Survivors of DV/Abuse/Assault/ Trauma

Question 1

What are the forms of abuse?

Answer 1

Physical, sexual, emotional/psychological, economic, neglect

Question 2

Types of abuse?

Answer 2

partner/ spousal, child, elder, sexual assault, secondary to other forms

Question 3

Assessment for abuse and neglect

Answer 3

1. Recurrent and/or unexplained injuries
2. History of multiple or suspicious accidents
3. Old or new fx, esp. if multiple; bone growth
4. bruises, abrasions on upper arms/wrist
5. Cigarette or other burns
6. Unkempt. body odor, fleas or lice: contaminated with urine or feces, soiled clothing or bedding
7. elderly or physically incapacitated
8. Insufficient clothing, inappropriate clothing
9. malnourishment, dehydration
10. Unusual recurrent illnesses or med-related problems
11. Increased school/work absences, truancy
12. Change in school/social/ role functioning
13. Caregivers seem unconcerned, non empathetic guarded EAGER TO SHORTEN THE CONTACT

Question 4

Indicators suggestive of sexual abuse

Answer 4

• STD’s , genital or rectal bleeding, recurrent UTI’s, insomnia
• In children, precocious sexual activities/ knowledge; sexual acting out; seductiveness

Question 5

S/sx of financial abuse /neglect

Answer 5

1. unable to account for their funds, have provided others with financial access or information
2. money is being spent without beliefs to show for it ( no improvement to home, insufficient food/ toiletries, clothes)
3. Others accompany the person when spending or accessing money and seem to be directing the purchases or withdraws

Question 6

What are risk factors that could indicate abuse to others?

Answer 6

previous abusive relationships, lack of empathy, jealousy, pressure for quick involvement/ commitment

controlling/ demanding personality; easily threatened

Anger management issues

“Playful” use of force in romantic/ sexual encounters, rigid expectation: roles in relationship

Attempts to isolate partner; blames partner for his problems

Stalking: cruelty to animal or people

Question 7

Nursing role r/t evidence

Answer 7

DO NOT CONTAMINATE THE EVIDENCE ( preserve the evidence )
- If you neglect or damage evidence you help the perpetrator
- Seek only that information needed to treat the survivor ( where injured? who injuries you? )
- DO NOT INTERROGATE THE PT R/T THE TRAUMA d/t the risk of contaminating reports ( via leading questions, implanting memories )
- For spontaneous comments by pt document patients comments in quotes
- Assure that physical evidence is immediately bagged and labelled before it can be contaminated

Question 8

Domestic Violence: Myths

Answer 8

1. Most victims are impoverished or less educated
   - FALSE: happens in all classes and categories
2. Divorce will help
   
   • FALSE: risk of attacks increase to 75% soon after separation- but in the long term yes it can help
3. Victims do not seek help
   
   • may have already tried, may be intimidated to leave
4. Providers are obligated to report domestic violence
   - FALSE: only child and elder reporting is mandatory
   - PROVIDERS MUST HAVE THE VICTIMS PERMISSION TO REPORT DOMESTIC VIOLENCE

Question 9

Violence Within Families

Answer 9

• Usually involve issues of power and control
• Often involves multigenerational transmission ( victims becomes perpetrators )
• Often accompanied by social isolation
• often involve or accelerated by drug or alcohol abuse
• Affects everyone
• Can occur in outwardly ‘loving families”
• Can affect later healthy ( females survivors have higher risk of later cardiovascular events )

Question 10

Possible survivor responses to abuse

Answer 10

• Depression, anxiety
• increased risk of developing PTSD, Borderline personality disorder or dissociative disorders
• Increased risk of abuse, suicide, homicide
• Isolation
• Discomfort with relationships, sexuality
• Substance abuse
• Acting out sexually or aggressively
• Repression of memory of abuse

Question 11

The role of control and power

Answer 11

• Efforts of the survivor ( cell phone, friends, getting a job, etc.) can be seen as unacceptable threat to his control
• To take back control he will often kill the victim and himself

Question 12

Why do the victims stay?

Answer 12

1. Ambivalence ( They love the person )
2. Financial and/or emotional dependence
3. Fear will lose custody of kids, puts kids more at risk
4. denial ( believe perpetrator is not at fault )
5. Fear of even greater violence
6. Believe there is no help, will be rejected, authorities wont listen, “blame the victim”

Question 13

Why do the victims leave?

Answer 13

1. Concern for the children
2. Come to believe they can leave leave ( they developed confidence )
3. Support from other becomes available
4. Others resources become available ( shelters, safe housing, finances, transportation, a job )
5. “Awakening” phenomena results in readiness

Question 14

Assessment; Domestic violence

Answer 14

• ASK QUESTIONS
• IF YOU DONT ASK SHE WILL NOT TELL
• look for unlikely explanations for injuries, increased accidents, somatic complaints, dehydration or malnourishment, reluctance to speak with provider or stay in care setting

Question 15

Question to ask to assess for DV

Answer 15

• Do you feel safe at home?
• What happens when you and your partner disagree?
• Do you worry about your child’s safety?
  What do you worry about (fear) the most?
  Are there weapons in the home?

Question 16

Interventions for domestic violence

Answer 16

Remember that her response make sense for her ( in any given situation people are doing the best they can )
- She will try to leave 7-10 times before becoming successful
- Each time she hears “no one deserves to be treated like this” she becomes stronger
- “No contact” and “Temporary Protective Orders” - complicated, limited, can help but may ignore
- Meet their physical needs: treatment, nutrition
- provide non judgmental listening, express concern (w/o pressure)
- Instill realistic hope
- Explore and educate ( safe housing )
- assure pt has an advocate when police becomes involved
- CONNECT (not simply refer ) to resources- DV experts should be involved before she leaves the hospital, call abuse hotline and with pt permission put her on the phone

Question 17

Intervention for CHILD and ELDER abuse

Answer 17

MANDATORY REPORTING TO children services or adult protective services

Even a SUSPICION requires reporting evidence is NOT needed.

Question 18

False memories: Children

Answer 18

• Children dont lie spontaneously about abuse unless provider somehow enables this
• Only skilled/ certified interrogators should be questioning child after abuse
• false memories are more likely if interrogation includes leading questions
• memory distorts overtime , early, detailed, objective recording of patients report is key.

Question 19

Summary of OH reporting requirements

Answer 19

• Providers must report all SUSPECTED abuse or neglect of children or people over 60 years old or those unable to protect themselves s/t physical or mental handicap
• provides MUST HAVE THE SURVIVORS PERMISSION TO REPORT DOMESTIC VIOLENCE
• EXCEPTION: ALL STAB AND GUNSHOT WOUNDS, SEVERE PHYSICAL HARM, AND 2ND AND 3RD DEGREE BURNS, MUST BE REPORTED

Question 20

Sexual Assault

Answer 20

• Sexual contact w/o consent ( or unable to give consent )
• Rape= sexual contact w/o consent under the threat of force ( does not require physical resistance be demonstrated )
• It is not a crime of sex but of control
• In most states providers are NOT required to report sexual assault; Ohio law does not specifically require reporting of sexual assault
• When others report it against patients will, it takes control away from the survivor
• Prompt reporting and especially prompt collection of evidence by qualified persons ( SANE ) improves chances of successful prosecutions: no cost for SANE, but ER charges will accure

Occupational Hazard: vicarious traumatization ( indirect exposure through reports/injuries of patients 1