Violence

Question 1

Abuse

Answer 1

any act resulting in physical or sexual harm, or suffering, including threats or actions in public or private life

Question 2

Profile of a perpetrator

Answer 2

may have..

• witnessed abuse or been victim of abuse
• substance misuse
• limited education
• personality or psychological disorders
• personal stressors
• low self-esteem

Question 3

Feelings that precipitate violence

Answer 3

• discounted, ignored, rejected
• embarrassed, humiliated
• frightened, overwhelmed
• powerlessness, threatened
• tired, unheard

Question 4

Bullying

Answer 4

specific form of aggression, which is intentional, repeated and involves a disparity of power between the victim and perpetrators
social media expands the risk of bullying

Question 5

Vulnerabilities (Children)

Answer 5

• academic difficulties (intellectual or developmental)

- depression, anxiety or withdrawal, attachment issues, ADHD

Question 6

Intimate Partner Abuse

Answer 6

• violence among dating partners was more common than among spouses
• 4 out of 5 victims of police reported violence were women
• statistics about men may be underreported
• rate of intimate partner sexual assault was 36 times higher among women

Question 7

Vulnerabilities (Women)

Answer 7

• pregnancy
• social instability: young, unmarried, failed to complete high school, unemployed, unplanned pregnancy
• unhealthy lifestyle: diet, substance abuse, emotional problems

Question 8

Elder Abuse

Answer 8

• psychological and emotional were most common (criticism, yelling, insult)
• financial, physical, sexual abuse and neglect

Question 9

Vulnerabilities (Elderly)

Answer 9

• limited mobility, impairment in ADLs
• cognitive disabilities or other MI
• poor physical health
• dependency on caregiver
• isolation
• stressful events
• history of intergenerational conflict with caregiver

Question 10

Domestic Violence

Answer 10

• gendered crime
• more than 6% of Ontario women report physical or sexual assault by spousal partner
• women represent 83% of victims of spousal violence

Question 11

Unreported Incidences

Answer 11

• less than one quarter of victims of spousal violence report incident to police
• victimized multiple times
• women are 3 times more likely to report
• women aged 15 to 34 are 2-3 times more likely to experience spousal victimization
• estimated 15% of female university students experience sexual assault
• women aged 15-24 most at risk for spousal homicide
• 95% of spousal homicides are female

Question 12

Vulnerabilities (Indigenous Women)

Answer 12

• indigenous women are 2.5 more likely to experience spousal violence than non-indigenous women
• impoverished living conditions, SES status
• remote areas decrease availability of resources and support
• substance use
• fractured identities, marginalized

Question 13

Same Sex Abuse

Answer 13

• limited services to support, no where to turn to
• attitudinal barriers, lack of understanding by police and hc professionals
• homophobia denies reality
• met with indifference or seeing abuse as an affirmation of instability of the relationship
• affect relationships within gay/lesbian community

Question 14

Consequences of Sexual Abuse

Answer 14

• changes vulnerability of body and mind
• ability to deal with stress is altered
• body can be on constant stress arousal, hypervigilant

psychological

• the closer the relationship, the more severe the consequence..damaged trust
• increase risk anxiety and depression
• can be triggered when own child reaches that age

behavioural

• decreased help seeking from healthcare system, decreased examination
• or high help seeking

physical

• somatic complaints
• IBS

Question 15

Screening for Abuse

Answer 15

When to ask
How to ask
Who to ask

Question 16

Interventions for Abuse

Answer 16

Prevention

• education: public, professionals, women’s groups, police, schools/communities
• safety programs
• lobby for prevention
• consider what is a healthy relationship

Modify impact

• screening
• standardized tool
• nursing assessment
• be aware of services
• trauma-informed, be careful not to revictimize

Question 17

Nurse’s Role (Abuse)

Answer 17

1. ASK
Are you safe?
Would you like to talk about it?
When did this happen?
Have you talked to anyone else about this?
How are you coping?
What do you need right now?
2. Acknowledge the abuse
3. Validate the experience
4. Assess immediate safety
5. Explore options and concerns - make a plan
6. Report to appropriate service WITH CONSENT
7. Document the intervention

Question 18

Considerations about reporting abuse

Answer 18

• potential isolation from community
• general mistrust r/t to racism, classism and sexism
• religious factors
• language/communication barriers
• limited culturally sensitive services

Question 19

Sources of Recovery and Resilience

Answer 19

a. spiritual support
b. social support

nurses can:

• support use of internal and external resources
• support use of positive support
• help to determine who is supportive
• support redefining selves, draw on strengths
• find meaning, answer “why me”, break violence cycle

Question 20

Barriers to Help

Answer 20

Attitudinal

• staff knowledge/attitudes
• societal beliefs and resistance to acknowledging abuse
• belief systems of groups to normalizing of violence

Systemic

• “family is sacred”
• “authority should not be questioned”
• gender stereotypes about abuse
• taboo subjects that are difficult to talk about

Individual

• children don’t always tell, or may have told but dismissed or blamed
• think of self as victim
• can’t describe experience
• suppressed memory

Individual barriers as nurses..

• rather not know
• discomfort with strong emotions
• lack of knowledge and skills

Question 21

Domestic Violence Assessment

Answer 21

• skill training
• identify victims in primary care setting
• posters, questionnaires, creative ways to ask (colour marker on urine sample)

Question 22

Principles of trauma informed care

Answer 22

Commit to a “do no harm” philosophy to avoid retraumatizing clients

principles:

• physical and psychological safety
• trustworthiness and honesty
• collaboration and levelling power differences
• empowerment for clients to make tx decisions
• voice and choice for client
• resilience and ability for client to grow and recover, provide safe and empowering experience
• inclusiveness
• cultural and gender awareness

Question 23

Use of Restraint in Healthcare

Answer 23

least restraint policies

a. medications
b. seclusion (environment)
c. limb/body restraint (physical)

• sustain continued communication
• de-escalation techniques
• use restraint as last resort
• debrief after, reestablish relationship

Question 24

De-escalation Techniques

Answer 24

• respond early, assess personal safety
• calm, clear tone of voice, empathic
• establish immediate needs
• provide clear options
• non-aggressive posture
• assertive but not aggressive

Question 25

Forensic Psychiatric Nursing

Answer 25

nursing care to victims and perpetrators involved with legal system
involves trauma-informed care principles
provide nursing care and support to client even if they committed horrendous acts