Chapter 18

1. Chapter 18 Child, Partner and Elder Abuse

2. Abuse • Family violence and abuse is prevalent among all ethnic, socioeconomic, age & social groups • Family abuse, trusted authority figures, spiritual abuse and caregiver abuse • Emotional abuse • Kills the spirit & ability to succeed later in life, feel deeply or make emotional contact with others • Physical abuse: Includes emotional abuse in addition to potential for long term physical deformity, internal damage ,acute painful tissue damage, bone damage and death

3. Theory • Social Learning Theory • Intergenerational violence theory: family violence relies on role modeling, identification & human interaction • Societal & Cultural Factors • Correlates that may exist when family abuse is high: poverty, unemployment, inadequate resources, overcrowding & social isolation • Psychological Factors: Focus on abuser having personality traits that cause abusiveness

4. Child abuse • Takes place when child is harmed by someone else physically, psychologically, sexually or by acts of neglect • 4 types of abuse • Cases are typically underreported • Parents account for 78.9 % of child abuse • Children < 4 yrs old greatest risk

5. Application of nursing process • Assessment • Child: the abused child is excessively fearful of parent or caregiver • Parent or caregiver: vary by degrees of intelligence, education, socioeconomic backgrounds & religious affiliations • Diagnosis & Outcomes Identification • Ensures child’s safety & well being • Implementation: when child abuse is suspected nurses are legally responsible to report • Followup • Primary Prevention: 40 % child abuse cases linked to substance abuse

6. Intimate partner violence • Defined as current or former emotional, psychological, physical or sexual abuse between current or former partners of intimate relationship • Abusive relationship is about instilling fear & wanting to have power & control • Characteristics of IPV • The Battered Partner: lives in fear of next beating • The Batterer: violence is learned behavior, low sense of self, poor impulse control • Cycle of Violence • Process that increases in intensity & escalates • Why abused partners stayed • Fear of increased violence or danger to children

7. Application of nursing process • Assessment • 3 questions reveal current or previous IPV • Have you been hit, kicked, punched or hurt by someone within the past yr? If yes, who? • Do you feel safe in your current relationship? • Is there a partner from previous relationship who is making you feel uncomfortable? • Diagnosis & Outcomes Identification • Situational crisis that threatens a woman's physical & psychological health, her life and her children's lives • Women treatment in ER may admit to IPV but seldom come for treatment • Safe environment: safe house, safety plan, hotlines, support groups • Implementation: It is not her fault, does not deserve to be beaten, cannot make anyone hurt you

8. Elder abuse • Serious & rapidly growing problem • 1 out of 20 elderly abused yearly • Adult Protective Services: investigates suspected elder abuse • Characteristics of elder abuse • The abused elder: 80+ yrs 2-3x more likely to be abused • The abuser: caretaker stress and burden causative factor

9. Application of nursing process • Assessment Health care workers mandated to report elder abuse • 2x as many MD & clinic visits • Bedsores, begging for food, malnutrition, in need of medical or dental care, fear of being alone with caregiver • Diagnosis & Outcomes Identification • Neglect & financial exploitation • Implementation • Interventions include medical, legal and social services • Evaluation: Failures are related to social, economical & political systems