Domestic Violence/Interpersonal Violence

Question 1

Definition of Domestic Violence/Interpersonal Violence

Answer 1

Pattern of assaultive and coercive behaviors, including inflicted physical injury, psychological abuse, sexual assault, progressive social isolation, stalking, deprivation, intimidation, and threats.

Question 2

Facts about Domestic Violence/Interpersonal Violence

Answer 2

1. Affects people regardless of race, ethnicity, class, sexual and gender identity, religious affiliation, age, immigration status, and ability.
2. Behaviors are perpetrated by someone who is, was, or wishes to be involved in an intimate dating relationship with an adult or adolescent, and are aimed at establishing control by one partner over the other

Question 3

Vulnerable Population

Answer 3

1. Infants and Children: Unable to fight back
2. Youth: Bullying is PREVALENT; Bullying can set up for emotional effects later on in life (person flips slides and becomes the violent one) Teen tend to run away from home
3. Older Adults: Rely on others to take care of them
4. Substance Use/Abuse: When under the influence, judgement is altered and unrightfully decisions are made
5. Mental Health Conditions: Client mind is already altered
6. Exposure to Violence as a Child: Children play violent video games making them think violence is okay
7. Sociocultural Factors
8. Both men and women

Question 4

Types of Domestic Violence

Answer 4

1. Self-Directed
2. Collective Violence
3. Interpersonal Violence

Question 5

Self-Directed Violence:

Answer 5

Any intentional act that could result in injury or death to oneself.
o It can include a range of behaviors such as, suicide attempts, self-harm, suicidal gestures and threats

Question 6

Collective Violence:

Answer 6

When a group of people use violence against another group or individuals to achieves political, economic or social goals
o Example: Gangs

Question 7

Interpersonal Violence

Answer 7

1. Violent act between people who have some form of prior or existing relationship in a physical, psychological, sexual, and neglect and/or deprivation nature

Question 8

Types of Interpersonal Violence

Answer 8

1. Sexual
2. Physical
3. Psychological
4. Deprivation
5. Neglect

Question 9

Sexual Abuse

Answer 9

1. Takes place when a person knowingly causes another person to engage in a sex act by threatening or place the other person in fear, or if someone engages in a sexual act with a person who is incapable of appraising the nature of the act or unable to give consent

Question 10

Physical Abuse

Answer 10

1. Aggressive or violent behavior by one person towards another that results in bodily injury
   * Example: pinching, slapping, tripping, punching and grabbing, twisting of arms or legs, pulling hair, beating, choking, pushing, biting, use of a weapon

Question 11

Psychological Abuse

Answer 11

1. Violence may be carried out by threatening emotional or physical harm
   * Example: threats of child abuse, threatening to publicly reveal the victim’s sexual orientation, threatening suicide, threatening to take children away, threatening to harm pets and threatening to harm family
   * Emotional Abuse: pattern of behavior in which the perpetrator insults, humiliates, and generally instills fear in a n individual in order to control them
   o Example: playing mind games, laying the blame for anything on the victim, putting you down, treating you like a servant, not allowing you to make anything big decisions and making you feel bad about yourself

Question 12

Deprivation

Answer 12

Deliberate denial to an eligible adult of required medications, medical care, shelter, food, therapeutic devices or other physical assistance, thereby exposing that person to the risk of physical, mental or emotional harm

Question 13

Neglect

Answer 13

1. An act of omission in the care leading to potential or actual harm
   
   • Example: inadequate health care, education, supervision, protection from hazards in the environment and unmet basic needs such as clothing and food

Question 14

Predisposing Factors of Domestic Violence

Answer 14

1. Low self-esteem
2. Low education or income
3. Young age
4. Aggressive or delinquent behavior as a youth
5. Heavy alcohol and drug use
6. Depression and suicide attempts
7. Anger and hostility

Question 15

Knowledge of Who Domestic Violence Affects

Answer 15

1. IT AFFECTS EVERYONE

Question 16

Abuser Characteristics

Answer 16

1. Not leaving the person’s side
2. Not letting the patient talk
3. Only allowing the patient to stay for a certain amount of time
4. Charming: quickly smother the others with gifts and praise; immediately pushes for an exclusive relationship using phrases like “I can’t live without you” or “I’ll kill myself if you leave
5. Manipulative: Easily detects vulnerability in others and uses it as a weapon to control, belittle, and demean the victim

Question 17

Signs of Abuse

Answer 17

1. Physical
2. Mental/Emotional
3. Sexual

• THERE CAN ALSO BE NO OBVIOUS SIGNS OF ABUSE

Question 18

Signs of Abuse Can Also Be..

Answer 18

1. Abuse can be controlling money, withholding basic necessities, tracking phone/car use
2. Look for signs of controlling behavior: partner making decisions, answering for patient, controlling access
3. Look for clothing used to hide physical signs- long sleeves in summer, scarfs, etc.

Question 19

Physical Assessment

Answer 19

1. Direct impact of physical traumatic injury and the accompanying pain, need for repair, and related recovery time
2. Scratches, bruises, swelling, lesions, burns and cuts, headaches, back pain, sexually transmitted diseases, gastrointestinal disorders, and heart or circulatory conditions
3. Fractures: face (especially cheek, jaw, nose with DV/Intimate)
4. Unintended pregnancy and gynecologic complications—bleeding, infection, pain during intercourse, chronic pelvic pain, STIs, HIV transmission, and urinary tract infections, pregnancy effects on fetus
5. Skin: signs of trauma (bruising in various stages of healing, burns, scar), lice, branding or tattoos
6. Reproductive: genital mutilation or scarring, vaginal or anal trauma, STDs or other infections, signs of multiple terminated pregnancies, pelvic inflammatory disease
7. Skeletal: old fractures, abnormal gait
8. Respiratory: TB and untreated asthma
9. Psychological: strong startle reflex, panic/anxiety, depression, flat affect, withdrawn and passive or stoic behavior, signs of drug misuse, deferring to a companion, suicide and aggressive behavior
   10 Interactional: Companion speak for the person; companion refuses to leave patient even during an examination; the victim seems afraid to answer or defers the answer to the companion

Question 20

Mental Assessment

Answer 20

1. PTSD
2. Depression
3. Strong Startle Reflex
4. Panic/Anxiety
5. Flat Affect
6. Deferring to a Companion
7. Withdrawn, passive or stoic behavior
8. Suicide, or aggressive behavior

Question 21

General Assessment

Answer 21

Detachment, avoidance, insomnia, difficulty focusing, hypervigilance, fear, hopelessness, withdrawn

Question 22

Documentation

Answer 22

1. Assess and log accumulation of all S/S
2. Document injury by narrative note
3. OBJECTIVE, state FACTS only (be as descriptive as you can; include dimensions/size of bruises, color, etc.)

Question 23

Worse Case/Extreme Version

Answer 23

1. Critical Moments:
   o Rape
   o Patient is being seen in healthcare as a direct result of a violent incident
2. Worse Case
   o Suicide
   o Homicide

Question 24

Interventions: NURSING FOCUS

Answer 24

1. Ensure immediate safety of patient (our TOP priority)
2. Perform screening: oral questions, written assessment, physical assessment
3. Protect patients: isolate or hide in system, stop visitors
4. Report to physician and police (WE ARE MANDATORY REPORTERS)
5. Know the policy in your institution for next steps
6. Document physical and emotional assessment findings OBJECTIVELY (make sure statement is not biased)

Question 25

Other Interventions

Answer 25

1. Interpret questions and resources accurately (consider other languages)
2. Involve social work and discharge planning (for housing, finances, and resources)
3. See if facility has a security or risk management department to log and connect to legal system
4. Ensure timely communication to physician, nurse managers, and interdisciplinary team
5. Be an Advocate!

Question 26

Clinical Management

Answer 26

1. Primary Prevention:
   > Individual, community, societal change (happens outside of hospital)
2. Secondary Prevention:
   > Use of screening tools during healthcare encounters (ER, Clinic)
3. Collaborative Interventions
   > NURSES ARE MANDATORY REPORTERS
   > Referrals to State agency and Child Welfare Agency
   > Collaborate with Social Worker, Case Manager

Question 27

Interventions to Support Effective Coping:

Answer 27

1. Therapeutic Communication
2. Do’s
   o Share observations
   o Share empathy
   o Be fully present
   o Supportive silence
   o Paraphrase
3. Don’t
   o Change the subject
   o False hope or reassurance
   o Approve or disapprove of client’s statements
   o Argue

Question 28

Coping Response

Answer 28

1. Education
2. Social support
3. Exercise
4. Therapeutic lifestyle change
5. Music therapy
6. Relaxation strategies
7. Alternative therapies