Abuse and Violence 1.

Tension Building Phase - involves minor battering incidents

CRISIS AND CRISIS INTERVENTION 2. Acute Battering Incident - more serious form of battering
• Crisis - situation that occurs when an individual’s habitual coping 3. Aftermath/Honeymoon stage - the husband becomes loving and
ability becomes ineffective to meet the demands of a situation gives wife hope

Characteristics of a crisis state • Priority in the Care of the Battered Wife

• individualized • Provision of Shelter
• lasts for 4-6 weeks
• person affective becomes passive and submissive Spouse or Partner Abuse
Assessment
Types of Crises • It is necessary to identify victims of abuse in all settings, since they
• Maturational/Developmental Crisis often do not seek treatment directly
• Situational Crisis • SAFE questions can be used to assess:
• Social Crisis – Stress/Safety
– Afraid/Abused
Phases of a Crisis – Friends/Family
1. Denial-initial reaction – Emergency plan
2. Increased Tension -the person recognizes the presence of a crisis
and continues to do ADL Spouse or Partner Abuse
3. Disorganization- the person is preoccupied with the crisis and is Treatment and Intervention
unable to do ADL • Domestic violence laws vary among states and are not always
4. Attempts to Reorganize- the individual mobilizes previous coping followed
mechanisms • Women may stay in abusive relationships for fear of violence to
children, fear of increased violence or death, financial dependence
Clinical Picture of Abuse and Violence • Identifying women in violent situations is a priority. More health
Abuse is the wrongful use and maltreatment of another person can be care agencies are beginning to ask routine screening questions of all
child, spouse, partner, or elder parent women
• Providing women with information about shelters, services, and so
Victims of abuse and trauma can have both physical and forth is essential
psychological injuries, including: • The nurse must never indicate that he or she thinks the woman
• Agitation anxiety, silence should leave the relationship; need to keep the door open for further
• Suppressed anger or resentment communication
• Shame and guilt
• Feelings of being degraded or dehumanized, low self-esteem Child Abuse
• Relationship problems; mistrust of authority figures Child abuse is intentional injury of a child, including:
– Physical abuse or injuries
Characteristics of Violent Families – Sexual assault or intrusion
•Social isolation – Neglect or failure to prevent harm (failure to provide adequate
•Power and control by abusive person •Alcohol and other drug abuse physical or emotional care or supervision abandonment)
• Intergenerational transmission process – Psychological abuse
All states have mandatory child abuse reporting laws that include
Spouse or Partner Abuse nurses.
• Involves the mistreatment of one person by another in the context of
an intimate relationship Child Abuse
•90% to 95% of domestic violence victims are women Parents who abuse children:
•Pregnancy escalates domestic violence • Have minimal parenting knowledge and skills • Are emotionally
•Abuse can occur in same-sex relationships immature and needy
• Are incapable of meeting their own needs, much less those of a
Spouse or Partner Abuse (cont’d) child
Cycle of Abuse and Violence • Often raise their children the way they were raised, including
• Initial episode of violence corporal punishment and abuse
• Honeymoon period: abuser promises it will never happen again, • Expect the child to meet all their needs for love and affection
gives gifts and flowers, is affectionate
• Tensions begins to build with arguments, silence, complaints Child Abuse
• Violence occurs again • happens when an older adult takes advantage of his authority over a
• This cycle repeats over and over younger child
Violence
Battered Wife Syndrome • Refers to the use of force
• cycle of domestic violence characterized by wife beating by the Neglect
husband, humiliation, and other forms of aggression • Lack of provision of those things which are necessary for the child's
• Low-Self Esteem - most common trait of abusive men growth and development
• Dependence - most common trait of abuse women Physical Abuse
• Abuse in the form of inflicting pain
Characteristics of Abusive Husbands Emotional Abuse
1. They usually came from violent families • Abuse in the form of insults and undermining one's confidence
2. They are immature, dependent, non-assertive
3. They have strong feelings of inadequacy Characteristics of Abusive Parents
• 1. They came from violent families
• Phases of BWS • 2. They were also abused by their parents
• 3. They have inadequate parenting skills • Missing valuables
• 4. They are socially isolated because they don’t trust anyone Elder Abuse (cont’d)
• 5. They are emotionally immature Assessment (cont’d)
• 6. They have negative attitude towards the management of the Possible indicators of abuse by caregiver: • Caregiver speaks for the
abused elderly person • Caregiver shows indifference or anger
• Caregiver blames elderly person for physical problems
Common Indicators of Child Abuse • Caregiver shows defensiveness
• 1. Serious injuries in various stages of healing • Caregiver and client give conflicting accounts
• 2. Healthy hair in various length Elder Abuse (cont’d)
• 3. Apathy Treatment and Intervention
• 4. Depression Treatment and intervention may involve:
• 5. Self-Esteem is low •Providing adequate support and respite for the caregivers
•Changing caregiving arrangements
Child Abuse • Moving the elderly person to a safe environment
Assessment Rape
Suspect child abuse when there are: Rape is a crime of violence and aggression expressed through sexual
• Unusual injuries such as scalding and cigarette burns means. The act is against the victim’s will or against someone who
• Delays in seeking treatment, inconsistent history, or illogical cannot give consent.
explanation for the injuries Rape (cont’d)
• Urinary tract infections; red, swollen, or bruised genitalia; tears of •The victim can be any age
vagina or rectum •Half of rapes are committed by someone known to the victim
• Old injuries that were not treated •Rape is underreported to the police
• Multiple, unexplained bruises •Same-sex rape can occur between partners but is most common in
Child Abuse (cont’d) institutions
Treatment and Intervention Rape (cont’d)
•Getting the child to a safe place once abuse is identified Male rapists have been categorized as:
• Family therapy •Sexual sadists aroused by pain of victim
• Individual therapy for the child •Exploitative predators
• Intensive involvement of social service agencies • Inadequate men
•Treatment for parents for any substance abuse or psychiatric issues •Those who rape as a displaced expression of anger and rage
Elder Abuse Rape (cont’d)
Elder abuse is maltreatment of older adults by family members or Physical and psychological trauma to rape victims is severe:
caretakers, including: • Medical problems: victims are significantly less healthy;
– Physical, sexual, or psychological abuse or neglect pregnancy, STDs, HIV are concerns
– Self-neglect •Victims may feel frightened, helpless, guilty, humiliated, and
– Financial exploitation embarrassed; may avoid previously pleasurable activities
– Denial of adequate medical treatment •Relationship problems may occur
Elder Abuse (cont’d) Rape (cont’d)
•60% of perpetrators are spouses, 20% adult children, 20% others Treatment and Intervention
•People who abuse elders are almost always in a caretaker role • Immediate support to ventilate fear and rage
•Elders are reluctant to report abuse because they fear the alternative •Care by persons who believe that the rape happened
(nursing home) •Coordination of all needed services in one location
•Not all states have mandatory elder abuse reporting laws Rape (cont’d)
Elder Abuse (cont’d) Treatment and Intervention (cont’d)
Assessment •Giving the victim control over choices whenever possible
Possible indicators of physical abuse: • Malnourished, dehydrated •Prophylactic treatment for STDs
•Rashes, sores, lice •Referral to therapy services;
•Smell of urine, feces, dirt counseling; and groups for longer-term help
• Failure to keep needed medical appointments Community Violence
• Untreated medical condition Of great concern are homicides and suicides associated with schools.
Elder Abuse (cont’d) Solutions emphasize:
Assessment (cont’d) • Problem-solving skills, anger management, and social skills
Possible indicators of emotional or psychological abuse: development
•Reluctance to talk openly •Helplessness • Parenting programs that promote strong bonding between parents
•Withdrawal or depression •Anger or agitation and children and conflict management in the home
• Mentoring programs for young people
Elder Abuse (cont’d) Community Violence (cont’d)
Assessment (cont’d) A history of violence, victimization, and witnessing of violence can
Possible indicators of self-neglect: • Inability to manage own finances lead to problems with aggression, depression, relationships,
• Inability to perform activities of daily living achievement, and abuse of drugs and alcohol.
• Inadequate clothing Psychiatric Disorders Related to Abuse and Violence
•Signs of malnutrition or dehydration •Rashes and sores Two psychiatric disorders are associated with histories of violence
and abuse:
Elder Abuse (cont’d) 1.Posttraumatic stress disorder (PTSD) 2.Dissociative disorders
Assessment (cont’d) Psychiatric Disorders Related to Abuse and Violence (cont’d)
Possible indicators of financial exploitation: • Inability to manage PTSD
money Disturbing behavior resulting after a traumatic event at least 3
• Unusual activity in bank accounts • Different signatures on checks months after the trauma occurred
• Recent changes in will that client could not make
Up to 60% of persons at risk (combat veterans, victims of violence experience a distorted sense of time and, in extreme cases, they may
and natural disasters) develop PTSD. sense an “out-of-body” experience in which they see themselves
Symptoms of PTSD include: • Persistent nightmares from the vantage point of another person.
• Memories • Derealization is conceptualized as a sense of “unreality or
• Flashbacks detachment from, or unfamiliarity with, the world, be it individuals,
• Emotional numbness inanimate objects, or all surroundings” (APA, 2013, p. 303).
• Insomnia • A person who experiences derealization might feel as though he is
• Irritability in a fog or a dream, or that the surrounding world is somehow
• Hypervigilance artificial and unreal. Individuals with depersonalization/derealization
• Angry outbursts disorder often have difficulty describing their symptoms and may
Psychiatric Disorders Related to Abuse and Violence (cont’d) think they are going crazy (APA, 2013).
Dissociative Disorders • https://youtu.be/mCcxWq_J0YU
Dissociation is a subconscious defense mechanism that helps a Dissociative Identity Disorder
person protect the emotional self from recognizing the full impact of • Dissociative identity disorder (formerly multiple personality
some horrific or traumatic event by allowing the mind to forget or disorder)
remove itself from the painful situation or memory. • Dissociative identity disorder (DID), previously known as multiple
Dissociation can occur both during and after the event and becomes personality disorder (MPD), is a mental disorder characterized by the
easier with repeated use. maintenance of at least two distinct and relatively enduring
Psychiatric Disorders Related to Abuse and Violence (cont’d) personality states. The disorder is
Dissociative Disorders accompanied by memory gaps beyond what would be explained by
Dissociation is a subconscious defense mechanism that helps a ordinary forgetfulness.
person protect the emotional self from recognizing the full impact of Psychiatric Disorders Related to Abuse and Violence
some horrific or traumatic event by allowing the mind to forget or (cont’d)Treatment and Interventions
remove itself from the painful situation or memory. • Involvement in group and/or individual therapy in the community
Dissociation can occur both during and after the event and becomes •Clients with dissociative disorder or PTSD are seen in the acute
easier with repeated use. setting for brief periods when symptoms are severe or there is
Psychiatric Disorders Related to Abuse and Violence (cont’d) concern for their safety
• Dissociative disorders listed in the DSM-5 include dissociative Application of the Nursing Process Assessment
amnesia, depersonalization/derealization disorder, and dissociative • Includes history of trauma or abuse
identity disorder. • Client often appears hyperalert, anxious, or agitated
• Dissociative disorders: group of DSM-5 disorders in which the • Mood and affect: client is fearful and anxious; needs large personal
primary feature is that a person becomes dissociated, or split off, space; has a wide range of emotions
from his or her core sense of self, resulting in disturbances in identity • Thought processes and content: nightmares, flashbacks, destructive
and memory thoughts or impulses
• Depersonalization/derealization disorder: dissociative disorder in Application of the Nursing Process (cont’d)
which people feel detached from the self (depersonalization), and the Assessment (cont’d)
world feels artificial and unreal (derealization) • Sensorium and intellectual processes: disorientation (during
• Dissociative amnesia: dissociative disorder characterized by an flashbacks), memory gaps
inability to recall important personal information, usually following • Judgment and insight: impaired decision-making and problem-
an extremely stressful or traumatic experience solving abilities
• Dissociative fugue: symptom of dissociative amnesia in which a • Self-concept: client has low self-esteem
person suddenly wanders away from one’s home and experiences • Roles and relationships: problems with relationships, work,
confusion about his or her identity authority figures
Dissociative Amnesia • Physiologic considerations: difficulty sleeping, under- or
• Amnesia refers to the partial or total forgetting of some experience overeating, use of alcohol or drugs for self-medication
or event. Application of the Nursing Process (cont’d)
• An individual with dissociative amnesia is unable to recall Data Analysis
important personal information, usually following an extremely Nursing diagnoses include:
stressful or traumatic experience such as combat, natural disasters, or • Risk for Self-Mutilation
being the victim of violence. • Ineffective Coping
Dissociative fugue • Post-Trauma Response
• Dissociative fugue (from the word “to flee” in French), whereby • Chronic Low Self-Esteem
they suddenly wander away from their home, experience confusion • Powerlessness
about their identity, and sometimes even adopt a new identity Application of the Nursing Process (cont’d)
(Cardeña & Gleaves, 2006). Most fugue episodes last only a few Outcome Identification
hours or days, but some can last longer. The client will:
• Dissociative fugue has also been noted to be associated with a • Be physically safe
previous history of child abuse. Other factors that could predispose • Distinguish between self-harm ideas and taking action on those
someone to dissociative reactions include neuropsychological ideas
cognitive dysfunctions and genetic factors. • Learn healthy ways to deal with stress • Express emotions
Depersonalization/Derealization Disorder nondestructively
• Depersonalization/derealization disorder is characterized by • Establish social support network in the community
recurring episodes of depersonalization, derealization, or both. Application of the Nursing Process (cont’d)
Depersonalization is defined as feelings of “unreality or detachment Intervention
from, or unfamiliarity with, one’s whole self or from aspects of the •Promoting the client’s safety
self” •Helping the client cope with stress and emotions using grounding
• Individuals who experience depersonalization might believe their techniques
thoughts and feelings are not their own; they may feel robotic as •Helping to promote the client’s self esteem
though they lack control over their movements and speech; they may •Establishing social support
Application of the Nursing Process (cont’d)
Evaluation
Is the patient:
• Learning to protecting him- or herself?
• Learning to manage stress and emotions?
•Able to function in their daily lives?
Self-Awareness Issues
•Becoming comfortable asking all women about abuse (SAFE
questions)
• Listening to accounts of abuse from clients and families
•Recognizing client’s strengths, not just problems
•Working with perpetrators of abuse; dealing with own feelings
about abuse and violence