Ch 8. Interpersonal Violence

Question 1

Know the 3 main types of Interpersonal Violence (actually 4)

Answer 1

Intimate Partner Violence
Sexual Assault
Child maltreatment
Elder Abuse

Question 2

Recognize health care providers’ role as mandatory reporters of certain types of abuse.

Answer 2

Most provinces/territories require the public and health care providers to report suspected child abuse. 
Child abuse and IPV often overlap.
Types of abuse
> Physical
> Sexual
> Neglect
> Emotional

Ex. Throwing an object at a child
Any sexual contact b/w an adult and a child under 16
Not making sure a child is supervised properly
Threatening to move a child out of their home
Violent shaking
Not giving a child proper food or warm clothing
Making sexual comments to a child
Watching Child Pornography

Question 3

Gender and IPV

Answer 3

Men are more likely to be injured by strangers in a public or social venue

Women are in greater danger of experiencing violence in their own home

Women are at greater risk for sexual violence

Older women at higher risk than older men of Elder abuse

Question 4

Four levels of sexual assault

Answer 4

Forced sexual activity without physical injury
Sexual assault with a weapon or verbal threats
Sexual assault causing bodily harm
Aggravated sexual assault

Question 5

Discuss the health effects of violence.

Answer 5

• Direct effects of physical injury (bruises, fractures)
•Chronic health problems
>Chronic pain
>Neurological
>Gastrointestinal
>Gynecological
>Chronic pelvic pain
>Unintended pregnancy
>STIs, including HIV
>Urinary tract infections
• Mental health problems
>Symptoms of post-traumatic stress disorder
>Substance abuse
>Depression
>Suicidal thoughts/attempts

Question 6

Identify and elaborate on the core components of an IPV assessment

Answer 6

All care should be “trauma- and violence- informed”
• Women who are victims of IPV will disclose when they feel confident enough to do so.
• The health care provider can: Assume that a majority of patients will have a history of abuse of some form

Listening – non judgmental, be accepting
• How do my beliefs influence the care I give? What groups are most vulnerable?

High index of suspicion for abuse
•Up to 50% of all women have experienced some form of abuse
• 7% of Canadian women are currently in abusive relationships
• More isolated = more vulnerable
• Have a high index of suspicion when patients present with direct injuries, chronic pain, substance use

Assessing collaboratively, using a relational approach
Physical examination
•Complete head-to-toe exam
• Multiple factors can contribute to bruises in older adults (Medications and abnormal blood values; Underlying hematological disorders; Accidental bruising (on extremities))
• Health evaluation for known or suspected elder abuse and neglect should include baseline laboratory tests

Documentation

Question 7

Discuss the importance of both written and photographic documentation of abuse.

Answer 7

Everything must be quoted as said.

Detailed, objective, unbiased notes
Include “exceptionally poignant” statements that specify the perpetrator and the threat
Do not sanitize language, either used by the patient or quoted by the patient and attributed to the perpetrator
With children, use the words of the child
Use of injury maps
Photographic documentation