Podcast
Questions and Answers
Which behavioral characteristic is NOT commonly associated with child and adolescent victims of sexual abuse?
Which behavioral characteristic is NOT commonly associated with child and adolescent victims of sexual abuse?
Which of the following is a long-term mental health issue linked to ACEs (Adverse Childhood Experiences)?
Which of the following is a long-term mental health issue linked to ACEs (Adverse Childhood Experiences)?
What physical sign is commonly associated with abuse or neglect in elderly victims?
What physical sign is commonly associated with abuse or neglect in elderly victims?
Elderly victims of abuse may exhibit which type of behavior that reflects their situation?
Elderly victims of abuse may exhibit which type of behavior that reflects their situation?
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Which of the following statements about psychological characteristics of child victims is accurate?
Which of the following statements about psychological characteristics of child victims is accurate?
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What is a common misconception regarding sexual assault?
What is a common misconception regarding sexual assault?
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Which of the following is NOT a potential indicator of abuse in elderly individuals?
Which of the following is NOT a potential indicator of abuse in elderly individuals?
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Which emotional response is likely to be seen in elderly victims of abuse?
Which emotional response is likely to be seen in elderly victims of abuse?
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Which of the following is NOT a common characteristic of victims of abuse?
Which of the following is NOT a common characteristic of victims of abuse?
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What is a key psychological effect of abuse on victims?
What is a key psychological effect of abuse on victims?
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Which nursing diagnosis is most appropriate for a victim of intimate partner abuse?
Which nursing diagnosis is most appropriate for a victim of intimate partner abuse?
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What is one of the primary roles of nursing in dealing with victims of abuse?
What is one of the primary roles of nursing in dealing with victims of abuse?
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Which resource is specifically designed for sexual assault victims?
Which resource is specifically designed for sexual assault victims?
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Which of the following situations would most likely require immediate advocacy intervention by nursing staff?
Which of the following situations would most likely require immediate advocacy intervention by nursing staff?
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In the context of nursing advocacy, which ethical dilemma is commonly faced?
In the context of nursing advocacy, which ethical dilemma is commonly faced?
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What can be considered a physical effect of assaultive behaviors on victims?
What can be considered a physical effect of assaultive behaviors on victims?
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What age range is most commonly associated with perpetrators of stranger rape?
What age range is most commonly associated with perpetrators of stranger rape?
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Which response type is characterized by calmness and subdued affect following a rape incident?
Which response type is characterized by calmness and subdued affect following a rape incident?
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What phase of rape-trauma syndrome does 'social withdrawal' primarily occur?
What phase of rape-trauma syndrome does 'social withdrawal' primarily occur?
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Which of the following is NOT a nursing diagnosis for sexual assault as mentioned?
Which of the following is NOT a nursing diagnosis for sexual assault as mentioned?
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Which of the following behaviors may indicate a patient's history of trauma?
Which of the following behaviors may indicate a patient's history of trauma?
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What form of rape was made illegal in all states by 1993?
What form of rape was made illegal in all states by 1993?
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What is a key priority in the medical intervention for victims of trauma?
What is a key priority in the medical intervention for victims of trauma?
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What is the primary goal of trauma-informed care for survivors of abuse?
What is the primary goal of trauma-informed care for survivors of abuse?
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Which of the following types of evidence is classified as 'trace' evidence?
Which of the following types of evidence is classified as 'trace' evidence?
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Which demographic is typically targeted in acquaintance rape scenarios?
Which demographic is typically targeted in acquaintance rape scenarios?
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What must a nurse do when documenting wounds from undiagnosed trauma?
What must a nurse do when documenting wounds from undiagnosed trauma?
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What type of response involves a victim telling no one about the assault?
What type of response involves a victim telling no one about the assault?
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Which duty do nurses have in relation to suspected cases of abuse?
Which duty do nurses have in relation to suspected cases of abuse?
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Which of the following is a common emotional reaction immediately following a rape incident?
Which of the following is a common emotional reaction immediately following a rape incident?
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What percentage of stranger rapists reportedly use weapons during the crime?
What percentage of stranger rapists reportedly use weapons during the crime?
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Which intervention is appropriate for preserving evidence in a trauma case?
Which intervention is appropriate for preserving evidence in a trauma case?
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What is one consequence of ignoring or minimizing a patient's trauma?
What is one consequence of ignoring or minimizing a patient's trauma?
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Which of the following factors is NOT essential to assess during the evaluation of a trauma patient?
Which of the following factors is NOT essential to assess during the evaluation of a trauma patient?
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Which nursing diagnosis is NOT applicable for the victim/survivor?
Which nursing diagnosis is NOT applicable for the victim/survivor?
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What is a key goal in the planning phase for the abuser?
What is a key goal in the planning phase for the abuser?
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What is the most critical aspect of safety implementation?
What is the most critical aspect of safety implementation?
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Which of the following outcomes is NOT part of evaluation for the victim?
Which of the following outcomes is NOT part of evaluation for the victim?
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In the context of the abuser, what does 'altered role performance' suggest?
In the context of the abuser, what does 'altered role performance' suggest?
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Which option best describes a primary goal during the implementation phase?
Which option best describes a primary goal during the implementation phase?
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What factor is most likely to indicate improvement in the victim's situation?
What factor is most likely to indicate improvement in the victim's situation?
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Which nursing diagnosis reflects a common issue for the abuser?
Which nursing diagnosis reflects a common issue for the abuser?
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Study Notes
Violence & Advocacy
- It is important to be aware of the potentially triggering nature of this topic.
- Students are encouraged to leave the discussion if they feel uncomfortable.
- Resources are provided for students who may need support during or after the discussion.
- The learning outcomes for this topic are to:
- Examine common characteristics of victims and victimizers.
- Describe physical and psychological effects of abuse and assaultive behaviors on victims.
- Identify nursing diagnoses, goals of care, and interventions for victims and victimizers of abuse and assault.
- Examine resources for victims of abuse and assault.
- Evaluate the effectiveness of intervention strategies.
- Explore nursing advocacy and ethical dilemmas related to violence and assault.
- The required readings are from Townsend (10th edition) Chapter 15: Anger & Aggression Management and Perry (7th edition) Chapter 33: Child Maltreatment (pages 900-907), Chapter 34: Survivors of Abuse or Neglect.
- The topics covered are assault, sexual abuse, rape-trauma syndrome, intimate partner abuse, elder abuse, child abuse, and advocacy
Resources
- CFCC Counseling Office is available at 910-362-7017
- The Suicide Lifeline is 1-800-273-8255
- Crisis Text Line can be reached by texting HOME to 741741
- Domestic Violence Shelter & Services, Inc. is located at 2901 Market St., WIlmington, NC 28401 and has a phone number of 910-343-0703
- The National Domestic Violence Hotline is 800-799-7233 or 800-787-3224 (TTY)
- Rape Crisis Center of Coastal Horizons Center, Inc. is 910-392-7460 (New Hanover) or 910-754-7949
- The Rape, Abuse, & Incest National Network number is 800-656-HOPE (4673).
Anger vs. Aggression
- It can be difficult to discern between anger and aggression for medical professionals.
Characteristics of Child and Adolescent Victims: Physical, Emotional, and Sexual
- Physical and Emotional: Fearful of caregiver, developmental delays, may not cry when approached by examiner or during painful procedure, poor academic performance, acts overly adult or infantile, self-injury/suicidal thoughts, runs away, drugs & ETOH.
- Sexual: Unusual interest or avoidance of all things of a sexual nature, sleep problems, nightmares, unusual sexual knowledge for age, say their bodies are dirty or damaged, fear of something being wrong with their genitals, aspects of molestation in drawings, games, or fantasies.
Behavioral and Psychological Characteristics of Child And Adolescent Victims: ACEs (Adverse Childhood Experiences)
- The existence of ACEs increases the risk of physical and mental health issues in children and adolescents.
- Long-term issues can include:
- Depression
- Eating Disorders
- Anxiety
- Hypersexuality
- Suicidal Ideations
- Borderline Personality Disorder
- PTSD
Physical Signs of Abuse & Neglect in the Elderly
- Malnourishment
- Dehydration
- Fecal or urine smell on the person
- Dirt, fleas or lice on the person
- Pressure ulcers, sores, skin rashes
- Bruises, abrasions, fractures, hematomas, or grip marks on arms - Multiple injuries in various stages of healing
- May lack needed items: medications, glasses, hearing aids, etc.
Behavioral & Psychological Characteristics in Elderly Victims
- May have a physical or mental impairment.
- May exhibit aggressive or very submissive behavior.
- May fear reporting abuse
- May be dependent on a caregiver.
- May make excuses for the perpetrator.
- May have low self-esteem
- May experience hopelessness
- May have financial issues.
Sexual Assault
- Sexual assault is any type of sexual act in which an individual is coerced or forced to submit against his or her will.
- Rape is an act of aggression and not an act of passion.
Stranger Rape Profiles
- Perpetrator characteristics: Ages 25-44, 54% Caucasian, 32% African-American, married/cohabiting, 62% use weapons.
- Victim characteristics: Ages 16-34, Single women, Close to home, Not chosen for any reason, “Just there”.
- Perpetrators often terrorize the victim but do not cause injury.
Acquaintance Rape/"Date Rape"
- The rapist is acquainted with the victim: first date, dating for months, just friends.
- Common on college campuses.
- Many cases go unreported.
Marital Rape-
- Illegal in all states as of 1993.
- Many states still have some form of exemption for husbands.
Rape vs. Statutory Rape
- Statutory rape—sexual intercourse with someone underage (this is a legal term that applies to age of consent laws.
- Rape—non-consensual sexual acts with someone of any age.
Manifestation of Rape
-
Initial Emotional Reaction: (occurs within hours after rape)
- Expressed response: crying, sobbing, restlessness, tension
- Controlled response: calm, composed, subdued affect.
-
Long-Term Reactions:
- Compounded reaction: additional symptoms emerge like depression, suicide, substance abuse, psychotic behaviors
- Silent Rape Reaction: victim tells no one of the assault
Rape Trauma Syndrome
- Major Symptoms
- Re-experiencing the trauma
- Social withdrawal
- Avoidance of behaviors and actions
- Increased physiological arousal characteristics
- Phases
- Acute: Initial response
- Outward Adjustment: Outwardly appears normal
- Underground: Suppressing but not fully processing the trauma
- Reorganization: Beginning to deal with the trauma
- Renormalization: Adjusting to life after trauma
Nursing Diagnoses for Sexual Assault
-
Victim/Surviror
- Powerlessness
- Risk for delayed development
- Rape-trauma syndrome
- Ineffective coping
- Interrupted family processes
- Hopelessness
- Risk for self abuse
- Pain
- Post-trauma response
- Low self esteem
- Impaired skin integrity
-
Abuser
- Ineffective individual coping
- Knowledge deficit
- Noncompliance
- Altered role performance
- Self-esteem disturbance
- Impaired social interaction
- Risk for violence
- Spiritual distress
- Risk for trauma
Nursing Care for Sexual Assault
- Provide privacy.
- Create a non-judgmental relationship.
- Allow the patient to have a sense of control: For example, they may only want a female nurse.
- Care Plans for Survivors of Abuse p. 777-779
Interviewing the Sexual Assault Patient
- The interview should direct care and guide evidence collection.
- It should be completed at the beginning of the visit with law enforcement.
- Patient comfort should be a priority.
- The patient should be fully dressed if possible.
- A support person should be at the bedside.
- The interview should include:
- Medical history
- Allergies
- LMP
- Recent consensual intercourse
- Barriers used
- Emotional responses
- Medical history
- Prior experiences
Trauma-Informed Care
- The foundation of all treatment modalities for survivors of abuse or neglect.
- Requires universal screening because anyone can be a victim.
- Trauma recovery is an essential aspect of overall care.
- Ignoring or minimizing trauma can lead to revictimization and retraumatization.
Nursing Process: Assessment
- Assess physical, psychological, and behavioral characteristics.
- Determine if there is evidence of conflict between the patient and significant others.
- Interview in private.
- Look for inconsistencies between injuries and explanation.
- Note any proneness to injuries.
- Note any delay in seeking treatment.
- Assess history of abuse or substance abuse.
- Assess for stress in the family unit.
- Complete a cultural assessment.
- The RN needs to be aware of non-verbal signs of tension escalation.
Mandated Reporting
- Nurses have a legal obligation to report their findings according to state laws.
- Mandated reports:
- Child Abuse and Neglect
- Elder Abuse & Neglect
- Abuse or Neglect of a dependent individual
- Reporters are immune from civil or criminal repercussions when acting in good faith.
Nursing Preservation of Evidence
- The priority intervention is medical stabilization.
- Crime-related evidence is essential and must be safeguarded in a manner consistent with the investigation.
- Common types of evidence:
- Clothing, bullets, gunshot powder on skin
- Bloodstains
- Hairs, fibers, grass
- Other debris found on the individual: glass fragments, paint, wood.
- Clothing removed from a victim should never be placed in plastic bags.
- Clothing should not be shaken.
- Wounds must be examined.
- Clothing must be checked for evidence.
- Each separate item of clothing should be carefully placed in a paper bag, sealed, dated, timed, and signed.
- When trauma is sexual assault, a SANE may be called to the ER.
- Treatment and evaluation of STIs must be completed promptly.
- Pregnancy risk evaluation and prevention information should be provided.
- Crisis intervention and arrangements for follow-up counseling must be arranged.
Types of Evidence
- Physical: Evidence that comes directly from the body.
- Transient: Evidence that is not permanent: bruising, scratches, bites, saliva, semen.
- Touchable: Evidence that is found on the body: clothing, jewelry, etc.
- Trace: Evidence that is microscopic: hairs, fibers, paint chips, etc.
Investigation of Wounds
- When clients present in the ED with undiagnosed trauma, a clinical forensic nurse specialist should make a detailed documentation of injuries.
- Failure to do so could interfere with the administration of justice should legal implications later arise.
Nursing Diagnoses
- For the Victim/Survivor:*
- Anxiety
- Ineffective individual coping
- Ineffective denial
- Fear
- Altered Growth & Development
- Hopelessness
- Risk for injury
- Pain
- Post-trauma response
- Rape-trauma syndrome
- Low self-esteem
- Impaired skin integrity
- Risk for trauma.
- For the Abuser:*
- Ineffective individual coping
- Knowledge deficit
- Noncompliance
- Altered role performance
- Self-esteem disturbance
- Impaired social interaction
- Risk for violence
- Spiritual distress.
Planning
- The patient will maintain a safe home environment.
- The patient will receive treatment for injuries.
- The family will remain free from violence.
- The family will accept assistance and follow through with referrals.
- The abuser will establish and maintain impulse control and coping strategies.
- The abuser will cooperate with recommended/court-ordered treatment programs.
- The abuser will refrain from violence against others.
Implementation
- Safety must be provided by separating the victim from the perpetrator.
- Assist the patient in developing an escape plan if needed.
- Report to law enforcement as required.
- Follow guidelines for collection and preservation of evidence.
- Ensure sensitive, compassionate care.
- Thorough documentation is crucial.
- Collaborate with the team for interagency referrals.
- Assist with locating therapy and other resources.
- As the RN: Always be near an exit.
Evaluation
- Safety maintained
- Victim demonstrates self-empowerment and improved self-esteem
- Utilizing community resources to improve coping
- Abuser accepts responsibility for violent behavior
- Abuser refrains from violence against others.
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Description
This quiz explores the critical topic of violence and advocacy in the nursing field. Students will examine characteristics of victims and victimizers, the effects of abuse, and nursing interventions. The focus is on understanding ethical dilemmas and resources available for those affected by violence.
