Violence and abuse

Question 1

IPV

Answer 1

-Physical or sexual violence or psychological/emotional abuse
-Most affected population are heterosexual women or LGBTQIA+ individuals
-Children who witness abuse are more likely to continue the cycle
-Violence occurs in all socioeconomic classes
-Violence is a learned behavior and can be changed
-1/4 women will be victims of violence in their lifetimes
-Abusers appear normal and not to suffer from mental illness
-1/5 women will be victims during pregnancy

Question 2

The cycle of violence

Answer 2

-Tension building: longest phase, excessive drinking or jealousy causes tension, woman feels guilty for causing husband’s outburst, victim feels like she’s “walking on eggshells”
-Physically abusive: explosion of violence, unpredictable behaviorassault or murder, victims consider themselves lucky that their injuries were not worse, deny tx
-Honeymoon: period of calm, loving behavior, abuser apologized

Question 3

Types of abuser

Answer 3

-Emotional: swearing, promising, humiliating, destroying possessions, threatening to leave partner
-Physical: hitting or grabbing, throwing things, slapping, spitting, kicking, punching, attacking w/ object
-Financial: preventing victim from getting a job, sabotaging current job, controlling all money spent, failing to contribute financially
-Sexual: rape, biting breast or genitals, shoving objects into vagina or anus, forcing sexual acts upon other ppl or animals

Question 4

Abuse profiles: victims

Answer 4

-Battered woman syndrome: experiencing violence by partner over extended period of time
-Responds to violence w/ avoidance
-Belief that abuse is caused by flaw within victim
-Many victims were abused as children and may have poor self-esteem, poor health, PTSD, depression, insomnia, low education achievement, hx of suicide attempts, injury, or drug abuse

Question 5

Abuse profiles: abusers

Answer 5

-Feel insecure, powerless, and helpless
-Violence typically occurs at home
-Refuse to share power
-Exhibit childlike aggression or antisocial behaviors
-Fail to accept responsibility and will blame others
-Hx of substance abuse, trouble w/ justice system, few close relationships, sensitivity to criticism, tendency to hold grudges, involvement in power struggles, emotional dysregulation, lack of insight, feelings of being misunderstood, mental illness, troubled relationships, jealousy, controlling behaviors, erratic employment, financial problems

Question 6

Violence against pregnant women

Answer 6

-Having children does not protect victim from IPV
-IPV will last longer if pregnant
-Fear of harm for unborn child will motivate woman to try to escape
-Caused by: stressors of pregnancy, young age, less than high school degree, unemployment, cohabitation, single marital status, sexual possessiveness, heavy drinking, resentment toward change in woman’s body, perception that baby will be competitor, outside attention toward woman, financial burden, stress of role to become a father
-Signs of abuse: poor attendance to visits, unrealistic fears, weight fluctuations, difficulty w/ pelvic exams, nonadherence to tx

Question 7

Nursing mgmt for IPV

Answer 7

-Routine screening: looking for injuries, injury sequelae, mental health problems, frequent tranquilizer use, delay in seeking medical attention for injuries, comments of abuse from a “friend”, STIs or PID, appearing nervous when responding to questions; partner appears overly solicitous or overprotective, unwilling to leave client alone w/ HCP, answers questions for her, attempts to control situation
-Isolate client immediately from family: bring woman to a private room, educate woman about connection btwn violence and her s/s, help woman acknowledge her situation, offer woman referrals
-Ask direct/indirect questions: SAVE model, nonjudgmental attitude
-Assess immediate safety: ask if she feels safe at home, if she needs an immediate place of safety, if she has a plan of escape, if she needs an alternate exit from this building, if she has ppl she can contact for help; Danger Assessment Tool helps assess potential for homicidal behavior in an ongoing abusive relationship
-Document and report your findings: use direct quotes, obtain photos, describe visible injuries, alert police
-Educate abt community services: hotline number, support groups, counseling, legal services
-Provide emotional support: strengthen sense of control, encourage realistic goals, allow her to griver for her losses
-Offer a safety plan

Question 8

SAVE model

Answer 8

-Screen all of clients for violence
-Ask direct questions in a nonjudgmental way
-Validate the client
-Evaluate, educate, and refer the client

Question 9

Nursing analysis diagnoses

Answer 9

-Deficient knowledge related to understanding the cycle of violence and availability of resources
-Anxiety related to threat to self-concept, situational crisis of abuse
-Situational low self-esteem related to negative family interactions
-Powerlessness related to lifestyle of helplessness
Impaired individual and family coping related to abusive patterns

Question 10

Nursing interventions

Answer 10

-Listening: “I hear and understand what you are saying”
-Communicating belief: “That must have been frightening for you.”
-Validating the decision to disclose: “It must have been difficult for you to talk about this today.”
-Emphasizing the unacceptability of this violence: “You don’t deserve to be treated this way.”
-Most important to help woman regain sense of control in her life, a lack of control prevent woman from escaping

Question 11

Nursing prevention

Answer 11

-Primary: community educational initiatives
-Secondary: screening high-risk individuals
-Tertiary: helping severely abused women and children, rehabilitating abusers
-ABCDES model provides framework for providing sensitive nursing interventions

Question 13

Safety plan for leaving abusive relationship

Answer 13

-Take following items: driver’s license or photo ID, SSN or green card/work permit, birth certificates, phone numbers for social services or women’s shelter, deed or lease to home, court papers, prescriptions, change of clothing, pay stubs, credit cards, cash, health insurance cards
-Turn to authorities for assistance in gathering this material
-Develop a plan and rehearse it
-Don’t use phone cards, they leave a trail to follow

Question 14

Characteristics of assailants

Answer 14

-Most under 25
-Married
-Lead normal sex lives
-Are jealous, hot tempered, don’t handle stress well, don’t view women as equals

Question 15

Sexual abuse

Answer 15

-Forced to have sexual contact of any kind w/o consent
-Peak age is 8-12 yrs
-Assailant is usually someone of a close relationship
-Childhood sexual abuse if victim is < 18 yrs

Question 16

Incest

Answer 16

-Sexual activity btwn persons so closely related that marriage btwn them is legally or culturally prohibited
-Survivors are often tricked, coerced, or manipulated

Question 17

Rape

Answer 17

-Expression of violence, not a sexual act
-Legal rather than a medical term
-Penile penetration of vagina, mouth, or rectum of a female or male w/o consent
-May or may not include use of a weapon
-Statutory rape: adult abuse rapes a minor
-Most women don’t report rape
-Acquaintance rape: rape by someone a person knows (coworker, teacher, husband’s friend< boss)
-Date rape: rape within a dating relationship or marriage
-Most common rape drug aka club drugs, forget pills, mind erasers, or drop drug is rohypnol (aka roofies)
-Rohypnol dissolves in liquid and has non odor, taste, or color, 10x stronger than diazepam, effects within 30 min and memory loss for 8 hrs
-Other date rape drugs are GHB and ketamine
-GHB (aka liquid ecstasy) produces euphoria, intense sex drive, sleepiness, and memory loss
-Ketamine (aka special K, vitamin K, or super acid) separates perception and sensation

Question 18

Protecting oneself against date rape drugs

Answer 18

-Avoid parties where alc is served
-Never leave drink unattended
-Don’t accept drink from anyone
-Accept drinks from bartender or in closed container only
-If drink is left unattended, pour it out and don’t drink it
-Don’t drink anything that tastes or smells strange
-Don’t drink from punch bowl or a keg
-Call 911 if you think you were drugged

Question 19

Phases of rape recovery

Answer 19

-Acute (disorganization): shock, fear, disbelief, anger, shame, guilt, feelings of uncleanliness, insomnia, nightmares, sobbing
-Outward adjustment (denial): appears outwardly composed and returns to work or school, refuses to discuss assault, denies need for counseling
-Reorganization: denial and suppression don’t work, attempts to make life adjustments by moving or changing jobs, using emotional distancing to cope
-Integration and recovery: begin to feel safe and starts to trust others, may become advocate for other victims

Question 20

PTSD

Answer 20

-4 groups
-Intrusion: reexperiencing trauma, including nightmares, flashbacks, recurrent thoughts
-Avoidance: avoiding trauma-related stimuli, social withdrawal, emotional numbing
-Hyperarousal: increased emotional arousal, exaggerated startle response, irritability
-Cognitive and mood symptoms: negative thoughts, excessive guilt, self-blame

Question 21

Nursing mgmt for rape victims

Answer 21

-SANE (sexual assault nurse examiner)
-Early intervention shortly after event occurs
-Many survivors seek tx in ED if no rape crisis center is available, unfortunately many ED staff don’t know how to care for rape victims, they may wait for hours in public waiting rooms to end up leaving the hospitals
-Providing supportive care: take to isolated area, provide change of clothes, access to shower and toiletries
-Collecting and documenting evidence: instructed to bring all clothing, especially undergarments, worn at time of assault, victim shouldn’t shower or bathe
-Assessing for STIs, pelvic exam to rule out STIs
-Preventing pregnancy: emergency contraceptive pill, best if taken within 12 hrs
-Assessing for PTSD

Question 22

Female genital cutting (FGC)

Answer 22

-Correlated w/ genital mutilation, forced sexual experienced, and health complications
-Associated w/ feminine beauty in some cultures (rite of passage from childhood into adulthood)
-Used to decrease sexual desires, remain abstinent until marriage
-Most common long-term issue is formation of inclusion clitoral dermoid cysts and labial fusion (can become large as a grapefruit and lead to difficulty in walking and sitting)
-Type 1: clitoris
-Type 2: clitoris and labia minora
-Type 3: clitoris, labia minora, labia majora, suturing remaining tissue (infibulation)
-Type 4: pricking, piercing, or incision of clitoris or labia, stretching, cauterizing, scraping, introducing corrosive substance into vagina, placing herbs into vagnia to narrow it

Question 23

Nursing mgmt for FGC

Answer 23

-Use terms for this practice that the recipient uses, not “female genital cutting” or “mutilation”
-Use pictures
-Include male family members as they are influential
-Always look and talk to the client, not the interpreter
-Maintain respect for older women who have experienced FGC

Question 24

Human trafficking

Answer 24

-Illegal act of recruiting, transporting, harboring, or receiving people through force, fraud, or coercion to exploit them for labor, sexual acts, or other forms of exploitation
-Modern slavery
-Forced labor found in sex industry, domestic servitude, agriculture, sweatshops, restaurants and hotel work
-Victims are usually women and children who lack education, eployment, and economic opportunities within their own countries, Traffickers promise victims employments in the US
-Traffickers transport victims from their countries to unfamiliar destinations away from their support systems
-Once in US, traffickers abuse victims