Community - Exam 2 Violence & Human Abuse Flashcards by Seth Anderson

Violence is… and is influenced by… and nurses are considered…~

predictable and preventable

learned behaviors and social norms

first responders#

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Community violence~

Violence that occurs between strangers, friends, or acquaintences

includes physical assault

occurs inside residential dwellings#

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Intimate partner violence~

physical, sexual, or psychological harm caused by a current or former intimate partner#

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Sexual violence~

sexual activity without consent#

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Public health approach~

Define the problem

who is impacted; type of violence; when and how is it occurring

Identify risk factors

Why are some communities impacted and others aren’t

Develop and test prevention strategies

what works?

Disseminate and implement strategies

campaigns for prevention… etc.#

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Socioecological Model: A framework for prevention~

Individual > relationship > community > societal

Determines risk of a person being affected by or perpetrating violence#

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Individual level~

biological and personal history that increases likelihood

Age (adolescents)
education (lower)
income (lower)
substance use
history of abuse (highest predictor)#

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Relationship level~

Examines close relationships impact

Woman and children if live with abuser

adolescents who socialize with violent peeps (gang)#

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Community Level~

examines settings where social relationships occur

Neighborhoods:
- high population
- poverty (inadequacy)
- gangs
- transient members
- diversity

Schools:
- violence: cyber bullying or actual

Protective factors: resources, mental health, treatment center, support#

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Societal level~

cultural norms (discipline, accepting of abuse)

organized religion (divorce and discipline)#

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Homicide~

often by friend, acquaintance, or family

large % are from firearm
85% of firearm fatalities are among males
2018 - 40k firearm deaths in US

Homicides within famililes: women are 9x more likely to be killed by intimate partner than stranger
- top risk factor is previous domestic violence

It’s increasing the most among youth and adolescents#

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Assault~

males most likely to be assaulted

youth are much more likely

greatest predictor of being assaulted is age

360 teens/day go to ED for assault

Homicide leading cause of death among teens#

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Sexual violence and rape~

underreported
shame, embarrassment, afraid, won’t be believed

crime of violence, not of passion

issues are hostility, power, control, not desire

It is lack of consent#

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Sexual violence and rape stats~

More than 1 in 3 women

Nearly 1 in 4 men

Estimated cost is $122,461 per victim (productivity, criminal justice, etc.)

In Iowa, the cost comes from a special fund#

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Responding to sexual assault~

varied reactions

self-blame

survivors need to be able to talk in non-judgment

often no physical evidence

follow up services are a must (therapy)

Assured of confidentiality, safety, security, privacy#

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Sexual assault responders~

Trained nurse examiner

sexual assault nurse examiners

SANE-nursing

subspecialty of forensic nursing - 40 hour course

peds and adults separate (up to 14 and then beyond)#

Family violence is often not~

exclusive

if child abuse, then also maybe intimate partner and elder abuse#

Family violence is violence of the… against the…~

most powerful
least powerful

power and control

recognition is key - nurses should notice factors#

Development of abusive patterns - upbringing~

Greatest predictor: previous exposure to violence

abusers have learned violence as a way to manage conflict

Children may learn that violence is part of love, due to parental violence#

Development of abusive patters - living conditions~

Risk factors include young parents or who have many children, substance abuse, mental health, low income

crowded living situation

social isolation

Children under 4 are most likely to be abused

lifetime incidence almost equals that of diabetes and stroke

social isolation is a risk factor#

Development of abusive patterns - increased stress~

Unemployment

marital strains

financial stressors#

Child abuse~

physical, emotional, neglect, sexual

ineffective family functioning

Abusive parents have unrealistic expectation of child’s developmental abilities#

Child abuse and neglect incidence~

1 in 7 children in the last year

estimated cost: $428 billion

1800 kids died in 2019#

Child neglect~

physical:
- failure to provide
- associated with poverty

emotional:
- omission of nurturing, acceptance, and caring
- treated as a non-person
- effects development and self-esteem
- quiet, withdrawn children#

Child sexual abuse~

1 in 4 girls and 1 in 13 boys will experience - many cases unreported more common than autism, heart defect, down syndrome, asthma majority of cases are by someone they kmow and trust (81% of perpetrators are parent/caregiver) Long-term effects are emotional and psychological - depression - ptsd - substance abuse - sex disorders - suicidal behavior often groomed, gifted, no force, influence and threat#

Red flags for child sexual abuse~

difficulty walking/sitting changes in appetite bizarre or inappropriate knowledge of sexual behavior somatic symptoms (HA, eating/sleeping/menstural/GI probs) difficulty forming relationships, especially with men behavioral issues substance abuse increased sexual activity#

Child sexual abuse disclosures~

stay calm, listen carefully, don't show your horrification encourage child to speak freely without asking detailed questions affirm the child and reassure that you believe them report to authorities immediately - safety is always first priority - do not send home to environment with abuse#

Facts about disclosures~

very young children 'accidentally' disclose school-aged disclose to caregiver adolescents tell friends intellectually disabled show through behavior change children seldom lie absence of evidence proves nothing - physical evidence is rare many children do not understand that it is wrong Ask: what is the part of your body that you pee with, has anything every happened to that part that you didn't like/anybody ever touch it?#

Intimate partner violence statistics~

Severe physical violence: 1 in 5 women 1 in 7 men Contact sexual violence: 1 in 5 women 1 in 12 men Stalked by intimate partner: 10% of women 2% of men Increased risk for people who have witnessed intimate partner violence growing up#

Intimate partner violence (IPV) signs~

physical: bruises/lacerations often on places not easily seen abused women have more physical health problems than others#

IPV nurse role~

honest, open, sensitive communication complete screenings in quiet, private, alone#

IPV as a process~

seriousness intitially minimized places external blame (work, drinking, etc.) apologizes, remorse escalates in severity and frequency 14% of homicides are by intimate partners; 70% of those are women Greatest risk factor for adult female suicide#

Elder Abuse~

physical, sexual, emotional, financial, neglect most cases underreported due to fear to disclose precipitating factors - burden on the caregiver - resentment of caregiver - elder may have been abusive Most common type of psychological abuse is rejection/ignoring#

Elder abuse examples~

Rough handling (bruises/bleeding) impose unrealistic toileting demands give food they can't/shouldn't/don't want to eat give sedative meds#

Caring for clients who experience violence~

1. build trust/confidence 2. focus on pt no situation 3. assess immediate danger 4. emergency care 5. dev. safety plan 6. referral (services/legal) 7. mandatory report#

Primary prevention~

teach alternative methods of conflict resolution organize parenting class (for realistic expectations) educate about community resources respite services for caretakers#

Secondary prevention~

identify/screen at risk assess unexplained injuries refer to ED for SANE screen all preggos#

Tertiary prevention~

Access to resources for survivors support group for caregivers/survivors long-term follow-up/supervision parameters#