Violence Flashcards
Abuse
any act resulting in physical or sexual harm, or suffering, including threats or actions in public or private life
Profile of a perpetrator
may have..
- witnessed abuse or been victim of abuse
- substance misuse
- limited education
- personality or psychological disorders
- personal stressors
- low self-esteem
Feelings that precipitate violence
- discounted, ignored, rejected
- embarrassed, humiliated
- frightened, overwhelmed
- powerlessness, threatened
- tired, unheard
Bullying
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
Vulnerabilities (Children)
- academic difficulties (intellectual or developmental)
- depression, anxiety or withdrawal, attachment issues, ADHD
Intimate Partner Abuse
- 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
Vulnerabilities (Women)
- pregnancy
- social instability: young, unmarried, failed to complete high school, unemployed, unplanned pregnancy
- unhealthy lifestyle: diet, substance abuse, emotional problems
Elder Abuse
- psychological and emotional were most common (criticism, yelling, insult)
- financial, physical, sexual abuse and neglect
Vulnerabilities (Elderly)
- 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
Domestic Violence
- gendered crime
- more than 6% of Ontario women report physical or sexual assault by spousal partner
- women represent 83% of victims of spousal violence
Unreported Incidences
- 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
Vulnerabilities (Indigenous Women)
- 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
Same Sex Abuse
- 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
Consequences of Sexual Abuse
- 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
Screening for Abuse
When to ask
How to ask
Who to ask
Interventions for Abuse
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
Nurse’s Role (Abuse)
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
Considerations about reporting abuse
- potential isolation from community
- general mistrust r/t to racism, classism and sexism
- religious factors
- language/communication barriers
- limited culturally sensitive services
Sources of Recovery and Resilience
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
Barriers to Help
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
Domestic Violence Assessment
- skill training
- identify victims in primary care setting
- posters, questionnaires, creative ways to ask (colour marker on urine sample)
Principles of trauma informed care
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
Use of Restraint in Healthcare
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
De-escalation Techniques
- respond early, assess personal safety
- calm, clear tone of voice, empathic
- establish immediate needs
- provide clear options
- non-aggressive posture
- assertive but not aggressive
Forensic Psychiatric Nursing
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
