caring for abused persons (329 E3) Flashcards
physical abuse
the infliction of physical pain or bodily harm
sexual abuse
any form of sexual contact or exposure without consent or in circumstances in which the victim is incapable of giving consent
emotional abuse
the undermining of a person’s self worth
neglect
the failure to provide for physical, emotional, educational and medical needs
economic abuse
controlling a person’s access to economic resources making an individual financially dependent
crisis situation
a situation that puts stress on a family with a violent member
-lack of effective impulse control
-lack of problem solving skills
-lack of a healthy support system
perpetrator
any member of a household who is violent toward another member
vulnerable person
the family member upon whom abuse is perpetrated
survivor (vs. victim)
recognizes the recovery and healing process that follows victimization and does not have a connotation of passivity
intimate partner violence (IPV) includes
physical violence, rape, and/or stalking and psychological aggression by a current or former intimate partner
risk factors for IPV
-perspective dominance
-pathological jealousy
-substance abuse
-pregnancy
greatest risk is when a person threats to leave or actually leaves the relationship
cycle of violence
tension building -> acute battering -> honeymoon stage
the cycle moves in a continuous circle
cycle of violence: tension building
-minor incidents (pushing, shoving and verbal abuse)
-victim reduces tensions, ignores/accepts/excuses behavior out of fear
-abuser reduces tension, rationalizes behavior
abuser reduces tension of incident w/ alcohol and drugs and victim by minimizing the importance of the incident
cycle of violence: acute battering
-tension peaks
-triggered by events or abuser’s emotional state
some experts believe that the victim provokes to decrease the tension and go to the honeymoon stage
cycle of violence: honeymoon
-tension reduces
-abuser: is remorseful, apologetic, promises gifts
-victim: needed love, hopeful, abandons legal plans
with the cycle of violence, overtime
-Decrease in calm stages
-Increase in intensity
-Increase in depression
-Increase in hopelessness
-Increase in immobilization
-Increase in self-deprecation
older adult abuse definition
intentional actions that cause harm or creates a risk of harm to a vulnerable person. This mistreatment includes failure to provide for the older adults’ basic needs or to protect them from harm
all types of abuse from financial to sexual to physical
risk factors for older adult abuse
-poor mental health
-poor physical health
-disruptive disorders (alzheimer’s)
-dependency
-families w/ a hx of violence
most typical victim of older adult abuse
-female
-over 75
-living w/ a relative
-physical and/or mental impairment
vague symptoms of abuse
-Chronic pain
-Insomnia
-Hyperventilation
-Gynecological problems
interview process in regards to abuse
-Private
-Sit nearby
-Establish rapport
-Avoid words like “abuse” or “violence”
-Ask specific questions about conflict resolution
-Do not interrupt
look at the interview guidelines box
DOs and DONTs
assessing for physical abuse: covert signs
A series of minor complaints such as:
-Headaches
-Back trouble
-Dizziness
-Accidents (especially falls)
assessing for physical abuse: overt signs
Bruises
-Scars
-Burns
-Wounds in various stages of healing: Head,
face, chest, arms, abdomen, back, buttocks,
and genitalia (Box 28.3)
when assessing for physical abuse
if the explanation does not match the injury or if the patient minimizes the seriousness of the injury, expect abuse
observe non verbal responses
ask in a direct non threatening manner if someone close to them has caused this injury
start to ask the questions “when was the last time it happen?” “how long as it been happening” “in what ways are you hurt”
assessing for sexual abuse
Sexualized behavior
- one of the most common sx in children
Sexual knowledge
Drawing sexual explicit material
Sexual aggression
Sexual play
Sexual promiscuity in older children
+sx of PTSD
adults report depression, anxiety, a risk for suicide, aggression, chronic low self esteem, chronic pain, obesity, substance misuse, self mutilation and PTSD
assessing for emotional abuse
may exisit on its own or in conjuction w/ physical or sexual abuse
Low self-esteem
Feelings of inadequacy
Anxiety
Withdrawal
Learning difficulties
Poor impulse control
assessing for neglect
under nourished
dirty
poorly clothed
inadequate medical/dental care
assessing for economic abuse
Needs unmet with adequate finances
Unpaid bills -> Disconnected utilities
Extreme dependency
additional assessments for abuse
Level of anxiety and coping response
Individual & Family coping mechanisims/patterns
Support systems
Suicide potential
Homicidal potential
Drug and alcohol use
Self-Assessment
potential priority problems
Safety is the top priority
Risk of violence
Risk for suicide
Anxiety, Fear, Hopelessness
Low self-esteem
Individual impaired coping/impaired family coping
Dysfunctional family process
outcomes for an abused pt
Abuse cessation is top priority
Physical abuse has ceased
Emotional abuse has ceased
Sexual abuse has ceased
Financial exploitation has ceased
make these with the survivor and their support person
re listen to planning & implementation
review plan of care slides
preventions for abuse: primary
Measures taken to prevent the occurrence of abuse
Examples: Reducing stress and the influence of risk factors, increasing social supports, coping skills and self-esteem
preventions for abuse: secondary
Early intervention in abusive situations
Examples: Screening programs for individuals at risk, medical treatment for injuries, coordination of community services
preventions for abuse: tertiary
Occurs in MH settings; nurse facilitates healing and rehabilitation
Examples: Counseling individuals and families, providing support for groups of survivors, and assisting survivors of violence to achieve their optimal level of safety, health, and well-being, legal advocacy programs for survivors of intimate partner violence, complementary therapies, such as mindfulness-based stress reduction, can also assist survivors in the healing process
treatments: individual therapy
goals are the survivor feels empowerment, has the ability to recognize and choose productive life options, and the development of a solid sense of self
nurses must address the guilt, shame and stigmatization experienced by survivors of abuse
treatments: family therapy
all members need support and understanding
interventions provided may maximize positive interactions amongst all family members
couples therapy can put the abuse at increased risk of harm or death -> should only happen if abuser had individual therapy first and has demonstrated change
treatments: group therapy
participation in group therapy provides assurance that one is not alone and that change is possible
+CBT
attempted rape
Threats of rape or intention to rape that is
unsuccessful
completed rape
“Penetration, no matter how slight, of the vagina or anus with any body part or object, or oral penetration by a sex organ of another person, without the consent of the victim” (FBI, 2019)
clinical picture of sexual assault
No typical patient presentation; emotional responses will vary
Long-term effects may include: Major depressive disorder, anxiety, fear, and suicide
Difficulties in daily functioning
Low self-esteem
Sexual dysfunction
Somatic Complaints
acute stress disorder caused by SA
sx <1mo
-Intrusive symptoms (memories, dreams, flashbacks)
-Negative thoughts, moods, feelings
-Avoidance
-Arousal symptoms
-Disassociation
post traumatic stress disorder caused by SA
sx >1mo
-Depersonalization: Feeling like they are living in a dream
-Derealization: Feeling like the world is dreamlike, distant or distorted
sexual assault nurse examiner (SANE)
Specialized training
Medical and legal competency
Capable of being an expert witness in court
Works as part of the Sexual Assault Response Team (SART)
re listen to care plan process for SA
review
