41. Violence and Abuse Flashcards
effects of violence
- permanent changes in survivor’s reality and meaning of life
- deep wounds
- endangerment of core beliefs about self, others, and the world
- damage or destruction of survivor’s self-esteem
theories of violence
- biochemical (increased dopamine, serotonin, and NE)
- substance abuse
- social learning theory
- economic disadvantage
- community disorganization
- attitudes supportive of violence
- imbalances in relationship power (subordination of women)
- factors influencing leaving vs staying in violent relationships (fear, lack social networks, or lack of resources)
what does the social learning theory say
- children witnessing violence in homes often perpetrate violent behaviors in families as adults
- learn to accept violence and expect it
most common type of violence and abuse
domestic (family violence)
types of domestic abuse
- intimate partner violence (IPV): physical, psychological, or sexual
- stalking
- rape/sexual assault
- child abuse: neglect, physical, psychological, sexual
- elder abuse: physical, sexual, emotional, neglect, abandonment, financial
repeated unwanted contact, attention, and harassment
stalking
characteristics of stalking
- crime of intimidation
- cyberstalking
- women 18-24 have highest risk of being stalked
characteristics of rape/sexual assault
- act of aggression no passion
- can occur at any age
- highest risk group: 16-24
- most victim single women and occurs near own neighborhood
nursing interventions for rape victim
- you’re safe
- I’m sorry this happened to you
- this is not your fault
- I’m glad you survived
- you did the best you could
- explain every assessment procedure ahead of time
- provide privacy
- encourage victim to give account of incident
- provide information about referrals
rape survivor is openly emotional
express-response pattern
rape survivor will mask emotions and will appear to be calm w/ blunted affect; may feel numb
control-response pattern
rape survivor will have variety of sxs (muscle tension, headache, sleep disturbances, or ABD pain)
somatic reaction
when the rape survivor suppresses feelings and doesn’t tell anyone; may regress to childhood and experience night terrors
silent rape reaction
reaction to intimate partner violence
- women: afraid or reluctant to identify abusers due to retaliation; attribute injuries to other causes
- men: hesitant to report victimization or fail to consider behaviors as abuse
describe psychological IPV
- criticize, insult, humiliate, or ridicule
- destroy another person’s property
- threaten or harm pets
- control or monitor spending and activities
- isolate person from friends or family
- more constant than physical violence (episodic)
- varieties of abuse to exert power and control
secondary victims of IPV
children of IPV victims
T/F: victims of IPV are also victimized by family courts
True
phase 1 of cycle of battery
tension build up phase (abuser is moody and victim is being careful to not trigger them)
phase 2 of cycle of battery
acute battering incident (when abuse takes place)
phase 3 of cycle of battery
honeymoon phase (abuse is calm and loving; trying to regain control and power over victim; using undoing defense mechanism)
when the abuse tries to make the victim feel like they’re crazy and everything is their fault
gaslighting
survivors psychological response to trauma from violence
- fear
- low self-esteem
- guilt and shame
- problems w/ intimacy
- revictimization (end up in another abuse relationship)
survivors biological response to trauma from violence
- physical injury
- negative health consequences
- somatic complaints
- GYN problems (STDs)
mental health consequences from violence trauma
- depression
- PTSD
- alcohol and other drug disorders
- suicidal
- co-occurring disorders
profile of the victim
- all socioeconomic groups
- married or unmarried
- all employment types
- low self-esteem
- accept blame for abuse
- grew up in violence house
- accept relationship as male dominated
- can’t see possible options
- learned helplessness
profile of victimizer
- low self esteem
- dual personality
- under great deal of stress
- poor coping skills
- become threatened if woman shows any signs of interest in other people
- ignore young children
- threaten to take children
reasons why someone stays in abuse relationship
- fear of retaliation
- for the children
- for financial reasons
- lack of support network
- religious reasons
- hopefullness
most common form of child abuse
neglect
consequences of emotional abuse in children
results in impairment of social, emotional, intellectual functioning
indicators of child sexual abuse
- difficulty walking or sitting
- suddenly refuses to change for gym or to participate in physical activities
- reports nightmares or bedwetting
- experience sudden change in appetite
- demonstrates bizarre, sophisticated, or unusual sexual knowledge or behavior
characteristics of incestuous relationship
- father domineering and mother passive (she knows about it but uses denial or keeps quiet out of fear of being abused by husband)
- poor communication between parents
- usually starts when child is 8-10 years old
- usually oldest child
- child becomes bewildered
characteristics of adults who survive incest
- lack trust
- low self esteem
- poor sense of identity
- does not trust own feelings
- are not comfortable sexually as adults
- poor relationships w/ peers
- often find relationship where they are abused again
- often poor relationships w/ family (not believed)
characteristics of child abuser
- were likely abuse as children themselves
- stressful life situation
- lack of support systems
- lack of understanding of child development
- maladaptive coping strategies
- unrealistic expectations of child
assessment of victims of abuse
- establish nurse-pt relationship
- conduct lethality assessment (danger assessment screen) -> checks for danger of harm when returned home
- screen for violence and abuse (abuse assessment screen and Burgess-Partner Abuse Scale for Teens)
- obtain Hx and PE
evaluation and treatment for victims of abuse
- manage pt’s immediate safety
- ending abusive relationships
- recognizing that one is not to blame
- demonstrate strengths and coping skills
- re-establish social network
- follow-up efforts important (monitor living environment and sxs)
treatment for abuser
- usually court mandated
- extensive outpatient programs includes: cognitive behavioral techniques, psychoeducational topics, anger management, and couple counseling
goals of care for victims of abuse
- prevent injury
- stop violence
- ensure safety
nursing assessment for psychological domain
- MSE
- observation for sxs (anhedonia, difficulty concentrating, feelings of worthlessness/guilt)
- suicidal or homicidal intent
- problems w/ intimacy
nursing assessment for social domain
- social networks and support
- restrictions on freedom
- degree of dependency in relationship
- revictimization
teaching for abusive families
- child management skills
- parenting skills
- leisure skills
- household organization
- anger control and stress management
