Families in Crisis - Lecture 9

Families in Crisis - Lecture Notes

• Lecture 9, 2024-2025

Objectives

• Define crisis
• Describe the main categories of crisis
• Describe the main categories of family violence
• Identify characteristics of the forms of violence
• Describe the "cycle of violence" in spousal abuse
• Explain mistreatment of the elderly
• Describe the role of a community health nurse in preventing and addressing family crises at all levels

Introduction

• Families in crisis require help.
• Community Health Nurses (CHNs) have a crucial role in providing this help.
• Primary and secondary prevention involves assessing families, teaching parenting/coping skills, and providing resources.
• Tertiary prevention, during a crisis, entails assessment, education, and support for families.

Introduction: How Does a Crisis Occur?

• Individuals are dynamic systems within unique environments.
• Behavior maintains balance within the individual and relationships.
• Disruption by internal or external forces disrupts balance and equilibrium resulting in a crisis.
• Individuals try to restore equilibrium using available resources and coping mechanisms. Coping mechanisms involve actions and thought processes to deal with difficult situations.
• Inability to cope effectively leads to a crisis.
• A family crisis is a stressful event disrupting family equilibrium, potentially with or without warning.
• Crises are often triggered by an identifiable event that overwhelms coping skills. This may follow a series of previous difficulties ("the straw that breaks the camel's back").
• Crises occur suddenly sometimes without prior stressors. Crises aren't universal.
• Not every event throws a person off course—it depends on how the individual perceives the event.

Crisis Resolution

• Crises can be resolved positively (gaining strength from challenges) or negatively (feeling overwhelmed, impacting children, causing psychological harm).
• Crisis resolution typically takes place within a few weeks.
• People's need to maintain homeostasis contributes to crises being temporary.
• Adaptive vs. Maladaptive: Crises are resolved either constructively (e.g., a battered wife reevaluates her life, improves self-esteem, and supports her children) or destructively (resulting in illness or death).

Types of Crisis

1. Developmental Crisis

• Disruptions at transition points during normal growth and development that upset normalcy
• Triggered by life transitions (e.g., starting school, marriage, having a baby, retirement, or death).
• Can be anticipated—families may prepare in advance.
• Generally have a gradual onset.
• Related to developmental demands and societal expectations

2. Situational Crisis

• Disruptive events arising from external circumstances, often without warning.
• Events can be positive (e.g., a significant job promotion) or negative (e.g., a child getting burned).
• Require significant behavioral changes and coping strategies beyond usual capacities.
• Examples include illness, unemployment, abuse, divorce, unwanted pregnancy, and accidents to individuals.

3. Multiple Crisis

• Overlapping crises compounding stress on involved persons.
• Examples include those simultaneously experiencing a developmental crisis (birth) and a situational crisis (birth defect).
• Another example involves retirement combined with a house fire.

Family Violence

• Includes abuse and neglect, encompassing:

  • Abuse: Any action (or inaction) by a caregiver causing harm (physical, emotional, or sexual).
  • Neglect: Withholding resources (physical, emotional, or educational) needed for healthy development.

• Common across all income levels.

• A global public health issue.

• Abused women rarely confront the abuser.

• Abused children demand protection.

• Domestic violence often involves a pattern of abuse (cycle of violence).

• Abusers are typically male although not exclusively.

• Violence is sometimes present in love relationships, even when the abuser isn't under substance influence.

• Children and women are not property.

Family Violence Against Children

• Includes physical, mental/emotional, sexual abuse, and neglect.
  • Physical punishment/battering.
  • Mental/emotional abuse.
  • Sexual exploitation (including incest).
  • Neglect (physical, emotional, medical, or educational needs).
  • Special situations: Shaken Baby Syndrome and Munchausen syndrome by proxy

Family Violence Against Spouses

• A major cause of morbidity and mortality in women.
• Rooted in childhood violence.
• Used as a control tactic.
• Can involve any gender but often perpetrated by men.
• Pregnant women are at high risk.
• Includes physical, sexual, emotional, and economic abuse.
• Characterized as a cyclical pattern called the cycle of violence with:
  • Tension-building phase: Increased tension.
  • Acute battering phase: Violence incident.
  • Loving reconciliation phase: Calm after violence.

Characteristics of Batterers (Abusers)

• Low self-esteem.
• Blame the victim (traditionalist view).
• Severe stress reaction.
• Jealous.
• Dual personality (as a coping mechanism).
• Use violence to control or enhance self-esteem.
• History of family violence.
• Preoccupation with weapons.

Violence Against the Elderly

• Research on elder abuse is still developing.
• Frequently perpetrated by adult children, often men with past conflicts.
• Spousal violence sometimes doesn't stop when one becomes elderly.
• A global public health issue. Has many types. Types of elder abuse include:
  • Physical (hitting, slapping).
  • Emotional (threatening, yelling).
  • Neglect (not meeting needs).
  • Economic (stealing money).
  • Sexual.

Risk Factors for Elder Abuse

• Invisibility (lack of community contact).
• Increased dependency.
• Impairment and isolation.
• Poverty.
• Pathologic caregiving (e.g., caregiver has mental health issues).
• Learned helplessness.
• Living in a violent community.
• Deteriorating housing/crime-ridden neighborhoods.

Other Forms of Family Violence

• Suicide: Taking action to end one's life.
• Homicide: Non-war related killing of another.
• Rape: Sexual intercourse/penetration without consent.

Violence and Prevention Levels

A. Primary Prevention

• Aim to prevent violent situations by promoting holistic health, skills, and resources to families.
• Include increasing problem-solving skills, improving self-esteem, identifying needs, empowering families, and raising awareness of their strengths through home visits and education.

B. Secondary Prevention

• Identify cases of violence.
• Provide immediate services (medical, emotional support, police involvement).
• Utilize crisis intervention models.
• Help clients rebuild safety and security, allowing them to express and validate their feelings.
• Access to/promote access to specific services.

C. Tertiary Prevention

• Rehabilitation of the family, potentially involving separated or incarcerated persons.

Prevention Matrix

• Includes primary, secondary, and tertiary levels of prevention.
• Emphasizes health promotion, education, disease prevention & crisis resolution interventions.