Final - Abuse & Violence

Question 1

What is multigenerational transmission of violence?

Answer 1

• —Violence perpetuated through generations by a cycle of violence.
• Child learns abusive behaviors through experiences with parents/other adults & come to believe violence to be way of solving problems (becomes automatic).

Question 2

Describe the correlation between alcohol and drug abuse & violence

Answer 2

• —Survivors of violence often report substance abuse by the abuser
• —Use of alcohol/drugs may increase violent behavior by reducing fear or inhibitions
• —Crack cocaine, amphetamines, mescaline, “angel dust” (PCP) and steriods associated with increased violence
• —“Date-rape drugs” e.g. flunitrazepam (Rohypnol), place people, primarily young women, in danger of sexual exploitation, physical harm

Question 3

What are Implications of Abuse & Violence for Survivors?

Answer 3

• —Physical injury and death; developmental issues.
• —A whole range of psychiatric & emotional problems:
  
  • fear; anger; anxiety; depression; flashbacks; suicidal ideation; sleep disturbances; appetite & eating problems; drug use & abuse; somatic complaints; school & work issues–truancy, poor performance & drop out, etc.
  • More likely to develop PTSD –> especially with rape
  • Depression
  • Belemia
• —Potential to develop into any of the major mood, anxiety & other disorders previously discussed.

Question 4

What are some nursing attitudes towards survivors?

Answer 4

• —Paternalistic – knows what is good for the survivor & advises on what to do, while sympathizing.
• —Empowering – recognizes & respects the competencies of the survivors & empathisizes & strategizes with them.
• —Blaming – projects blame due to failure to properly explore own attitudes & isolate personal biases.
• —
• —

Question 5

What are preventive interventions for violence?

Answer 5

• —Primary prevention—changing society’s acceptance of violence & abuse
• —Secondary prevention—identifying families at risk
• —Tertiary prevention—addressing immediate & long-term needs of survivors of abuse

Question 6

What are some barries to identification of abusive relationships from the patient’s perspective?

(Can be dependent personality disorders)

Answer 6

• “Denial” of person being abused
• Shame, embarrassment, or cultural beliefs
• Past negative experiences with family members & health care providers
• Intrapersonal & relationship dynamics that hold perpetrator & victim together

Question 7

What are some barries to identification of abusive relationships from the provider’s perspective (Ex: The nurse)?

Answer 7

• Avoidance of delving into topic of potential abuse
• Fear of “offending” clients
• Holding false stereotypes regarding abusive behavior
• Feeling powerless to address the problem
• Lack of awareness of local resources

Question 8

What are some possible indicators of child sexual abuse?

Answer 8

• —Sexual acting out, physical aggression, excessive masturbation, social withdrawal, expressions of low self-esteem, impaired school performance, disturbed sleep
• —Recurrent urinary tract infections, sexually transmitted infections, unintended pregnancy
• —Bleeding, soreness, or itching in or around genitals, perineum, or rectal area
• —Chronic pain syndromes
• —Has difficulty walking or standing
• —Suddenly refuses to change for gym or to participate in physical activities
• Reports nightmares of bedwetting
• Experiences sudden change in appetite
• Runs away

Question 9

What are some nursing interventions for child abuse?

Answer 9

• —When child abuse suspected, nurse must report it to protective services
• —Investigation by state protective service agency legally mandated
• —Reinforces to family the seriousness of the problem
• —Explain to family what will happen in investigation, amount of time involved

Question 10

What is intimate partner violence?

Answer 10

• —Pattern of assaultive and coercive behaviors, including physical, sexual, and psychological abuse and violence, used against intimate partners
• —Behavior to achieve compliance from or control over target person
• —May include dating, married, or cohabitating relationships, heterosexuals, homosexuals

Question 11

What are the different cycles of battering?

Answer 11

• —The Tension-Building Phase –> person might be on edge
• —The Acute Battering Incident –> most violence, shorter period, often the batter minimizes the incident, blams the other person, victim most likely to leave in this phase
• —Calm, Loving, Respite (“Honeymoon”) Phase –> occurs when person trying to get forgiveness, person thinks everything will be okay, vicims might feel dependent, powerless, hoplessness,
• When the person leaves for good that is the highest chance for homicide

Question 12

Describe the nursing assesment for intimate partner violence

Answer 12

• —Ask about quality of primary intimate partner relationship
  
  • ¡Feelings of being controlled or needing to control?
  • ¡Excessive jealousy?
  • ¡How do you solve conflicts?
  • ¡Do arguments ever involve pushing or shoving?
• —Start with questions about minor domestic violence
• —Patient who hesitates, looks away, displays discomfort with the subject can be asked about physical violence later in interview

Question 13

What are some nursing inverventions for intimate partner violence?

Answer 13

• —Tell survivors they are not alone
• —Tell them they are not to blame
• —Confidentiality counts
• —Document situation thoroughly
• —Educate about legal aspects, available community resources
• —Safety, especially if planning to leave relationship – ensure there is a safety plan

Question 14

What are the treatment options for intimate partner violence?

Answer 14

• —Combines behavioral therapy centered on anger control
• —Traditional marriage therapy or couple counseling as only treatment in potentially dangerous to survivor
  
  • ¡Unequal power in relationship
  • ¡Possibility of retaliatory violence

Question 15

Describe elder abuse

Answer 15

• —Older adults primarily abused, neglected, or exploited by caregivers, mostly spouses, adult children, or other family members
• —Personal care attendants may perpetrate elder abuse, neglect, exploitation
• —Socially isolated, cognitively impaired, or those dependent on others for daily personal needs seem most vulnerable to abuse and neglect

Question 16

What would you assess for when looking for possible elder abuse?

Answer 16

• —Physical assessment and careful attention to nonverbal behavior critical
• —May have bruises to upper arms from shaking
• —Regard abrasions and lacerations not usually caused by falls, especially to face or torso , with suspicion
• —Vaginal lacerations or bruises and twisting bone fractures particularly indicate abuse

Question 17

What are some signs of elder neglect?

Answer 17

• —Signs of neglect more common than those of physical abuse
• —Neglect may be manifested by poor hygiene, skin breakdown, malnutrition, dehydration, underdosing or overdosing of prescriptive medications
• —Determine if neglect is intentional

Question 18

What are some nursing interventions for elder abuse?

Answer 18

• —Most states have mandatory reporting of abuse or neglect of elderly
• —Respite care or other stress relievers may be key interventions for overburdened caretaker
• —In other cases, primary intervention may be therapeutic assistance for abusers
  
  • ¡May include counseling, therapy for mental disorders, substance abuse treatment

Question 19

What is sexual assault?

Answer 19

• —Forced penetration or act of sexual contact with another person without consent
• —Lack of consent could relate to survivor’s cognitive or personality development, feelings of fear or coercion, or offender’s physical or verbal threats
• —Sexual assault is not a sexual act but is instead motivated by desire to humiliate, defile, dominate the survivor

Question 20

What is marital rape?

Answer 20

• —Legally recognized in most states, often reported long with physical abuse
• —Many husbands of abused women believe it is their right to have sex whenever they want
• —Survivors of marital rape described forced vaginal intercourse; anal intercourse; being hit, burned, or kicked during sex, having objects inserted into their body and threatened or beaten if they refuse

Question 21

What are some nursing interventions for patients who have been sexually assulted?

Answer 21

• —Provide nonjudgmental listening/support
• —If recent assault disclosed, need physical evidence if survivor chooses to take legal action against perpetrator
• —Evidence collection requires special training by a sexual assault nurse examiners (SANE)
• —Later interventions may include referrals to survivor’s groups, shelters for battered women, legal services
• —Coping strategies: changing one’s phone number or residence; talking with friends or family, taking classes in self-defense
• —Nursing actions to help survivor of sexual assualt: active listening, empathetic responses, active concern and caring, assistance in problem solving, referral to sexual assault crisis centers

Question 22

What are the 2 stages of sexual assault?

Answer 22

1. —Acute stage: immediately after attack
2. —Second phase: long-term process of reorganizaiton

Question 23

What are some nursing interventions for sexual assult?