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
