociocultural Assessment

33. Assessment • Follow protocols of hospital regarding rape victims. • Assess: • Level of anxiety • Coping mechanisms • Available support systems • Signs and symptoms of: • Emotional trauma • Physical trauma

34. Nursing Diagnosis • Rape-trauma syndrome • Ineffective coping

35. Outcomes Identification • Abuse protection • Abuse recovery: emotional • Abuse recovery: sexual • Coping • Personal resiliency • Sexual functioning • Stress level

36. Interventions • Individual-Based: • Assure safety, develop rapport, clarify presenting problems, identify victim’s strengths, abilities, coping skills, identify available support systems, suggest group therapy, experience anger, work through their terrifying fears • Community-Based: • Identify risk factors, implement crisis interventions

37. Interventions Counseling • 24-hour telephone hotline • Emergency department • Nonjudgmental care • Emotional support • Confidentiality • Listen and let survivor talk

38. InterventionsContinued Promotion of self-care activities • Provide detailed written information concerning referral and follow-up options Case management • After initial evaluation: • Provide follow-up assessment within 24 to 48 hours • Provide follow-up visits at 2, 4, and 6 weeks

39. Treatment of Families Experiencing Violence • Multidisciplinary Approach • Assess physical safety first for both victim and abuser • Psychoeducation • Focus on communication, anger management • Empowering the Victim • Address self-esteem, anxiety, depression • Treating the Abuser • Violence is a choice

40. Treatment Evaluation • Short-term: • Identification of domestic violence • Family’s ability to recognize the problem • Family’s willingness to accept assistance • Removal of the victim from the situation • Long-term: • Primary prevention • Secondary prevention

41. Spirituality • Questions and struggles • Connectedness • Trusting relationships • Self-forgiveness • Healing

42. Roles of the Nurse • Nurses are involved in: • Individual interventions for the victim • Family assessment, and family therapy • Community awareness and education • Prevention and public policy changes

43. Self-Awareness • Be aware of personal beliefs and feelings about rape. • Prepare to give empathetic and effective care. • Examine personal feelings about abortion.