Nursing Care of Survivors of Abuse and Violence 5/1/04

1. Nursing Care of Survivors of Abuse and Violence 5/1/04 • Mary Vercoutere

2. Introduction • Violence as a public health issue. Effects of violence can lead to problems of anxiety, depression, suicide and other health problems. • Experience of violence is devastating and survivors are often seen in psychiatric care. • The true prevalence is unknown due to underreporting. Of those reported, 95% of the victims of family violence are women. Domestic violence is the leading cause of injury to women between the ages of 15-44.

3. Topics of Discussion • Predisposing factors: Biological theories, psychological theories, sociocultural theories • Characteristics of Family Violence Types of mistreatment • Nursing Attitudes towards survivors of violence • Nursing Assessment/ Interventions

4. Predisposing Factors • Biological Theories • 1. Neurological systems in humans and animals effect the expression and inhibition of aggression. This includes the temporal lobe, limbic system and the amygdaloid nucleus. • 2. There are neurotransmitters that help in the expression and inhibition of aggression: norepinephrine,dopamine, serotonin.

5. Genetic • 3. Genetic components have been linked to aggressive and violent behavior. • 4. Disorders of the brain can lead to violent behavior such as brain tumors in the limbic system and temporal lobe. Diseases such as encephalitis, medications, epilepsy, dementias and psychosis.

6. Psychological Theories • This theory looks at a cause for violence from unmet needs for security and satisfaction in life. This leads to undeveloped ego strength. • When frustration is felt, it is aggression and violence that give the individual control and power in the situation. • Because the ego is underdeveloped the individual doesn’t feel guilt or responsibility in the situation. • Play therapy- the natural way children communicate.

7. Psycho/social Theories Children learn from role-models ie. Parents, TV, external models. Cultural; the general acceptance of violence in America has a profound effect on the violence in society. For example a husband’s use of violence may be accepted if his wife is having an affair.

8. Characteristics of Family Violence • Family violence includes a broad range of behavior including: physical and emotional abuse of children, neglect of children, spouse battering and elder abuse. • Regardless of the abuse, all members of the family, extended family are affected. • This may be a family secret. • Common characteristics are: multigenerational, isolation,abuse of power, effect of ETOH, drugs abuse.

9. Types of Mistreatment • Physical, sexual, psychological, emotional, and economic. • Assault: intentionally doing things to make the victim fearful and apprehensive that they may be harmed. • Battering: coercive control with the use of violence or threat of violence. Examples are hitting, biting,rape choking,stabbing, shooting or threats of this. • Cycle of battering. Tension building, triggering event, acute battering, honeymoon stage. 3. Why doesn’t she/he leave?

10. Profile of the Victim • Battered women/men represent all ages, educational, cultures, socioeconomic groups. • Low self esteem. • Accept the blame • Common are feelings of fear, guilt, anger, and shame. • Poor support system.

11. Profile of the perpetrator. • Puts their needs first. • Low self esteem. • Limited coping ability • Strives to keep the victim isolated and dependent on him/her. • Frequently was abused as a child.

12. Physical Signs of Injury • Bruises, especially of different colors and in places the victim couldn’t have caused themselves. • Bite marks,skin welts. • Burns, especially in the shape of an object. • Fractures and old fractures in various stages of healing. • Injuries that aren’t supported by a believable history.

13. Behavioral Signs • Behaviors alone do not indicate abuse. • Very aggressive or demanding behavior. • Fear of caretaker or partner. • Extreme rage, passivity, withdrawal. • Verbal report of abuse. • Wearing clothing that covers the body and is inappropriate for the weather. • Hyperactivity, disorganized thinking, self-injurious behavior, suicidal. • Regressive behavior.

14. Treatment • Nursing assessment, asses support systems • Diagnosis: Risk for Injury, Risk for Violence, Anxiety, Fear, Disabled Family Coping, Powerlessness, Caregiver Role Strain, others. • Outcome: • Cessation of abuse reported by victim • Emotional abuse has stopped. • Neglect has stopped. Financial exploitation has stopped.

15. Nursing Intervention • Legal responsibility to report. • Oral, immediate, written 24 or 48 hours. • Communication • Give support and explain the procedures • Goal for individuals is empowerment and picking self-healthy options for life, developing strong sense of self. • Discuss with the client whom to call for personal support. • Prevention: give referrals. • Family Therapy

16. Nurse’s Attitudes • Giving care to survivors of violence can be frustrating and difficult. • The attitude brought into the situation by the nurse can focus the response. • Studies of health-care providers have shown that myths about battered women are believed. Also that sympathy for the victim of an attack or rape decreases if their situation was that they were out late at night, had not locked their car door, gone shopping for beer, not milk. • Nurses’ show a lack of understanding on why abused children want to return to their parents and why battered wives stay with their husbands.

17. Negative Responses • Health care workers reflect society’s norms. ER charts were reviewed to evaluate: found was a lack of details, negative reporting of the events, and a lack of intervention. • Society norms that ‘people get what they deserve’ is underlying influence for negative feelings towards survivors. • Important for nurses to explore their own feelings,gain education on full spectrum of victims experience, changing feelings, gaining education about violence.

18. Conclusions