1 / 43

Nursing 204 West Coast University

Child, Older Adult, and Intimate Partner Abuse Chapter 26 . Nursing 204 West Coast University. Types of Abuse. Physical abuse Sexual abuse Emotional abuse Neglect Economic abuse. People at Risk for Violence. Sexual abuse

orly
Download Presentation

Nursing 204 West Coast University

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript


  1. Child, Older Adult, and Intimate Partner Abuse Chapter 26 Nursing 204 West Coast University

  2. Types of Abuse • Physical abuse • Sexual abuse • Emotional abuse • Neglect • Economic abuse

  3. People at Risk for Violence • Sexual abuse • 90+% of rape victims are women • Not age related • 18-20% of rape victims are teens • 50% of victims raped by spouse, partner, relative, or friend • 50% of rapes on college campuses are date rapes • 80+% of sexual assault involves alcohol

  4. Cycle of Violence • Process of escalation/de-escalation • Tension-building stage • Attempts to reduce tension by both partners • Acute battering stage • Honeymoon stage • Tension builds and cycle continues

  5. Epidemiologyand Comorbidity • Prevalence • Half of all Americans have experienced violence in their families • Comorbidity • Secondary effects of violence • Anxiety • Depression • Suicidal ideation

  6. Actual Occurrence of Violence Requires: • Perpetrator • Vulnerable person • Crisis situation

  7. Characteristics of Perpetrators • Consider their own needs more important than needs of others • Poor social skills • Extreme pathological jealousy • May control family finances • Likely to abuse alcohol or drugs

  8. Characteristics of Vulnerable Persons: Women • Pregnancy may trigger or increase violence • Violence may escalate when wife makes move toward independence • Greatest risk for violence when attempts to leave relationship

  9. Characteristics of Vulnerable Persons: Children • Younger than 3 years • Perceived as different • Remind parents of someone they do not like • Product of an unwanted pregnancy • Interference with emotional bonding between parent and child

  10. Characteristics of Vulnerable Persons: Older Adults • Poor mental or physical health • Dependent on perpetrator • Female, older than 75 years, white, living with a relative • Elderly father cared for by a daughter he abused as a child • Elderly woman cared for by a husband who has abused her in the past

  11. Theories of Domestic Violence • Neurobiologic theory • Role of serotonin (5-HT), corticotropin-releasing factor (CRF) • Intrapersonal theory • Experience of previous abuse a strong predictor for violence • Social learning theory • Family models, media models • Gender bias theory • Socioeconomic factors

  12. Assessment: Interview Guidelines • Verbal approaches • Tell me about what happened to you. • Who takes care of you? (for children and dependent elders) • What happens if you do something wrong? • How do you and your partner resolve disagreements? • What do you do for fun? • Who helps you with your children/parent? • What time do you have for yourself?

  13. Assessment: Interview GuidelinesContinued • Open-ended questions for parents • What arrangements do you make when you have to leave your child alone? • How do you discipline your child? • When your infant cries for a long time, how do you get him/her to stop? • What about your child’s behavior bothers you the most?

  14. Assessment • Should include: • Violence indicators • Level of anxiety • Coping responses • Family coping patterns • Support systems • Suicide and/or homicide potential • Drug and alcohol use

  15. Nursing Diagnoses • Risk for injury • Risk for violence (self- or other- directed) • Anxiety • Fear • Disabled family coping • Powerlessness • Caregiver role strain

  16. Outcomes Identification • Evidence that the victim is no longer hurt or exploited • Physical abuse has ceased • Emotional abuse has ceased • Sexual abuse has ceased • Financial exploitation has ceased

  17. Planning • Guidelines developed by • The Joint Commission on Accreditation of Healthcare Organizations • The Nursing Network on Violence Against Women • The general tolerance of violence in America must be addressed if long-lasting changes are to be made.

  18. Implementation • Reporting abuse • Counseling – safety plan • Case management • Milieu management • Promotion of self-care activities • Health teaching and health promotion

  19. Prevention of Abuse • Primary prevention • Measures taken to prevent the occurrence of abuse • Secondary prevention • Early intervention in abusive situations to minimize their disabling or long-term effects • Tertiary prevention • Facilitating healing and rehabilitative process • Providing support • Assisting survivors of violence to achieve their optimal level of safety, health, and well-being

  20. Sexual Assault Chapter 27

  21. Sexual Assault • Any type of sexual activity the victim does not want or agree to • From inappropriate touching to penetration • Verbal sexual assault can occur by phone or electronically online • Forced activities • Prostitution or posing for pornographic pictures or videos • Children, older adults, women, or men can be victims

  22. Rape • Type of sexual assault • Nonconsensual vaginal, anal, or oral penetration, obtained by force or by threat of bodily harm or when a person is incapable of giving consent • Second most violent crime (FBI, 2008)

  23. Epidemiology • People of lower socioeconomic classes more often victims • 80% of victims are white • 1/3 of all assaults occur inside home • Most of time, no weapon involved • Young females (12–19) at particular risk • 9% to 10% of all rapes are male victim

  24. Profile of Sexual Perpetrators • Young • 30% under 21 • 23% under 30 • Under the influence of alcohol or drugs at time of offense • 61% acquainted with victim

  25. Psychological Effects of Sexual Assault • Depression • Suicide • Anxiety • Fear • Difficulties with daily functioning • Low self-esteem • Sexual dysfunction • Somatic complaints

  26. Responses to Rape • A variety of factors contribute to the response. • Depersonalization, denial are common defense mechanisms • Anxiety, agitation, nonpurposeful behaviors, shock, disbelief, fear are common emotional responses • The victim usually experiences extensive physical injuries.

  27. Long-term Consequences • Post-trauma depression which may develop into a major depressive disorder • Disruption in daily functioning • Flashbacks, violent dreams, preoccupation with thoughts of future danger • Social withdrawal, concerns about safety • Sexual problems

  28. History of Sexual Abuse in Psychiatric Patients Associated with a Characteristic Pattern • Depression • Anxiety disorders • Chemical dependency • Suicide attempts • Self-mutilation • Compulsive sexual behavior • Psychosis-like symptoms

  29. Rape-Trauma Syndrome: Acute Phase • Occurs immediately after the assault • May last for a few weeks • Lifestyle disorganized • Somatic symptoms are common • Reaction to crisis includes disruptions in cognitive, affective, and behavioral functions

  30. Rape-Trauma Syndrome: Long-Term Reorganization Phase Reactions likely to be experienced include: • Intrusive thoughts • Increased motor activity • Increased emotional lability • Fears and phobias

  31. Theories of Sexual Abuse • Intrapersonal Theory • Guidelines for perpetrator assessment: • Low self-esteem • Emotionally deprived as children • Lack impulse control • Rigid, overcontrolling, aggressive • Family Systems Theory • Family system may be enmeshed, chaotic, with poor communication patterns

  32. Nursing Process • Physical Assessment • Behavioral Assessment • Affective Assessment • Cognitive Assessment • Sociocultural Assessment

  33. Assessment • Follow protocols of hospital regarding rape victims. • Assess: • Level of anxiety • Coping mechanisms • Available support systems • Signs and symptoms of: • Emotional trauma • Physical trauma

  34. Nursing Diagnosis • Rape-trauma syndrome • Ineffective coping

  35. Outcomes Identification • Abuse protection • Abuse recovery: emotional • Abuse recovery: sexual • Coping • Personal resiliency • Sexual functioning • Stress level

  36. Interventions • Individual-Based: • Assure safety, develop rapport, clarify presenting problems, identify victim’s strengths, abilities, coping skills, identify available support systems, suggest group therapy, experience anger, work through their terrifying fears • Community-Based: • Identify risk factors, implement crisis interventions

  37. Interventions Counseling • 24-hour telephone hotline • Emergency department • Nonjudgmental care • Emotional support • Confidentiality • Listen and let survivor talk

  38. InterventionsContinued Promotion of self-care activities • Provide detailed written information concerning referral and follow-up options Case management • After initial evaluation: • Provide follow-up assessment within 24 to 48 hours • Provide follow-up visits at 2, 4, and 6 weeks

  39. Treatment of Families Experiencing Violence • Multidisciplinary Approach • Assess physical safety first for both victim and abuser • Psychoeducation • Focus on communication, anger management • Empowering the Victim • Address self-esteem, anxiety, depression • Treating the Abuser • Violence is a choice

  40. Treatment Evaluation • Short-term: • Identification of domestic violence • Family’s ability to recognize the problem • Family’s willingness to accept assistance • Removal of the victim from the situation • Long-term: • Primary prevention • Secondary prevention

  41. Spirituality • Questions and struggles • Connectedness • Trusting relationships • Self-forgiveness • Healing

  42. Roles of the Nurse • Nurses are involved in: • Individual interventions for the victim • Family assessment, and family therapy • Community awareness and education • Prevention and public policy changes

  43. Self-Awareness • Be aware of personal beliefs and feelings about rape. • Prepare to give empathetic and effective care. • Examine personal feelings about abortion.

More Related