Exam 2-Interpersonal violence; Mental Health Care for Survivors of Violence Flashcards
types of violence and abuse
-domestic (family) violence: MOST COMMON TYPE
-intimate partner violence= IPV; significant public health problem, with behaviors including physical, sexual, and psychological abuse, or a combination of these perpetrated by current or former spouse, SO, or dating partner.
-child abuse
-child neglect
-abuse of older adults
-physical violence
-sexual violence
-psychological/emotional violence
-neglect used as violence
-economic violence
effects of violence
-permanent changes in survivor’s reality and meaning of life
-deep wounds
-endangerment of core beliefs about self, others, and the world
-damage or destruction of survivor’s self esteem
survivor characteristics
-vulnerable
-low self esteem
-hopelessness
-guilty feelings
-thinking they deserved it
-try to protect their abuser
-anger
-fear
perpetrator characteristics
-use threats
-“discipline”
-believes in punishment
-difficulty with adult role/responsibility
-likely to have been abused as child
intimate partner violence
-physical abuse: any act of aggression with or without use of an object or weapon
-behavior becomes a pattern that increases in severity
-contributes to other health problems
-women more likely to be seriously injured or killed
-psychological: criticize, insult, humiliate, ridicule, destroy property, threaten or harm pets, control or monitor spending and activities, or isolate person from family or friends. more constant than physical violence, which is episodic!!
-1 in 4 women abused, 1 in 10 men. ~ 63% of female murder victims are killed by partners
violence/IPV comorbidities
-survivors can suffer multiple conditions besides injuries and death from IPV
-anxiety disorders, depression, PTSD, substance abuse disorder
-asthma, GI conditions, CV problems, bladder infections, migraines, joint pain, gynecologic disorders, STDs, TBIs
risk factors for IPV
-occurs across all demographics and socioeconomic levels
-HIGHEST RISK AMONG YOUNGER WOMEN, DIVORCED AND SEPARATED WOMEN, NATIVE AMERICAN AND ALASKAN NATIVE WOMEN
-frequent conflicts, jealousy, possessiveness=increase risk of violence
-LGBTQIA+ couples are victims, receiving less support due to social stigma
-pregnancy
-personal stressors
-presence of firearms
-substance abuse
-individuals: low self esteem, emotionally insecure, depression, antisocial or borderline personality traits, hx of violence
sexual assault and rape
sexual assault: any form of nonconsenting sexual activity
rape: most severe form of sexual assault, crime of violence
-anyone of any age, majority rapes reported in females: adolescents and young adults most vulnerable, two thirds women raped by someone they know to them; men less likely to report rape or sexual assault
-perpetrator: majority are men, in women sexual assault of children or statutory offenses are more likely
-LGBTQ+ youth at greater risk of experiencing several forms of violence than cisgender and/or heterosexual counterparts
-common health consequences: genital trauma, GI disturbance, acute/chronic pain, dysmenorrhea, sexual dysfunction, urinary retention/incontinence, unintended pregnancy
stalking
attempts to make repeated contacts with selected victim. follows you, sends you things, talks to you when you dont want them to, threatening you
-may be someone you know casually, a stranger, or a past or current friend, boyfriend or girlfriend
WHILE RAPE IS A CRIME OF VIOLENCE, STALKING IS A CRIME OF HARASSMENT
maltreatment vs abuse vs neglect
maltreatment: words or behaviors, actual or threatened physical harm
abuse: emotional, physical, or sexual
neglect: failure to meet needs for appropriate growth and development, protection from harm, may be seen as physical, emotional, medical/dental, and educational neglect.
child abuse
acts of commission= intentional harmful behaviors, including physical, sexual, or psychological abuse: spanking, hitting, kicking, shoving, resulting in nonaccidental injury
acts of omission= not meeting physical, emotional, educational, and health care needs. MOST COMMON FORM OF CHILD ABUSE. considered child neglect. most vulnerable population are children younger than 4, and those with mental, physical, or emotional disabilities
-psychological abuse: verbal abuse, or other subtle forms
-a victim of prolonged sexual abuse will develop low self esteem, feel worthlessness, and have a distorted view of sex, become withdrawn, distrustful, or suicidal. they may show an unusual interest in or avoidance of sexually related content, seductiveness, refusal to go to school, delinquency, secretiveness, and unusual aggressiveness.
older adult abuse
abuse or neglect older than age of 60 years.
-physical, sexual, emotional, neglect, abandonment, financial
MOST COMMON=FINANCIAL
-risk factors: older age, impaired ADLs, cognitive disability, dependency on caregiver, isolation, stressful events, hx of intergenerational conflict
-high perpetrator risk factors: drugs, alcohol, stress, lack of social support, high emotional or financial dependence on older adult, depression, lack of training in providing care for older adults- CARE GIVER BURNOUT IS HUGE RISK FACTOR.
types of elder abuse
-physical elder abuse: non-accidental use of force resulting in physical pain, injury, or impairment. hitting, shoving, inappropriate use of drugs, restraints, or confinement.
-emotional or psychological abuse:
verbal=intimidation, humiliation, ridicule, habitual blaming
nonverbal= ignoring, isolating from friends/activities, terrorizing, acting in a menacing way
-sexual abuse: sexual contact without consent, showing pornographic material, forcing person to watch sex acts, forcing elder to undress
-neglect or abandonment: failure to fulfill caretaking obligation, wandering, dehydration, poor hygiene
-financial exploitation: misuse of funds, stealing money, forging signatures, identity theft, investment fraud
-healthcare fraud and abuse: charging for care not provided, overcharging or double-billing, kickbacks for referrals to other providers or for prescribing certain drugs overmedicating or under medicating, recommending fraudulent remedies, medicaid fraud
theories of violence
-social learning theory/intergenerational transmission of violence: victim of childhood abuse may predict violence as adult (witnessing violence in home)
-economic disadvantage, community disorganization, and attitudes supportive of violence: weak social control leads to increased crime and IPV
-imbalances in relationship power: gender (women by male romantic partners), patriarchal systems, limited women rights, cultural and religious norms, power and privilege
-cycle of violence: tension building-violence erupts- remorse ensues
-factors influencing leaving vs staying: fear of retaliation, continuing having feelings for abuser, complex! afraid of losing custody, threats against others, and leaving does not stop violence. LEAVING IS THE TIME OF GREATEST RISK FOR VIOLENCE.
-safety issues and mandatory reporting: we are mandated reporters, though states differ in reporting. all states require known or suspected abuse of children or vulnerable adults to be reported. decision made by professional team, not one individual.
WE CANNOT FORCE COMPETENT OLDER ADULTS FROM ABUSIVE SITUATIONS, AS THIS IS A VIOLATION OF AUTONOMY.
when should a nurse suspect abuse?
-seems afraid or anxious to please their partner
-goes along with everything their partner says and does
-checks in often with their partner to report where they are and what they’re doing
-receives frequent, harassing phone calls from their partner
-talks about partner’s temper, jealousy, or possessiveness
clues from history: inconsistent explanation of injuries, delay in seeking treatment, frequent ED visits, lack of prenatal care, may be vague about injuries on the body, and minimize the event or severity
routine screening is needed!!!
role of the nurse
-if initially seen in ED, provide safety, emotional support, assist with forensic screen, and discharge planning
-use trauma informed care!!
-recognize common responses of anger, distress, or denial
trauma informed care principles
trauma awareness: understand prevalence and impact of trauma among patients. support with activities such as screening and assessments
safety: commitment to physical and emotional safety for patients and staff
choice and empowerment: facilitate healing and avoid re-traumatization
strengths based: focus on strength and resilience of patients to help them move forward in a positive direction!
therapeutic relationships
establishing a trusting nurse-patient relationship is one of the most important step for caring for a victim of violence!!!
-important to establish open communication and ensure confidentiality
-supportive, empathetic approach is most effective
-nurse must make clear responsibility or mandated reporting
-open ended statements and questions
-nonjudgmental and not assuming anything with any injuries.
-ensure confidentiality and provide quiet, private places, to interact
-continually monitor personal feelings toward perpetrator and survivor- do not share personal opinions or feelings.
-do not ask about religious background or disclose personal feelings about victim
EBP of people experiencing violence
-safety assessment first!! determine if survivor is in danger, determine if any children are in the home and their danger risk, use danger assessment screen.
universal screening question
“is there anyone in your life who is hurting or threatening you in any way?”
brief danger assessment= DA5
developed as a short form of the danger assessment for use in healthcare settings, including emergency and urgent care settings. tested with and without an item on strangulation, potentially fatal and medically damaging IPV tactic used commonly by dangerous abusers.
-assess and rate the lethality and identify factors for homicide or severe injury by an intimate partner.
-5 questions, fast screener!
screening for violence and abuse
-universal screening for all women of childbearing age is highly recommended!!
-survivors are reluctant to report abuse due to fear.
-IF SUSPECTED ABUSER IS PRESENT, IMPORTANT TO SPEAK TO SURVIVOR ALONE!
-nurse needs age appropriate and culturally competent questions since due to sensitive nature of abuse
-provide privacy, allow time and silence
-nurse should not offer unsolicited advice or make judgements
-use validating messages to convey belief in survivor
-avoid pressuring or confronting survivor
-document assessment in own words
-most likely will not report unless specifically asked about it
screening children
-get information from child and parent/caregiver
-if abuse is suspected, ask for parental permission to speak to child alone. observe interaction between parent and child
-use behavioral questions, observe vocal changes, eye contact, breath pattern, change of subject
-limit questions only to what is necessary for reasonable suspicious to report- simple questions!! (have you been hit or punched?)
physical health- H +P
-note VS, sleep, appetite changes, exaggerated startle response, flashbacks, nightmares
-sexual abuse may require referral to sexual assault nurse examiner (SANE)
-assess injuries in need of immediate attention
-may note evidence of mild to severe physical consequences
-use body map to note injuries
-determine need for emergency contraception or prophylactic STD treatment
-assess developmental milestones, school hx, relationships with siblings and friends
-implausible explanations for injuries/symptoms should be signal for possible abuse
