Care of Survivors of Abuse, Domestic Violence, and Sexual Assault Flashcards
what are the forms of abuse?
physical
sexual
emotional/psychological
economic
neglect (children and dependent adults)
what are the types of abuse?
partner/spousal
child
elder
sexual assault- known perpetrator or stranger
secondary to other forms of criminal activity
what are the assessment for abuse and neglect?
recurrent and/or unexplained injuries
history of multiple or suspicious accidents
old or new fractures, especially if multiple; bone overgrowth (Caffey’s Syndrome)
bruises, abrasions, etc where they would not be expected from normal activities
bruises, abrasions on upper arms/wrists (from restraining or shaking the person)
bruises on ankles suggesting restraint
cigarette or other burns
unkempt, body odor, fleas, or lice; contaminated with urine or feces, soiled clothing or bedding
elderly or physically incapacitated
insufficient clothing, inappropriate clothing for the weather, soiled clothing or bedding
malnourishment or dehydration; insufficient food in the home
unusual recurrent illnesses or medication-related problems (neglect, lack of medications or medical care)
increased school/work absences, truancy
change in school/social/role functioning
caregivers seem unconcerned, non-empathic, guarded, resistant poorly controlled, easily frustrated, eager to shorten the contact
what are the indicators of suggestive sexual abuse?
STDs, genital or rectal bleeding, recurrent UTIs, and insomnia
in children, precocious sexual activites/knowledge; sexual acting out; seductiveness; genital bruising
what is the assessment for financial abuse/neglect?
unable to account for their funds, have provided others with financial access or information
money is being spent without benefits to show for it
others accompany the person when spending or accessing money and seem to be directing the purchases or withdraws
what are the emotional elements to be seen in assessments?
withdrawal, isolation
low self-esteem
anger, rage
aggression, acting out
depression
fearfulness
apathy
depression
anxiety
substance abuse
what are indicators suggestive of increased risk of perpetrating abuse?
previous abuse relationships
lack of empathy; jealousy (anti-social)
pressure for quick involvement/commitment
controlling/demanding personality; easily threatened
“anger management issues”
“playful” use of force in romantic/sexual encounters
rigid expectations re: roles in the relationship
attempts to isolate partner; blames partner for his problems
stalking; cruelty to animals or people
what is the nursing role related to evidence for abuse?
great care must be taken in the intentional and unintentional collection and preservation of evidence:
if you neglect or damage evidence you help the perpetrator
seek only that information needed to treat the survivor
do not interrogate the patient related to the trauma due to the risk of “contaminating” reports
instead , seek only info that you need to treat the patient
for spontaneous comments by patient, include detailed doccumentation of patient’s comment in quote
assure that physical evidence is immediately bagged and labelled before it can become contaminated
what does the provider must need report domestic violence?
the victim’s permission
what is the features of the violence within families?
usually involve issues of power and control
often involves multigenerational transmission (victims become perpetrators due to norm of violence)
often involve or accelerated by drug or alcohol abuse
affects all categories and classes of people
can occur in outwardly “loving families”
can affect later health, e.g. female survivors have higher risk of later cardiovascular events
what are the responses to abuse from possible survivor?
depression, anxiety
increased risk of developing PTSD, borderline personality disorder, or dissociative disorders
increased risk of abuse, suicide, and homicide
isolation (shame, fear of discovery and subsequent legal and social consequences)
discomfort with relationships, sexuality
substance abuse
acting out sexually or aggressively
repression of memory of abuse
negative impacts with relationship
what is seen by the perpetrator as an intolerable, unacceptable threat to his control and masculinity?
the survivor’s efforts to protect herself and her family
when would the perpetrator redoubles his efforts to assert control, and will often kill his victim and himself before surrendering control?
faced with survivor’s efforts to take back some power in the relationship
why would some stay in an abusive relationship
ambivalence- they also love the person
financial and/or emotional dependence (places togo, money to live on, poor self esteem, fear of being alone, etc)
fear will lose custody of kids, put kids at more risk
denial- believe the perpetrator is not at fault, will somehow change
fear of even greater violence- leaving will increase the risk
believe there is no help, will be rejected, authorities won’t listen, others will “blame the victim”
why would some people leave an abusive relationship?
concern for children
come to believe they can leave- that it’s an option, that they can be safe; they develop confidence and/or decrease dependence
support from others becomes available
other resources become available- shelters or other safe housing, finances, transportation, a job
“awakening” phenomena results in readiness
what happens during the assessment of those experiencing domestic violence?
each time she is asked about abuse she has another opportunity to break the silence
if you do not ask, she probably will not tell
enable clients to acknowledge abuse by how you word your assessment questions
look for- unlikely explanations for injuries, increased incidence of accidents, somatic complaints, dehydration or malnourishment, reluctance to speak with provider or stay in care setting, partner tries to cut the contract short
assess the children as well as the spouse to be sure they are safe too
what are the interventions for domestic violence?
keep in mind that the survivor knows more about her situation than anyone and is the expert about what she needs to do
remember that her response makes sense for her, in her situation (in any given situation people are usually doing the best they can under the circumstances, even if it “does not make sense” to others)
know that she will try to leave 7-10 before succeeding
each time she hears “no one deserves to be treated like this”, she becomes stronger
“no contract” and “temporary protective orders”- complicated, limited, can help (but may be ignored)
monitor oneself and remain objective (abuse can stir up strong emotions)
meet the physical needs: treatment, nutrition
provide non-judgmental listening, acceptance and support
express concern (without pressure)
instill realistic hope
explore and educate- safe houses, cell phone, support resources
assure patient has an advocate when police become involved
connect to resources
what does child abuse lead to?
societal problems as well as personal problems
how many children die from abuse each day?
4
who spend less time in school and kept out to prevent discovery of abuse by perpetrator’s or too ashamed to go?
abused children
what are interventions for child abuse?
mostly are same as for survivors of domestic violence except done in child-friendly manner and environment
increased emphasis on counseling
stuffed animals can comfort children
exception- in Ohio, these offenses involve mandatory reporting to CPS
who should be questioning the child after abuse becomes suspected, and interrogation should be videorecorded?
only skilled/certified interrogrators
what are more likely if an interrogation includes leading questions or the patient senses that certain responses are expected?
false memories
what is less reliable than believed and very prone to distortion and contamination?
“eye witness” testimony
what is expected under Ohio law about mandatory reporting?
providers must report all suspected abuse or neglect of children, persons 60+ years old, or those unable to protect themselves due to physical or mental handicap
providers must have the survivor’s permission to report domestic violence against adults (but must document knowledge or believe of DV
providers who report in good faith are protected from criminal charges or civil action
what is the exception of mandatory reporting in Ohio?
all stab and gunshot wounds, severe physical harm, and second and third degree burns must be reported
what is sexual contact without consent (or unable to give consent)?
sexual assault
what is sexual contact without consent under the threat of force (does not require physical resistance be demonstrated)?
rape
what is the primary dynamic in sexual assault?
control; it is not a crime of sex, but of control
what are most sexual assualts?
they are planned (perps set out to commit the offense, and though the victim may be random, he/she is usually chosen based on perceived vulnerability)
why would survivors may decline to report the offense?
d/t fears of retaliation, shame, lack of confidence in the criminal justice system, a desire to preserve privacy or forget the incident, fear of the reactions of others
what does not specifically require reporting of sexual assault, but does require reporting serious injuries and felonies in general?
Ohio law
what happens when sexual assault is reported?
it makes it a legal offense and the victim may be subpoenaed to testify
what improves the chances of successful prosecutions?
prompt reporting, and especially prompt collection of evidence by qualified persons, e.g. Sexual Assault Nurse Examiners (SANE)
what are considered felonies?
staff assaults against mentally impaired persons
what do many jurisdictions offer for domestic violence or crimes committed d/t mental illness or substance abuse?
specialized courts
what can be helpful but cannot be counted on to protect intended victims?
protective orders
what is a critical incident stress debriefing teams?
when groups of people have been traumatized, specialized response teams that provide support and education about trauma and coping
what is vicarious traumatization?
indirect exposure
what is being increasingly recognized as an occupational hazard within nursing and others working with survivors?
vicarious traumatization
