Nursing Care of Survivors of Abuse and Violence

1. Nursing Care of Survivors of Abuse and Violence • Mary Vercoutere,RN,MSN,CNS • Instructor

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 • Neurological systems in humans and animals effect the expression and inhibition of aggression. This includes the temporal lobe, limbic system and the amygdaloid nucleus. • There are neurotransmitters that help in the expression and inhibition of aggression: norepinephrine,dopamine, serotonin. • Head injury, brain damage

5. Genetic • Genetic components have been linked to aggressive and violent behavior. • Disorders of the brain can lead to violent behavior such as brain tumors in the limbic system and temporal lobe. • Diseases: encephalitis, epilepsy, mood disorders, dementias, Schizophrenia, Borderline personality DO, Antisocial Personality DO, 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. • Underdeveloped ego means the individual doesn’t feel guilt or self responsible.

7. Psycho/social Theories Children learn from role-models Example:Parents, TV, external models. 1950’s-60’s Heroes didn’t kill anybody Gene Autry, Roy Rogers, Hop Along Cassity Cultural- Current general acceptance of violence in America has profound effect on the violence in society. Example: a husband’s use of violence 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, think this is private. • Common characteristics are: multigenerational, isolation, problems with authority figures, abuse of power, effect of ETOH, drugs.

9. Children of Abuse • Psychotherapy to Process Grief and to bring out good so they don’t focus on the trauma. • Play Therapy: a natural way for children to communicate. • Reading stories : used to pull out child’s inner turmoil. • Children: Post Traumatic Stress Syndrome

10. Types of Mistreatment • Physical, sexual, psychological, emotional, and economic. • Assault: an intentional threat that makes the victim apprehensive and fear harm. • Battering: coercive control with the use of violence. Examples are hitting, biting, rape, choking, stabbing, burning,shooting. • Cycle of battering: Tension building, triggering event, acute battering, honeymoon stage.

11. Profile of the Victim • Battered women/men represent all ages, educational, cultures, socioeconomic groups. • Low self esteem. • Accept the blame, don’t want to press charges • Common are feelings of fear, guilt, anger, and shame. • Poor support system.

12. Profile of the Perpetrator • Gender: most risk is male, under 35yo, • Low self esteem, blames others. • Limited coping ability, views world as hostile and threatening. • Strives to keep the victim isolated, and dependent, puts their needs first. • Frequently has a history of violence; was abused as a child or a witness to abuse.

13. Physical Signs of Injury • Bruises, especially of different colors and in places the victim couldn’t have caused themselves, shapes of an object. • Bite marks,skin welts, perforated ear drums. • 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. • Miscarriages

14. 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.

15. Treatment • Nursing assessment, identify signs indicating stress ie restlessness, assess support systems. • Diagnosis: Risk for Injury, Risk for Violence, Anxiety, Fear, Disabled Family Coping, Powerlessness, Caregiver Role Strain, others. • Give validation:”What is the matter?” “You look upset.” • Outcome:Cessation of abuse reported by victim Emotional abuse has stopped. Neglect has stopped. Financial exploitation has stopped.

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

17. Nurse’s Attitudes • Difficulty when giving care to survivors of violence, frustrating, difficult. • The attitude brought into the situation by the nurse can focus the response. Stay calm. • 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 due to situation. Nurses’ show a lack of understanding on why abused children want to return to their parents and why battered wives stay with their husbands.

18. 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.

19. Conclusions • What is my gut feeling? • What if this was my sister, aunt, mother, or father? • Check your view. • Look at the bigger picture of this person’s life, not just the situation.