Unit 10 Child, Older Adult, and Intimate Partner Violence Chapter 28

Question 1

What are the different types of Abuse?

Answer 1

-Physical abuse
-Sexual abuse
-Emotional abuse
-Neglect
-Economic abuse

Question 2

What is -Physical abuse

Answer 2

is the infliction of physical pain or bodily harm such as slapping, punching, hitting, choking, pushing, restraining, biting, throwing, and burning.

Question 3

What is-Sexual abuse

Answer 3

is any form of sexual contact or exposure with- out consent or in circumstances in which the victim is inca- pable of giving consent. Sexual abuse is also referred to as sexual assault or rape and is discussed in

Question 4

What is Emotional abuse

Answer 4

is the undermining of a person’s self-worth. This may include constant criticism, humiliating, diminish- ing one’s abilities, name-calling, intimidating, isolating, and damaging relationships with others.

Question 5

What is Neglect

Answer 5

Failure to provide for physical, emotional, educational and/or medical needs

Question 6

What is Economic abuse

Answer 6

is controlling a person’s access to economic resources, making an individual financially dependent. For- bidding school attendance or employment keeps a person dependent

Question 7

What is child abuse?

Answer 7

Something improper done to a child including physical, sexual and emotional abuse.

acts of commission-commission are deliberate and intentional.
They include physi-cal, sexual, and emotional abuse.

acts of omission

An act of omission, or neglect, occurs when a child’s basic physical, emotional, or educational needs are not met or when a child is not protected from harm. Acts of omission include -physical neglect, -emotional neglect, -medical and dental neglect,
-educational neglect, -inadequate supervision, -and exposure to violence

Question 8

Risk Factors of Child Abuse

Answer 8

Risk Factors
– Younger than 4 yrs of age
– Perceived as being different (temperamental traits, congenital abnormalities, chronic
disease)
– Those who do not live with parent
– Result of unwanted pregnancy
– Interference between parent child bonding
– Presence of one type of abuse is a strong predictor of another type of abuse

Question 9

Characteristic of an Abusive Parent

Answer 9

• A history of abuse, neglect, or emotional deprivation as a child
• Family authoritarianism
• Low self-esteem, feelings of worthlessness, depression
• Poor coping skills
• Social isolation (may be suspicious of others)
• Involvement in a crisis situation
• Unrealistic expectations of child’s behavior
• Frequent use of harsh punishment
• History of severe mental illness, such as schizophrenia
• Violent temper outbursts
• Expects the child to satisfy needs for love, support, and reassurance
• Projection of blame onto the child for parents’ “troubles”
• Inability to seek help from others
• Perception of the child as bad or evil
• History of drug or alcohol misuse
• Feeling of little or no control over life
• Low tolerance for frustration
• Poor impulse control

Question 10

What is Intimate Partner Violence

Answer 10

Intimate partner violence is abuse within the context of an inti- mate partner relationship, where one partner asserts power and control over the other. Intimate partner violence includes physical violence, rape, stalking, and psychological aggression by a current or former intimate partner. The intimate partner may be a spouse, boyfriend/girlfriend, dating partner, or ongoing sexual partner.

Question 11

Risk factors for Intimate Partner Violence

Answer 11

–
Risk Factors
–
Pathological jealousy – –
Male who believes in male dominance and needs to be in charge –
Substance use/abuse
Pregnancy may trigger violence or increase violence

Question 12

May violence increase with pregnant patient

A. no
B. yes

Answer 12

Pregnancy may trigger or increase violence. The partner may resent the added responsibility of a baby or may resent the relationship the baby will have with its mother.

Question 13

When are victims at greatest risk

Answer 13

Violence also escalates when the woman makes a move toward independence, such as visiting friends without permission, getting a job, or going back to school. Victims are at greatest risk for violence when they threaten to or actually leave the relationship.

Question 14

What is the Cycle of Violence

Answer 14

Describes a pattern of behavior that perpetrators of violence may use to control their partners.

This cycle consists of three stages:
1.the tension-building stage,
2.the acute battering stage, and
3.the honeymoon stage.

Question 15

What occurs during the tension building stage

Answer 15

The tension-building stage begins with minor incidents, such as pushing, shoving, and verbal abuse. During this time, the victim often ignores or accepts the behavior due to fear of escalation. Abusers then rationalize that their behavior is acceptable. As the tension builds, both participants may try to reduce it. The abuser may try to reduce the tension with the use of alcohol or drugs, and the victim may try to reduce the tension by minimizing the importance of the incidents (“I should have had the house neater…dinner ready”).

ex-victim;Feels tense and afraid, like “walking on eggshells”
Feels helpless, becomes compliant, accepts blame

ex-abuser;Edgy, has minor explosions
May become verbally abusive; minor hitting, slapping, and other incidents begin

Question 16

What occurs during the acute battering stage

Answer 16

occurs when the tension peaks. It is usually triggered by an external event or by the abuser’s emotional state. Some experts believe that the victim may actually provoke the incident to remove the tension and fear and to move on to the honeymoon phase.

ex-victim;The victim may try to cover up the injury or may look for help

Question 17

Honeymoon stage

Answer 17

After the abuse occurs, the abuser and victim enter a period of calm known as the honeymoon stage. During this stage, the abuser usually demonstrates kindness and loving behav- iors. The abuser, at least initially, feels remorseful and apologetic and may bring presents, make promises, and tell the victim how much she is loved and needed. The victim usu- ally feels needed and loved and hopes for change. Legal pro- ceedings or plans to leave initiated during the acute battering stage may be abandoned.

Abuser
Loving behavior, such as bringing gifts and flowers and doing special things for the victim
Contrite, sorry, makes promises to change

Victim
Trusting, hoping for change, wants to believe partner’s promise

Question 18

Will the cycle of violence repeat itself without intervention?

A. No
B. Yes

Answer 18

B. Yes

Unfortunately, without intervention, the cycle will repeat itself.Over time, the periods of calmness and safety become briefer, and the periods of anger and fear are more intense. Each repeat of the pattern erodes the victim’s self-esteem. The victim either believes the violence was deserved or accepts the blame for it. This can lead to feelings of depression, hopelessness, immobilization, and self-deprecation. Fig. 28.2 illustrates the cycle of violence

Question 19

Nursing Considerations for victims of Intimate partner violence

Answer 19

Don’t be judgmental –Be empathetic

Provide Education and
Resources
-“pack a bag”

Question 20

s/s of abuse in the elderly and children

Answer 20

Physical signs – bleeding injuries, burns, miscarriage, internal injuries, bruises, any bruises on infant <6months
–
Allow the person to tell their story without interruption (open ended questions) –
Suicide and Homicide Risk –
Drug and Alcohol Use
–
Self Assessment –
Maintain accurate records – detailed documentatio

Question 21

Older adult abuse

Answer 21

–
Financial abuse is an additional problem in this population – Coercion – steal/transfer money, property or accounts
–
Risk Factors
–
Single care-giver –
Vulnerable due to poor mental or physical health (chronic health issues)
–
Parents who abuse their children are at risk for abuse as they age

Question 22

Nursing Interventions for patient with absue

Answer 22

If you suspect abuse, you report it
– Follow the procedure of the facility
– Don’t be judgmental
– Provide education, information, resource, safety plan
– Health Teaching & Health Promotion – Special Attention
– New parents – promote attachment, nurturing
– Teenage parents – providing care, promoting attachment
– Parents with cognitive deficits – recognizing infant needs and providing care
– Parents who were victims of abuse or witnessing intimate partner violence

Question 23

Interview guidelines for abuse- Do’s

Answer 23

• Conduct the interview in private.
• Be direct, honest, and professional.
• Use language the patient understands.
• Ask the patient to clarify words not understood.
• Be understanding.
• Be attentive.
• Inform the patient if you must make a referral to Children’s or Adult Protec-
  tive Services, and explain the process.
• Assess safety and help reduce danger (at discharge).

Question 24

Interview guidelines for abuse- Do Not

Answer 24

Do Not
* Try to “prove” abuse by accusations or demands.
* Display horror, anger, shock, or disapproval of the perpetrator or situation.
* Place blame or make judgments.
* Allow the patient to feel “at fault” or “in trouble.”
* Probe or press for answers the patient is not willing to give.
* Conduct the interview with a group of interviewers.

Question 25

Safety Plan

Answer 25

You should counsel individuals experiencing intimate partner violence about developing a safety plan, a plan for a rapid escape when abuse recurs. Ask patients to identify the signs of escalation of violence and to pick a particular sign that will tell them that “now is the time to leave.” If children are present, they can all agree on a code word that, when spoken by the parent, means “It is time to go.” If the individual plans ahead, it may be possible to leave before the violence occurs. It is important that the plan include a destination and transportation. The nurse should suggest packing the items listed in Box 28.5 ahead of time.

The person should keep the packed bag in a place where the perpetrator will not find it.

Question 26

Primary prevention

Answer 26

Primary prevention consists of measures taken to prevent the occurrence of abuse. Identifying individuals and families at high risk, providing health teaching, and coordinating support- ive services to prevent crises are examples of primary preven- tion. Specific strategies include:
1. Reducing stress
2. Reducing the influence of risk factors 3. Increasing social support
4. Increasing coping skills
5. Increasing self-esteem
PREVENT ABUSE
-Identifying those at higher risk
– Education and support – attachment, coping mechanisms to reduce stress, social support,
self-esteem

Question 27

Secondary Prevention

Answer 27

Secondary Prevention – early intervention to minimize long-term effects
– Screening program
– Community resources for Tx (therapy)
– Trauma-Informed Care

Question 28

Tertiary Prevention

Answer 28

Tertiary prevention, which often occurs in mental health set- tings, involves nurses facilitating the healing and rehabilitative process by counseling individuals and families, providing sup- port for groups of survivors, and assisting survivors of violence to achieve their optimal level of safety, health, and well-being. Legal advocacy programs for survivors of intimate partner vio- lence are an example of tertiary prevention. Complementary therapies, such as mindfulness-based stress reduction, can also assist survivors in the healing process.

Question 29

Interventions

Answer 29

– Therapy
– Individual (victim and abuser)
– Family
– Group (victim and abuser)
– Support Groups