Assessing for

Violence
EVANGELINE CARPIO-LOLA, RN
Family violence
•Defined as "a situation in which one family member causes physical or emotional harm to another
family member.” At the center of this violence is the abuser's need to gain power and control over the
victim" (Violence wheel, 2009).
•The abuse can be physical (e.g., slapping, hitting, kicking, punching, burning); emotional (e.g., threats of
physical harm, financial harm, harm to child or pet, or suicide; harassment; insults and other verbal abuse;
isolation; intimidation; mind games; throwing objects); or sexual (incest or rape).
Domestic violence
•("Domestic Violence Statistics," 2012) for 2011 note that one in every three women worldwide has been
beaten, coerced into sex, or otherwise abused at least once in her lifetime. Also noted is that "the costs of
intimate partner violence in the United States alone exceed $5.8 billion per year: $4.1 billion are for direct
medical and health care services, while productivity losses account for nearly $1.8 billion" ("Domestic
Violence Statistics," 2012).
Violence tends to have a negative connotation in the context of murder, torture, or hate, but has
more of a positive connotation if associated with self-defense or acts of war. American culture
condemns violence in the context of murder, torture, and hate. However, some movies,
television programs, and literature glorify it.
Aggression is defined as “a forceful action or procedure (as an unprovoked attack) especially
when intended to dominate or master” Aggression also has both positive and negative
connotations.
The positive connotation is associated with the drive for success, as in aggressive men.
The negative connotation is often associated with the notion of aggressive women, which
violates what is considered appropriate for gender norms in many cultures. The negative
connotation is also associated with aggression against a family member when one person tries
to dominate or master another
TYPES OF FAMILY VIOLENCE

Types of family violence include physical abuse, psychological abuse, economic

abuse, and sexual abuse. Abandonment, physical and emotional neglect, and
parental substance abuse are added by CME Resources (2012) in an overview of
types of abuse.
A. Physical Abuse
•Physical abuse includes pushing, shoving, slapping, kicking, choking, punching,
and burning. It may also involve holding, tying, or other methods of restraint. The
victim may be left in a dangerous place without resources. The abuser may refuse
to help the victim when sick, injured, or in need. Physical abuse may also involve
attacking the victim with household items (lamps, radios, ashtrays, irons, etc.) or
with common weapons (knives or guns).
B. Economic Abuse
Economic abuse may be evidenced by preventing the victim from getting or
keeping a job, controlling money and limiting access to funds, spending the
victim’s money, and controlling knowledge of family finances.
Economic abuse, also known as financial abuse, is the improper exploitation of
another person’s personal assets, properties, or funds. Examples of this type of
abuse include the cashing of another person’s checks without authorization or
permission, forging signatures, and misusing or stealing money or possessions.
Economic abuse may also occur if someone deceives another into signing a will or
contract, coerces a person into signing a will or contract, or controls another
person’s money and demands a detailed accounting of the funds.
C. Psychological Abuse
•Psychological abuse involves the use of constant insults or criticism, blaming the
victim for things that are not the victim’s fault, threats to hurt children or pets,
isolation from supporters (family, friends or coworkers), deprivation, humiliation,
stalking and intimidation, and manipulation of various kinds, such as threats of
suicide. Psychological abuse, also known as emotional abuse, has been defined by
Vancouver Coastal Health (2013) as “any act including confinement, isolation,
verbal assault, humiliation, intimidation, infantilization, or any other treatment
which may diminish the sense of identity, dignity, and self-worth.
 EFFECTS OF EMOTIONAL ABUSE ON ADULTS
SHORT-TERM EFFECTS OF EMOTIONAL ABUSE LONG-TERM EFFECTS OF EMOTIONAL ABUSE
• Surprise and confusion • Depression
• Questioning of one’s own memory: “Did that really happen?” • Withdrawal
• Anxiety or fear; hypervigilance • Low self-esteem and self-worth
• Shame or guilt • Emotional instability
• Aggression (as a defense to the abuse) • Sleep disturbances
• Physical pain without cause
• Becoming overly passive or compliant
• Suicidal ideation, thoughts, or attempts
• Frequent crying
• Extreme dependence on the abuser
• Avoidance of eye contact
• Underachievement
• Feeling powerless and defeated, as nothing you do ever seems to be
• Inability to trust
right (learned helplessness) • Feeling trapped and alone
• Feeling like you’re “walking on eggshells” • Substance abuse
• Feeling manipulated, used, and controlled • Stockholm syndrome is also common in long-term abuse situations. In Stockholm
• Feeling undesirable syndrome, the victim is so terrified of the abuser that the victim overly identifies
• Partners may also find themselves trying to do anything possible to and becomes bonded with the abuser in an attempt to stop the abuse. Victims will
bring the relationship back to the way it was before the abuse even defend their abuser and their emotionally abusive actions.
D. Sexual Abuse
•Sexual abuse involves forcing the victim to perform sexual acts against her or his
will, pursuing sexual activity after the victim has said no, using violence during
sex, and using weapons vaginally, orally, or anally.
CATEGORIES OF FAMILY VIOLENCE

•Categories of family violence include:

intimate partner violence (IPV)
child abuse,
elder mistreatment.

Family violence affects people of all ages, sexes, religions, ethnicities, and socioeconomic
levels.
Intimate Partner Violence (IPV)
•Intimate partner violence, as defined by the Family Violence Prevention Fund
(2010), “is a pattern of assaultive behavior and coercive behavior that may include
physical injury, psychologic abuse, sexual assault, progressive isolation, stalking,
deprivation, intimidation, and reproductive coercion,” and IPV “affects millions of
women regardless of age, economic status, race, religion, ethnicity, sexual
orientation, or educational background.”
Child Abuse
•The Child Abuse Prevention and Treatment Act (CAPTA) defines child abuse as
“any recent act or failure to act on the part of a parent or caretaker which
results in death, serious physical or emotional harm, sexual abuse or
exploitation”
•The Child Welfare Information Gateway (2008b) defined child abuse as:
“physical or mental injury, sexual abuse, negligent treatment or maltreatment
of a child under the age of 18 by a person who is responsible for the child’s
welfare under circumstances that indicate that the child’s health or welfare is
harmed.”
Elder mistreatment
•Also known as elder abuse
Includes neglect, physical abuse, sexual abuse, financial abuse, psychological
abuse (including humiliation, intimidation, and threats), exploitation,
abandonment, or prejudicial attitudes that decrease quality of life and are
demeaning to those over the age of 65 years.
•Some of the consequences of elder mistreatment include (1) inability of the frail
elderly to handle the trauma, (2) inability to get food or medication because of
neglect, (3) inability to pay for food or medication because of financial abuse, and
(4) inability to deal with illness/malnutrition/problems because of depression
associated with abuse
Nursing Assessment of Family
Violence
•There are four areas to assess to determine the presence of family violence:
physical abuse, psychological abuse, economic abuse, and sexual abuse
I. PREPARING YOURSELF FOR
THE EXAMINATION
•Before you can begin to effectively assess for the presence of family violence, you
must first examine your feelings, beliefs, and biases regarding violence. Violence is
a prevalent family and community health problem that needs to be confronted by
society today. No one under any circumstance should be physically,
psychologically, financially, or sexually abused
As a nurse, it is imperative that you become active in interrupting or ending
cycles of violence. During your assessment, be aware of “red flags” that may
indicate the presence of family violence; these red flags are often hidden from
others.
II. COLLECTING SUBJECTIVE
DATA
Interview Techniques
•Creating a safe and confidential environment is essential to obtain concise and valid subjective
data from any client who has experienced family violence. For any client over the age of 3 years,
ask screening questions in a secure, private setting with no one else present in the room. Do not
screen if there are any safety concerns for you or the client.
•Prior to screening, discuss any legal, mandatory reporting requirements or other limits to
confidentiality. Screening may be done orally and in a written format or through computer
generated questions. Find a reliable and appropriate interpreter if the client is non-English
speaking
•Remember when asking questions to allow the client to answer completely. Do not interrupt the
client. Convey a concerned and nonjudgmental attitude. Show appropriate empathy.
 III. COLLECTING OBJECTIVE
DATA: PHYSICAL EXAMINATION
Preparing the Client Preparing the client for an examination after the client has experienced
violence will differ for the specific circumstances.
For children, make certain that the child is as comfortable as possible. Include the parent
but be aware that the parent accompanying the child may be the abuser. If this is the case it
may complicate the full examination, with incorrect information being provided by the
parent to questions that you ask.
For adults, the specific injuries involved will determine the focus of the physical
examination. If possible, prepare the client for a complete physical examination. If rape is
involved, arrange a consultation with, and examination by, a SANE (Sexual Assault Nurse
Examiner) if at all possible, as the physical evidence obtained may be used in court
 III. COLLECTING OBJECTIVE
DATA: PHYSICAL EXAMINATION
Equipment
Equipment needed will vary depending on the specific injuries For a general examination,
equipment to measure vital signs is necessary
Physical Assessment
During examination of a client who you suspect or know has been abused, it is even more
essential to remember these key points:
1) Provide privacy for the client
2) Keep your hands warm to promote the clients comfort during examination
3) Remain nonjudgmental regarding the clients habits, lifestyle, and any revelations about
abuse. At the same time educate and inform about risk and possibilities for instance.
 IV. VALIDATING AND
DOCUMENTING FINDINGS
•Validate any family violence data you have collected. This is necessary to verify that
the data are reliable and accurate. Document your assessment data following the health
care facility or agency policy.
 THANK YOU!
References: Weber, J. R., & Kelley, J. H. (2017). Health assessment in nursing (6th ed.). Lippincott Williams and
Wilkins.