LEC 11: Interpersonal Violence & Nursing Practice Flashcards
1
Q
What is abuse (what forms does abuse take)?
A
- Emotional or psychological abuse
- Mind games
- Social abuse (social abuse involving children)
- Using the children as pawns in their game
- Economic/fanancial abuse
- Using monies to control the partner
- Ritual abuse
- Satanic
- Physical abuse
- Sexual abuse
- Religious abuse
2
Q
What is family violence?
A
- It is a complex problem
- Ranges across the lifespan
- It involves an abuse of power and the violation of position of trust
- Any behaviour by one person against another person in an intimate relationship which may endanger that person’s survival, security, or well-being
- Must look beyond the family and consider the values and attitudes of the community and the larger society
3
Q
Statistics Canada’s Measuring Violence Against Women:
A
- The rate of violence against women in Saskatchewan is almost double the national average
- Saskatchewant lead all provinces and territories in rates of intimate partner violence and sexual offence, and in rates of violence against girls and female teenagers
4
Q
Saskatchewan is #1
A
- In police-reported violent crime rates in Canada since 1997 (x2 the National Rate)
- In provincial family violence rate
- Provincial intimate partner violence rate
- Dating violence
- Provincial child and youth violent victimization rate
- Family-related violence against seniros
- 2nd highest violent crime severity index and homicide rate
5
Q
Family Violence Prevalence of Abuse in Canada
A
- Most often, victims of family violenc were in a spousal relationship with the accused, with about half of victims (49%) being currently or previously married to the accused. Another 18% of family violence victims were victimized by their parent, 13% by an exteneded family memebr, 11% by a sibling and 9% by a child, most often a grown child.
- Victims of family violence were predominantly femal (69%). This disproportionate representation was most pronounced for spousal violence, as 80% of victimes were female, but was also evident when the accused was a child (63%), extended family memebr (58%), parent (57%), and sibling (57%)
6
Q
Family Violence During Pregnancy
A
- Incidence of violence during pregnancy ranges from 4% to 17%. however domestic violence during pregancy is underreported
- Women who are abused during pregancy are 4 times as likely to experience serious physical violence
7
Q
Ways they May Assert Power Over the Prenatal Women
A
- forcing her to have an abortion or injure her with the intent of causing her to lose the baby
- forcing her to continue an unwanted pregnancy
- directing physical assaults at the woman’s breasts, abdomen and/or genital area
- controlling, limiting, delaying or denying her access to prenatal care
- refusing to support her during pregnancy, labour and delivery and/or recovery
- restricting her access to food or resources
- making negative comments about her appearance, the baby, or her parenting abilities
- denying her access to her newborn child
- blaming her for the baby and any changes that have to be made in the household because of it
- threatening the woman’s or child’s safety or custody
8
Q
Family Violence in Children/Youth
A
- Male family members were identified as the accused in a sizable majority of family-related sexual (96%) and physical assaults (71%) against children and youth.
- Infants (<1yr) experience higher rates of family-related homicide, than older children
- Young parents are disproportionally represented among those accused (60%)
9
Q
Family Violence: Abuse of the Elderly
A
- Most often, frustration, anger or despair was the apparent motive for family-perpetrated homicides against seniors. In contrast, financial gain was the most commonly identified reason behind senior homicides committed by non-family members.
- Between 4% - 10% of seniors (in Canada) experience some type of abuse
- Victims who are elderly are most likely to be victimized by an adult child or current/former spouse
- The issue of low numbers of 4-10% may be because seniros don’t normally report abuse
10
Q
Older Adults May Experience Different Types of Abuse Including:
A
- Physical or sexual abuse
- Psychological or emotional abuse
- Financial abuse
- Neglect, unintentional neglect, self neglect
11
Q
Adults who experience abuse are:
A
- 103% more likely to become smokers
- 95% more likely to become obese
- 103% more likely to become alcoholics
- 192% more likely to develop dru addicitons
- 43% more likely to become suicidal
12
Q
Consequences of Abuse of Women
A
- Health consequences
- Economic consequences
- Impact of abuse on children
- Physical
- Sexual and reproductive
- Psychological and behavioral
- Faal health consequences
13
Q
Impact on Children
A
- Physical effects
- Psychological and behavioral effects
- physical effects: not able to sleep
- Psychological: nightmares, fears to be alone
- Children exposed to violence
- Are the silent witness in this situation
14
Q
Three Stages of the Cycle of Violence
A
- Tension builds and escalates
- Violent incident-blow up
- Absence of violence- remorse/romance phase
15
Q
Cycle of Violence: Phase 1: Tension Building
A
¨Tension Building Phase
- Duration: days, weeks, months, years
- Initial infatuation of the relationship fades
- Abuser - starts exhibiting aggressive/abusive tendencies
- Victim - attempts to stop aggression by pleasing, placating, or staying out of the way, thinking those actions can control the abusive behavior
- When these actions do not control or stop the abuse, the victim withdraws
- Abuser feels rejected and tries harder to control the victim’s activities
- At this point, an abusive incident will inevitably happen
16
Q
Traits of the abuser in Phase 1 (tension building)
A
- Jelousy
- Actions that isolate the victim
- Rule changing
- Name calling
- Dominating
17
Q
Traits of the victim in Phase 1 (tension building)
A
- Use of calming techniques
- Minimizing abusers behaviours
- Anger suppression
- Fatigue
- Confusion
- Self-doubt
- Withdrawal
- Fear
18
Q
The Cylce of Abuse: Phase 2: Violent Incident Phase
A
- Physcial, emotional, mental, spiritual or sexual abuse
- The violent incident relieves the stress/tension of the abuser
- While the perpetrator feels instant relief, the victim experiences shock/denial
- Police are usually involved at this stage, victim may seek safe shelter
19
Q
Traits of the abuser in Phase 2 (violent incident)
A
- ANger
- Assault on the victim
- Uncontrolled tension
- Exahustion
20
Q
Traits of the victim in phase 2 (violent incident)
A
- Fear
- Anger
- May call the police
- May seek safety
21
Q
Cycle of Abuse: Phase 3: Remorse/Romance Phase
A
- Abuser becomes tender, apologetic, gift giving, proclaims love, one time event etc.
- Abuser may take actions and demonstrate willingness/desire to change (i.e. rehab, stop drinking etc)
- High number of women return to the abuser during this phase, believing the abuser and their actions to be sincere
22
Q
Traits of the abuser in phase 3 (remors/romance)
A
- Apologies and promises
- Shows insecurites
- Loving
- Demosntrates dependency on the victim
23
Q
Traits of the victim in phase 3 (remorse/romance)
A
- Guilt
- Hope
- Lonliness
- Low-self esteem
- Dependency
24
Q
Challenges Facing Women: Why do they stay?
A
- Fear of injury (or death)
- Finances
- Family
- Faith
- Father
- Fatigue
- Fantasy and forgivness
- Familiar
- Foresight
25
Q
What is the goal of nursing interventions in relation to family violence?
A
- To empower the client to take control
- To provide supprot
- To maximize safety
26
Q
Screening: Role of the Nurse
A
- Ask the question
- Acknowledge the abuse
- Validate the woman’s experience
- Access immediate safety
- Explore options
- Refer to services at the woman’s request
- Document the interaction
27
Q
Guiding Principles for Screening ABCD-ER
A
- Attitude and Approachability of the healthcare provider
- Belief in the women’s account of her experience
- Confidentiality is essential for disclosure
- Documentation that is consistent and legible
- Education about the serious effects of violence and abuse
- Recignition that dealing with violence and abuse has to be her pace, directed by her decisions
28
Q
Documentation
A
- Document quotes, observed behaviour, physical assessment and interventions (facts not opinions)
- Accuracy is important (specifics – who/what/where/when)
- Document as soon as possible – document physical and psychological symptoms – be objective, quote the client) when possible
- Use tools such as body maps to document locations and patterns of physical injuries
- With a clients permission photograph injuries
29
Q
What types of nursing actions might jeopardize your relationship with patients experiencing abuse?
A
- Telling people what to do
- Blaming the victim
- Violating confidentiality
- Confronting the abuser about the abuse
30
Q
Challenges of a rural setting related to family violence include:
A
- Lack of access to public transportation/phone service
- Decreased anonymity and condifentiality
- Lack of services/ ineffective services
- Increased number of weapons in the home
- Fwer resources
31
Q
What need to be considered when a disclosure of abuse is made?
A
- Reporting of violence and abuse against females
- Young women and disclosure of abuse
- Age of consent for sexual activity is 16 years in Canada
- Children who witness violence and abuse
32
Q
Child Maltreatment
A
- Professionals must report cases in which they suspect that a child is or may be suffering or may have suffered abuse
- Child protection overrides obligation to confidentiality
33
Q
Reporting Child Abuse/Neglect
A
- Anyone who suspects that a child is being abused or neglected has a legal duty to report it
- You are not expected to determine if a child is being abused or neglected
- Members of the public are obligated by the law to report suspected abuse or neglect
- There are legal consequences for failing to report a suspicion of abuse or neglect (in Saskatchewan)
34
Q
Abuse Against Older Adults
A
- Reassurance
- Unlike child abuse, reporting is not mandatory
- Abuse help lines in SK tel phonebooks
- Review available services
