Violence Against Women

Question 1

NOTE:

Answer 1

Violence against women (VAW) has become epidemic.
Intimate partner violence (IPV) is the most common form of VAW.
Reported lifetime incidence of 1 out of 6 woman.
The National Violence Against Women Survey defines IPV as “the actual or threatened physical, sexual, psychologic, or emotional abuse by a spouse, ex-spouse, boyfriend, girlfriend, ex-boyfriend, ex-girlfriend, date, or cohabitating partner”.

Question 2

NOTE:

Answer 2

About 30% of women killed in the United States are murdered by their husbands or boyfriends.
Nationally, 50% of all homeless women and children are on the streets because of violence in the home.
15 – 30 % of women seen in ER are in an abusive relationship.
Approximately 93% of victims of domestic violence are female.
Domestic violence occurs approximately 7% to males.

Question 3

NOTE:

Answer 3

IPV is a complex, stigmatized problem involving issues of emotional distress, personal safety, and social isolation.
In many places IPV has been socially tolerated or ignored.
Lack of reporting and inconsistent definitions have made it difficult to get an accurate count of the number of victims.
Consequences of IPV are profound.

Question 4

Abused Women had a higher incidence of:

Answer 4

–Social and family problems.
–Substance abuse.
–Menstrual and other reproductive disorders.
–Sexually transmitted infections.
–Musculoskeletal and GI disorders.
–Chest pain and headaches.
–Abdominal pain and UTI’s.
–Depression.

Question 5

Characteristics of Women in abusive relationships:

Answer 5

Race, religion, social background, age and educational level do not differentiate women at risk.
Poor and uneducated women tend to be disproportionately represented because they are financially more dependent, have fewer resources and support system.
Women with educational or financial resources have been hidden from public awareness.
They do not fit the stereotype and find it hard to leave.

Question 6

Characteristics of Women in abusvie relationships:

Answer 6

Survivors of IPV may believe they are to blame for their situations because they are not “good enough”.
The woman may blame herself for bringing on the violent behavior because she believes she must try harder to please the abuser.
In many cases, a traumatic bonding with the man hinges on loyalty, fear, and terror.
Socially isolated.
Leaving an abusive relationship is extremely difficult and the most dangerous time for murders to happen.

Question 7

Cultural Considerations:

Answer 7

IPV is seen in all races, ethnicities, religions, and socioeconomic backgrounds.
In the US, Caucasian women report less IPV than do non-Caucasians.
Native American and Alaska Native women report significantly more instances of IPV than do women of any other racial background.
Asian women report significantly less.
Women from almost all cultures identify fear as a common factor of IPV.

Question 8

Cultural Considerations:

Answer 8

Reporting rates may not reflect the magnitude of the problem because many women do not disclose violence because of fear, embarrassment, or not having been asked by those from whom they seek help.
The cross-cultural meaning of violence is difficult to ascertain because cultures also differ in their perceptions and definitions of in their perceptions and definitions of abuse.
Violence may be underreported as a result of cultural norms.

Question 9

African American Culture

Answer 9

Men are more likely to be psychologically, socially, and economically oppressed and discriminated against.
Violence may occur more frequently as a result of anger generated by environmental stresses and limited resources.
No valid evidence of greater violence seems to exist in this population although AA women tend to report violence at a slightly higher rate.

Question 10

Hispanic and Latino Cultures

Answer 10

Described as family oriented with a strong family network in which unity, cooperation, respect, and loyalty is important.
Traditional families are very hierarchic, with authority often given to older adults, parents, and men.
Sex roles are clearly delineated.
Same rate of IPV.
Higher rate of mental issues in women.
Higher rate of alcohol issues in men.

Question 11

Other Cultures

Answer 11

Native American Culture – report the highest rates of IPV in the US.
Asian Women – have lowest rate of reporting and reasons for not disclosing IPV vary across cultures.

Question 12

IPV During Pregnancy:

Answer 12

IPV has serious consequences for the health of the mother and fetus.
Prevalence of IPV during pregnancy is estimated at 4-8%.
It is more common than preeclampsia, gest. Diabetes, or an abnormal PAP.
Negative effects include: depression, suicide, low weight gain, infections, and substance abuse; GI symptoms from chronic stress, chest pain and hypertension; STI’s, bleeding, UTI’s, genital trauma; higher PPD rates.

Question 13

IPV During Pregnancy

Answer 13

Homicide is the leading cause of trauma death in pregnancy and postpartum.
Not only is physical abuse harmful to the mother, the risk of fetal injury also is very high.
Trauma may result in low birth weight, preterm birth, fetal demise, abruption, hemorrhage, and infections.
Pregnant adolescents may be abused at higher rates than are adult women and have a very high risk for abuse in the PP period.

Question 14

Physical Abuse

Answer 14

• pushing, hitting, slapping, shoving, choking

Question 15

Sexual Abuse

Answer 15

• Forces sex (vaginal, anal, or oral)

- Forces women to have sex with someone else

Question 16

Psychological Abuse

Answer 16

Putting her down.
Controlling who she sees and where she goes, limiting her outside involvement.
Denying responsibility for his actions, blaming her.
Using the children against her.
Treating her like a servant.
Preventing her from getting or keeping a job.

Question 17

Psychological Abuse Cont:

Answer 17

Making and/or carrying out threats to harm her or her family, threatening to commit suicide, pressuring her to drop charges.
Making her afraid through looks and gestures, yelling – intimidation.

Question 18

Contributing Factors:

Answer 18

Childhood experiences.
Male dominated families.
Marital conflict.
Unemployment.
Low socioeconomic status.
Traditional definitions of masculinity.
Addiction problems.

Question 19

Common Myths:

Answer 19

Battering occurs in a small percentage of the population – remember, 1 in 6.
Battered women provoke men to beat them.
Alcohol and drug abuse cause battering.
Battered women were battered children – most women report that their partners were the first person to beat them.

Question 20

Common Myths Cont:

Answer 20

Battered women can easily leave – easier said than done.
Domestic violence is a low-income or minority issue – happens equally across every sector.
Battered women will be safer when they are pregnant – battering may occur for the first time during pregnancy or intensify.

Question 21

Cycle of Violence: 3 Phases

Answer 21

• Tension Building
• Acute battering
• Honeymoon phase

Question 22

Tension Building Phase:

Answer 22

The batterer demonstrates power and control. This phase is characterized by anger, arguing, blaming the woman for problems

Question 23

Acute battering incident:

Answer 23

An episode of acute violence distinguished by lack of pedictability and major destructiveness

Question 24

Tranquil phase or Honeymoon phase:

Answer 24

Characterized by extremly loving and kind behaviors so the woman will forgive him

Question 25

Characteristics of Batterers:

Answer 25

Insecurity.
Inferiority.
Powerlessness.
Helplessness.
Male supremacy.
Emotionally immature.
Aggressive.
Expresses self through violence.
Low tolerance.

Question 26

Care Management:

Answer 26

Women experiencing IPV may be reluctant to seek help for various reasons:
–Need to avoid the stigma.
–Fear that they will not be believed.
–Fear of reprisal from their husbands or partners.
–Avoid involvement with police.

Question 27

Cues of Abuse:

Answer 27

When a woman seeks care for an injury, the nurse should be alert to the following cues:
–Hestiations in providing detailed information about the injury and how it occurred.
–Inappropriate affect for the situation.
–Delayed reporting of symptoms.
–Pattern of injury consistent with abuse.
–Inappropriate explanation for the injuries, such as being “accident prone”.
–Lack of eye contact.
–Signs of increased anxiety in the presence of the batterer, who frequently does the talking.

Question 28

Nursing Skills:

Answer 28

A women suspected of being emotionally abused or physically threatened or abused should be examined and interviewed in private with a same sex interviewer.
Nurses should never ask about abuse with a partner present because this may place client in danger.
Asking how couple deals with conflict may give you some information.
Asking if they have been hurt in a relationship.

Question 29

Tools for Sensitive Nursing Interventions: ABCDES:

Answer 29

A= she/he is not alone
B= Belief that it is not her fault
C= Confidentiality
D=Documentation
E= Education, especially that violence is likely to recur and escalate
S= Safety, the most significant part of intervention

Question 30

Nursing Skills:

Answer 30

The nurse should incorporate the following skills:
–Acknowledge and support the woman for talking about her situation. Reporting abuse is a risk.
–Let the woman work through her story, problems, and situation at her own pace.
–Let the woman know that she is believed and that her feelings are normal.

Question 31

Nursing Skills:

Answer 31

–Anticipate her ambivalence in the love-hate relationship with the batterer.
–Help clarify the woman’s beliefs and help her to change her false beliefs.
–Stress that no one should be abused and that the abuse is not her fault.

Question 32

Prevention:

Answer 32

Screening is a common approach to preventing the progression of health problems but screening alone is not helpful but assessment with adequate intervention may be useful in improving outcomes.
Nurses can make a difference in stopping the violence and preventing further injury by educating women.

Question 33

Sexual Violence:

Answer 33

Sexual violence is a broad term that encompasses a wide range of sexual victimization including sexual harassment, sexual assault, and rape.

Question 34

Sexual Harassment:

Answer 34

intentional unwanted completed or attempted touching of the genitals, anus, groin, or breasts; through clothing or not, voyeurism.

Question 35

Rape:

Answer 35

forced sexual intercourse or penetration of mouth, anus, or vagina by a body part or object without consent; involves use of force.

Question 36

Rape:

Answer 36

Rape occurs in all ethnic and social backgrounds.
Almost 1/3 occurred during adolescence.
The rapist may be a stranger, acquaintance, spouse or other relative, or an employer.
Rape has been reported against females from age 6 months to 93 years.
Remains one of the most underreported violent crimes in the US.
1,000,000 forcible rapes per year in U.S.
Approx. 80% are not reported.

Question 37

Why Do Some Men Rape?

Answer 37

–Having themselves been sexually abused as child.
–Seeing woman as sex objects and viewing them negatively with hostility.
–Belief that rape is a male entitlement.
–A woman is asking for it.
–Some perpetrators are conditioned to become aroused to forced sexual violence.

Question 38

Common Myth of Rape:

Answer 38

Only certain types of women are raped – no woman is safe from rape.
Women who party hard are setting themselves up to be raped – nobody deliberately “sets herself up” to be raped.
If a woman just relaxes, it will all be over with soon – rape is violence using sex as a weapon.
Most rapes are interracial – 80 to 90% of rapes involve people of the same race.

Question 39

Common Myths of Rape:

Answer 39

A rapist is easy to spot in a crowd – rapists come from all races, ethnicities, and socioeconomic groups. They can be married or single.
Women lie about rape as an act of revenge or guilt – false rape charges are infrequent.
Fighting back incites a rapist to violence – it is already an act of violence. Most rapists pick out potential victims they believe may be good targets.

Question 40

Roles of Drugs in Rape:

Answer 40

Most used drugs:
–Alcohol is still number one drug of choice.
–Rohyphol – potent sedative-hypnotic that is legal in 80 countries but illegal in the US. Typically slipped into a drink. Easily dissolves and is odorless.
–GHB (gamma-hydroxybutyrate) – Acts like a central nervous system excitant. Stimulates sexual conduct. Typically slipped into a drink, colorless, odorless, slightly salty.

–Ectasy– A stimulant combined with hallucinogen.

Question 41

Roles of Drugs in Rape:

Answer 41

These drugs are potentiated by alcohol and the combination can be lethal.
The frequency that these drugs are used may be underestimated because they are rapidly excreted, and lab testing has to be done within a few hours of ingestion.
Signs indicating that a woman may have been drugged include having no recall after taking a drink laced with the drug, feeling as if sex has occurred but not having any memory or the incident.

Question 42

Consequences of Sexual Assault:

Answer 42

Rape produces long-term mental health consequences similar to those experienced by combat veterans.
Psychologic effect can be severe.
Sexual assault and rape are associated with depression, rape-trauma syndrome and post-traumatic stress disorder, substance abuse, suicide ideals, chronic pelvic pain and sexual dysfunction.
1/3 of women seek counseling as a direct result of their sexual assault.

Question 43

Physical Care of Rape Victim:

Answer 43

Following rape, repairing tissue damage and preventing complications are primary concerns.
As many as 40% of those raped sustain injuries.
About 1% require hospitalization and major surgical repair.
0.1% are fatal.
Sexual assault survivors have the right to immediate, compassionate and comprehensive medical-legal examination and treatment by a trained professional.

Question 44

Physical Care of Rape Victim:

Answer 44

Make sure everything is explained thoroughly.
Safety of the woman is number one priority.
Getting a detailed history – is an essential first step in acquiring necessary medical and forensic data.
Collection of evidence – has 4 major uses:
–To confirm recent sexual contact.
–To show that force or coercion was used.
–To identify the assailant.
–To corroborate the survivor’s story.
A careful examination of the entire body is necessary.
Vaginal and rectal exams are performed.

Question 45

Physical Care of Rape Victim:

Answer 45

Collection of evidence continued:
–Clothing – each piece of clothing is marked, placed in an individual paper bag, sealed, and labeled.
–Swabs of stains and secretions.
–Hair and scraping – clippings or scrapings of the woman’s fingernails are examined.
–Blood samples – for sexually transmitted diseases and blood type.
–Urine sample – if assault drugs are suspected.
–Photographs – should be taken of all injuries.

Question 46

Physical Care of Rape Victim:

Answer 46

Prevention of sexually transmitted infections – trich, BV, gonorrhea and chlamydia are the most frequently diagnosed infections. Cultures should be obtained. Sometimes given prophylactic antibiotics (1 gm Zithromax). Should be told to follow-up with regular physician in 2 weeks.
Prevention of pregnancy – if she is at risk for pregnancy and a pregnancy test is negative, emergency postcoital contraception is offered.

Question 47

Rape Syndrome Trauma: Page 110

Answer 47

Three phases:

• Acute Phase (disorganization)
• Outward Adjustment
• Long-term (reorganization)

Question 48

Acute Phase: Disorganization

Answer 48

-fear, shock, disbelief, embarassment, degraded, fearful

Question 49

Outward adjustment:

Answer 49

-appears composed, coping by denial and suppression

Question 50

Long-Term: Reorganization

Answer 50

-after denial, she becomes depressed and anxious and starts talking about the rape; she regcognizes the blame is on the assaliant and begins trusting others again

Question 51

Remember:

Answer 51

Rape survivors need a lot of compassion, patience, and caring words…
Be an angel when you can!

Question 52

Case Study Review:

Answer 52

Safety and exit plan for these patients!!!