Comm Test 2: domestic violence Flashcards
- between persons with a relationship with trust
Domestic Violence
factors affecting abuse
work education organized religion population resources media
- negative: work place violence trust with coworkers and boss, lose job causes financial stress, at risk for violence (go back and shoot), lose lifestyle, lose friends
- Positive: support from coworkers
. Work
factors affecting abuse
- positive: resources and hotlines, support groups, counseling centers, need advocate
- negative: lack of edu for wat is considered abuse, no access don’t know where to go , feel like they have nothing
education
factors affecting abuse
- positive: community resources for help, food pantries and emergency supplies
- Negative: some are demining to woman, or don’t like other faiths ,media issue hear about allegations of child or sexual abuse
Organized religion (faith) factors affecting abuse
- negative: blended families have issues, very young and very old are prime targets, vulnerable get hit harder with poverty= working class poor builds stress bc can’t meet needs of family
Population
factor affecting abuse
-counseling centers, support groups
Resources factors affecting abuse
- Negative: video games promotes violence, publicize beheading- want crime to be known 15 min of fame
- positive raise awareness, public service announcements
Media
factors affecting abuse
- has a previous, unrelated conviction under this section or any other section with substantially similar elements (dui counts) OR
- committed the offense in the physical presence of a child less than 16-years-old, knowing that the child was present and might be able to see or hear the offense.
Indiana Law – Domestic Battery
Class D Felony if the person who committed the offense:
– a deliberate act that causes injury. Includes failure to protect
physical abuse
use, persuasion, or coercion to engage in sexual conduct/ adult fondling a child or minor
sexual abuse
– a deliberate act that damages self-esteem and personal worth/ start picking someone else’s esteem
emotional abuse
– failing to care for one for whom you are responsible to and for.
neglect abuse
- draw to express feelings, black fists and mom crying , frowning, no hands means helplessness
Child’s View of Partner Abuse
- Child be able to say don’t touch me
- Express rights of child to speak up
- Will not tolerate sexual abuse
It takes a community to protect a child
: Holistic harming of a human being by one who is acquainted with, trusts, has an on-going relationship with, lives with, married to, or has any other meaningful connection to the victim
. Domestic Violence
- Younger parents- edu on controlling anger, resources, not alone call on services, control impulse
- Socially isolated
- Lower SES
- Less formal education- learning what is abuse
- Inadequate support systems
- Poor parenting skills
- Victim of child abuse-siblical
- Single parent family(unrelated partner=resentment toward child)- you are the only outlet talk to someone about issues , don’t snap
Characteristics of a Child Abuser/Victims
A. Abuser:
- vulnerable
1. Birth to 3 years old- very vulnerable
2. Disability- drain and stress, need more resources
3. Chronic high stress environment
4. Crowded living conditions
5. Lower SES
6. Premies- bring home, a lot of extra needs, especially if first child
7. Unrelated caregivers- nursing home=tired of working
B. Victim
char of a child abuser/ victum
: Known by the victim
- 80% are adults
- Work with children: risky job, priest and pastors
- Long-term abuse
- Controlling behaviors: huge issue
- Need power: in control, want to leave lose control
Characteristics of Sexual Abuser/ Victim
A. Abuser
- 10% of men are
- 20% of women are
- Reluctant to report: deeply personal crime
- Males less likely to report
- Males most likely to be abused by another male
- 9-years-old is the mean age for abuse =parent who is overly concerned about the child, don’t want you in there
B. Victim
char of sexual
- edu to prevent snapping, belittle child in front of friend=makes uncomfortable victim takes it
various stages of healing=episodes of abuse
Note- signs of fresh wounds or bruises and old scars might be an indication that the child has suffered from more than one occasion
Physical Abuse
beating, biting, burning, hair pulling, hitting, punching, kicking, scalding, shaking, shoving, slapping, throwing, tying up, torturing
forms of physical abuse
minor bruising, scratches, gazes, cuts, eye injuries, fractures, injuries to brain, damage to internal organs
Range of severity:
physical abuse
- story match the injury= red flag, can be afraid of what will happen to family
- fractures
- bruises, contusions, etc…
- oral and dental injuries
- burns – thermal, scalding, other means.
- Head trauma – abusive head trauma FKA Shaken Baby Syndrome.
- Sexual injuries
- Pinching- marks left and bruise
- Any other injury deliberately performed against a human being.
Physical Injuries
- forehead, nose, head injuries involve parietal bone, occiput, or forehead, chin, palm of hand, elbows, knees, shins
Accidental Injuries places
- involve bony prominences
- match the history
- are in keeping with the development of the child
Accidental injuries typically:
-Abusers are smart= cloths cover, prime areas
A. Triangle of safety
- black eyes= bilateral seledum, soft tissue of cheeks, intra cranial injuries, mouth- bite marks on tongue= can be accidental if fall, inner aspect of arms= not radially visible , back and side of tongue
-pinch marks, chest and abd= usually, can be trauma from car accident, forearms when raised to protecting self, any groin or genital injury= sexual abuse, inner aspects of tights, soles of feet
- spiral fractures
Intentional Injuries
Ears, side of face, neck, and top of shoulders= very unusual
triangle of safety intentional injuries
-injuries to both sides of the body, injuries to soft tissue, injuries with particular patterns, any injury that doesn’t fit the explanation, delay inpresentation, untreated injuries
Remember concerns raised by
Nature of injury, past and present
Repeat MD or ER visits
Blames another party
Inconsistent Hx
Story d/n match history
Present with complaint about anything except the abusive injury
Disproportionate response of alleged abuser- clingy (red flag)
Refuse tests and treatment- lose nerve
Delay in seeking treatment- hoping will heal on own
Absence of parents- caregiver take to be seen like babysitter
Inappropriate response of the alleged victim- too much or too little
Warning Signs of Abuse
- surface, rigged outline, bc move around a little bit before get away, drag mark trying to get away, irregular
Accidental Cigarette Burns
circular, deeper wounds, where they are located, more uniform
. Intentional Cigarette Burns:
irregular with variable severity in appearance (some areas with blistering some without)
- typically no recognizable patterns and burs are not circumferential
- unprotected areas
- general location is flexor and anterior surfaces
- severity varies, predominance of superficial, first degree burns
- few in number, all of same apparent age and stage of healing
- edges are indistinct and irregular
- splash marks are present
Characteristics of Burns Accidental:
regular and more uniform appearance
- recognizable pattern with symmetry and regularity, circumferential = minimal splash marks: common for immersion burns
- areas that are relatively protected ( butt, genitals, thighs)
- general location is extensor and posterior surfaces
- severity is relatively uniform with predominance of deeper second and third degree
- multiple wound in various stages of healing
- edges are clear and sharply demarcated
- no splash marks
Characteristics of Burns non-accidental:
- pattern of what was used
- definitive on purpose=grid
- hotplate, light bulb, curling iron, cigarette lighter, immersion- line of demarcation, forks, knife, steam iron , belt buckle, sticks, knuckles
Pattern of Burn Marks
- no exact line
Immersion Injuries
1. Accidental
- specific demarcation
. Intentional immersion injuries
- hot drinks 44%, cooking liquids and hot food 22%, boiled water 20%, hot tap water 14%
Causes of Scald Injuries
- Twisting injury, Rotational pattern
Rare in children – unless abused
Accidental injury may come from sports- skiing snowboarding, roller skating
Spiral Fracture
- ankles, hands, throat
* big red flag, only happen if tied up unwillingly
Ligature Marks
- 30% die or have lifelong complications
- Head larger than body proportions
- Weak neck muscles
- Large amount of water
- Results in tearing of vessels and neurons
- don’t know till proven in court, can have finger marks on back and front because holding really tight
- neck muscles are pretty flexible in an infant
- babies are especially susceptible to injury when they are shaken bc their connecting tissues and bone structure have not sufficiently developed to offer any protection
Abusive Head Trauma (AKA = Shaken Baby Syndrome)
- brain bangs against the skull
- small blood vessels between the brain and the skull are tearing causing bleeding
- large blood clots can form pressing against the brain and causing massive swelling
- blood vessels in retina are red and big because detached
- blood between two hemispheres, vertebrae can crush spinal cord bc weak neck muscle
- injuries can result in brain damage, retardation, paralysis, blindness, deafness, and death
abusive head trauma
Subdural and subarachnoid hemorrhages Retinal hemorrhages Fractured ribs (possibly flail chest) 45% have prior injuries- most cases can be 1st Most have no signs of external injuries
Co-Morbidities of AHT
- flu-like sx
- vomiting
- poor eating
- listless
Symptoms of AHT
*General
- posturing
- seizures
- decreased LOC, respiratory function
severe symptoms of aht
- seizure disorder
- visual impairment
- developmental delays
- cerebral palsy
- hearing impairment
- cognitive impairment
Long-term effects of aht
tears in brain, shouldn’t be dark= bleeding
Dx: CT Scan Abusive Head Trauma:
- red blots in the eye
Severity, Visual changes, Recoverable, Time between injury and medical treatment
Retinal Hemorrhage
- can be accidents because they don’t have lines that are spreading out, not very common
Linear Skull Fracture
- non-accidental, lines look like a spider web, usually chronic injury, head trauma from weapon Ex: baseball bat, gunshot= few lines
Stellate Skull Fracture
- single, linear, narrow, usually parietal bone, no associated intracranial injury, unilateral, non-depressed, only one cranial bone, does not cross suture line
. accidental skull fracture
- multiple, stellate, wide > 3mm, any location, intracranial injury present, bilateral, complex depressed growing and enlarging, may be multiple cranial bones, crosses suture lines
3b. intentional skull fracture
- force feeding, shoving genitals in mouth= tear connective tissue on top of mouth , can have broken teeth
Oral and Dental Injuries
- skin isn’t broken, straight marks= belt buckle, switch / pattern of object
- notice where they are=pants cover
Bruising Injuries
- teeth marks of upper and lower
- can be asked for bite mark with dental paper
Bite Marks
Genital bleeding Vaginal discharge Anogenital bruising or redness Unexplained difficulty walking Unexplained STDs Unexplained frequent UTIs
Symptoms of Sexual Abuse
Routinely screen mothers and teenage girls who are dating. Especially at every prenatal visit!! I have to ask these questions.
r radar
Nurse should get supervisor, get physician in there, call social services, security= prepare for the worse, nurse goes back over the hx- ask few more questions: what type of table, role is to not alarm parent , separate both parents to see if story matches, report filed= police arrive/ can ask child- may not say anything bc want to be with parent= child draw a picture, parent may request to be present won’t say anything, can call security if danger to self child or someone else
may leave the child= in favor because able to treat
The nurse suspects abuse. Why and what should the nurse do? Spiral fracture= falling from table to the floor, dislocated shoulder
Ask direct questions. Preface with “Because violence is so common, I’ve begun to ask about it routinely. Do you feel safe at home? Have you ever been pushed, hit or hurt by your partner?”
A RADAR
Document your findings. Body maps and quotes are very important.
d radar
Assess patient safety. Can the child and mother return home safely?
radar a
Review options and referrals. Refer to a shelter and other resources as appropriate. Do not insist she take them. Arrange to see the family back soon for follow-up.
- stories start changing then it is a problem red flag
- look at who is doing all the talking
r radar
Observe parents and potential batterers for behaviors suggestive of abuse?
Relationship of parent or adult to the child?
Story equal to the injury?
Who is doing the talking?
Other injuries?
Nursing Interventions
Must report child abuse identity is protected.
Good quality pictures. picture with 2 or 3 angles/ name of patient on the print then name on back of print photographer/ take with objects to determine size (context) like quarter / get as close as you can to take
Social services, law enforcement, clergy.
Documentation – do not assume anything!, Save evidence – clothing, body fluid collection.
SANE – sexual assault nurse examiner.
Legal Aspect of Child Abuse
Spouse to Spouse, Same Sex Partners, Dating Partners
- Victims of domestic violence are “beaten down” long before they are “beaten up.”- not fighting back, or feel like they can’t
- most cases it will happen again
Intimate Partner Violence-
-Goes unnoticed
Name calling, threatening bodily harm, threatening children to control spouse, take away money or privileges, allowances for adult
Emotional Abuse ex
use intimidation emotional abuse minimizing denying and blaming using children using isolation using male privilege using economy abuse using coercion and threats
power and control wheel
=making her afraid by using looks, actions, gestures
- Smashing things, destroying her property, abusing pets, displaying weapons
Use intimidation
power and control wheel
- putting down, make feel bad about self, calling names, thinks she is crazy, playing mind games, humiliating her, making her feel guilty
Using emotional abuse
power and control wheel
- controlling what she does who she sees and talks to, what she reads, where she goes, limiting her outside involvement, using jealousy to justify actions
using isolation
power and control wheel
making light of the abuse and not taking her concerns seriously, saying the abuse didn’t happen, shifting responsibility for abusive behavior saying she caused it
minimizing denying and blaming-
power and control wheel
- making her feel guilty about the children, using them to relay messages, using visitation to harass her, threatening to take them away
using children
power and control wheel
- treating her like a servant, making all the big decisions, acting like the master of the castle, being the one to define men and women’s roles
using male privilege
power and control wheel
- prevent her from getting or keeping a job, making ask for money, taking her money, giving her an allowance, not letting her know about or have access to family income
using economy abuse
power and control wheel
- making and or carrying out threats to do something to hurt her, to commit suicide, to report her welfare, making her drop charges, making her do illegal things
using coercion and threats
power and control wheel
intensity enhances, breakdown of communication, victim is afraid of the abuser not sure what they are going to do
Cycle of domestic violence:
Phase 1
tension building:
verbal, emotional, sexual, anger blaming, intimidation, physical violence, and threats
Phase 2
cycle of domestic violence
- incident:
abuser apologizes, denies the abuse ever occurred, blames others, makes light of the situation
Phase 3
cycle of domestic violence
- reconciliation:
incident is forgotten and pretends that nothing ever happened
Phase 4
cycle of domestic violence
calm honeymoon stage:
: homicide, suicide, maternal death
Sexual Assault Partner Abuse
A. Fatal outcomes
physical health
chronic conditions
mental health
sexual assault partner abuse
non fatal outcomes
injury, functional impairment, physical symptoms
1b. negative health behaviors= drugs/ alcohol use, sexual risk taking, overeating/physical inactivity
physical health:
sexual assault partner abuse
non fatal outcome
chronic pain, somatic complaints, gastrointestinal disorders
chronic conditions: sexual assault partner abuse
non fatal outcome
post-traumatic stress, depression/anxiety, substance abuse
mental health: sexual assault partner abuse
non fatal outcome
- “Why don’t you just leave?”- afraid leave will get worse, abuser will lose power and control will try to regain
- “What did you do to provoke this?”- well if you haven’t done that I wouldn’t have hit you
- “Don’t you care about your children?”- use child against
- makes them feel like they are alone and being judged, asked by doctors and nurses
Frequent Questions asked to persons who are victims of abuse
Not abused as a child- won’t tolerate
No children
Power- money, main bread winner
Children become the focus of violence- try to get kids out
Supportive friends and family near by- middle of night able to run to them
Frequent and severe battering-escalated to broken bones, feel like they will die if they stay
Did not see their mothers beaten.
Victims Who Leave……
more elderly now, targets because they are weak or ill, abuser wants control may take drugs to sell want pension check
- Neglect
- physical abuse
- financial exploitation, emotional abuse, sexual,
Elder Abuse Statistics-
types of elder abuse
physical sexual emotional neglect abandonment financial
a. hitting, kicking pushing, slapping, burning, or force causing injury
b. - engaging in act without consent
c. - harming self-worth or well-being, name calling, and scaring
d. - failing to meet basic needs like food, housing, clothing, and medical care
e. - leaving elder alone or no longer providing care
f. - illegally misusing money, property, or assets
Types of Elder Abuse physical sexual emotional neglect abandonment financial
bilateral is intentional, pinch marks
anticoagulation med- lot of bruises, a lot of bruises with black eye- abused
- any stab marks, red markings, various stages of healing, look at hx, and other signs= make sure it fits
“Left on a toilet seat…”- long time, hours on end, various stages
- bite marks=circle bruise, definite impressions
*Elder Abuse Awareness- june
- Elder Abuse Center- resource NCEA
Injuries to the Elder-
- hearts and flowers
- same old stuff
- nagging
- warning signs
- violence
- Remorse
Cycle of Dating Violence
- fat lip= smacked face, eye bruised, cell phone is so he can check up on her, clothing he allows her to wear, bruised wrist from grabbing, bruised neck from choking
Unhealthy dating relationship
- Usually male.
- Sexually aggressive peers.
- Drug and alcohol use.
- Accepting of dating violence.
- Prefer impersonal sex: able to justify, see as object
- Impulsive tendencies: gang mentality= wouldn’t norm do on own
- Anti-social behavior.
Dating Violence Abuser
- 16 to 24 years of age.
- May have friends who are also one.
- Occurs in own living quarters.
- 16% of college women
- Previous assault.
Dating Violence Victim
intimidation, sexual abuse, physical abuse, threats, domination, humiliation, possessiveness, minimization and blame.
Power and control wheel in dating relationships:
Statistics- most likely to come from a classmate, friend
-seledem that it is a random person
Domestic Violence Date Rape
date rape drugs
ghb
rohypnol
ketamine
- odorless, colorless, can be made at home.
- available in bars and clubs.
- aphrodisiac, anesthetic-help pain
- respiratory depressant- too much, can be homicide bc too much drug
GHB (gamma hydroxybutyrate)
- “love drug”, reduce inhibitions, amnesia/ clear, able to put in drink and don’t know/ make blue
Rohypnol (flunitrazepam)
- amnesia, can stop heart and longs, used to put dogs and cats to sleep
Ketamine (ketamine hydrochloride)
Alone- reassure victim not alone
Belief- believe not their fault
Confidentiality- assure, name on picture still safe
Documentation- through, detailed, direct quotes
Education- for resources
- victim back in situation give Julian center number to call, put in shoe hide so it can’t be taken
** ask questions!!!
Nursing interventions
abuse
Keep your eyes on your drink.
If you feel unsure, get out of the situation.
Know where you are going and who is going with you.
Be aware of stalking behaviors
Have an emergency plan.
Prevention is the key!!!
Hx of an injury what to ask in eval of potential abused child
Separate hx from child and each parent
What caused the injury? Specifics
How when and where did the injury occur?
Were there any witnesses?
Who was present when the statement was made?
What are the physical characteristics of the injury?
*note any time between injury and when medical care was sought
Meds allergies review of system
Past med hx- past illnesses injuries surgeries or hospitilizations
Dev hx
Birth and neonatal hx
Behavioral hx
Social hx-household members caregivers daycare diet
Previous injuries
Childs hx eval of potential abused chil
Family med disorders
Parents hx-substance abuse, violent tendencies, past victim of abuse
Any stressors or crisis events
Family -including siblings: unexplained injuries maltreatment
Family hx eval of potential abused child
Can the injury be explain by how it was described given the childs age and stage of dev
Fall of ten feet or less don’t cause significant damage
Injury younger than three months
Older infants and young children rarely harm themselves or playmates
Mechanisms of injury eval of potential abused child
- reliabilit, tone, affect, stability
- vague, evasive, excessive distress, aggitated, aggressive
- parent and family interaction
- family dynamics
- childs emotional behavioral state
- childs dev level
- spontaneous or in response to questions
Observed in ed eval of potential abused child
Informants manner
Parents manner
Childs statements
radar for abuse
routine screenings ask direct questions documentation assess for safety resources and referrals
