Families in Crisis Lecture Notes PDF

Families in Crisis Lecture # 9 First 2024-2025 1  Objectives 1. Define crisis 2. Describe the main categories of crisis. 3. Describe the main categories of family violence. 4. Identify characteristics of the forms of violence. 5. Describe the "cy...

Families in Crisis Lecture # 9 First 2024-2025 1  Objectives 1. Define crisis 2. Describe the main categories of crisis. 3. Describe the main categories of family violence. 4. Identify characteristics of the forms of violence. 5. Describe the "cycle of violence" seen in spousal abuse. 6. Explain mistreatment to the elderly. 7. Describe the role of a community health nurse with families in crisis in all levels of prevention 2  Introduction Regardless of their responses, families in crisis need help, and CHNs have a unique opportunity and responsibility to provide that help Primary & secondary prevention measures used by CHNs to prevent crises include assessment of families, teaching families parenting skills and coping strategies & informing them about community resources. Tertiary prevention includes (during times of crisis) assessment and education, and assisting the family 3 Introduction: How does a crisis occur? Each of us is a dynamic system living within a given environment under circumstances unique to us alone. Our behavior, both consciously and subconsciously, is gauged to maintain a balance within ourselves and in our relations with others. When some internal or external force disrupts our system’s balance and alters its functioning, a loss of equilibrium occurs. 4 Introduction: How does a crisis occur? The individual then attempts to restore equilibrium by using whatever resources are available to him, in an effort to cope with the situation. Coping: actions and ways of thinking that assist people in dealing with and surviving difficult situations. If individuals cannot readily cope with a stressful event the person experiences a crisis. Family crisis: A stressful event(s) that comes with or without warning that disturbs the equilibrium of the family. 5 Introduction: How does a crisis occur? Crises are precipitated by a specific identifiable event that becomes too much for the usual problem- solving skills of those involved. Often, a single distressing event follows a host of previous difficulties and becomes the “straw that breaks the camel’s back.” Sometime, the events occur suddenly without previous stressors such as accidents No individual is immune from sudden overwhelming difficulties. 6 Introduction: How does a crisis occur? Often a crisis is not an event per se, but rather a person’s perception of the event as each person reacts in his own way (it is usually the individual’s interpretation of the event, rather than the event itself, that is crucial). A situation that throws one person off course may merely create an interesting detour for another 7 Introduction: How does a crisis occur? Crises are resolved, either positively (consider it a challenge=makes you stronger) or negatively (feel overwhelmed, defeated, inflict their feelings on their children, psychological damage), within a brief period, usually 4 to 8 weeks People’s strong need to regain homeostasis and the intense nature of crises contribute toward making the crisis a temporary condition that will not continue forever 8 Introduction: How does a crisis occur? Crisis resolution: Can be: A. Adaptive process (e.g. a battered wife reevaluates her life, gets divorced, learns employment skills, with stronger self-esteem, and is able to support her children financially and emotionally) in which growth and improved health occur, B. Maladaptive process resulting in illness or even death. 9  Types of Crisis 1. Developmental: Periods of disruption that occur at transition points during normal growth and development that can upset normalcy Precipitated by a life transition point (arise from physical and social changes: start school, marry, leave home, have a baby, retire, or die) Anticipated: people anticipate or prepare for the event, make changes in relationships, responsibilities, and roles (prepare: may observe others) Gradual onset Response to developmental demands and society’s expectations 10  Types of Crisis 2. Situational: a stressful, disruptive, event arising from external circumstances/events that occurs suddenly, often without warning (Not predicted, expected, or planned), to a person, family, group, or community.  Precipitated by a hazardous event (some crisis- precipitating events can be positive such as a significant job promotion or negative such as a child get burned by a cup of hot tea) that requires behavioral changes and coping mechanisms beyond the abilities of the people involved Example: having a disease, unemployment, physical abuse, divorce, unwanted pregnancy, drug abuse, sudden death of a loved one, accidents 11  Types of Crisis 3. Multiple crisis: Overlapping of different kinds of crises, compounding the stress felt by the persons involved. Example: A couple may experience a developmental crisis (birth) and a situational crisis (birth defect) simultaneously. Retirement with/ compounded by a fire that destroys the family home. 12  Family Violence  Violence (maltreatment = abuse & neglect) includes: A.Abuse: Any act or failure to act of a parent or caretaker that results in death, serious physical or emotional harm, or sexual abuse or exploitation B.Neglect: Withhold of resources (physical, emotional, or educational) necessary for healthy growth and development of a dependent person  Domestic violence, family violence, and interpersonal violence refer to morbidity and mortality attributable to violence within the home setting, involving action by a family member or intimate partner. 13  Family Violence  Truths about Family Violence: o Is common and it is a crisis for the family o Occurs across all incomes o Is a global public health problem o Abused women usually do not confront the abuser o Abused children must be protected (should be taken from their parents) o Public Laws and Protection are there. o Can occur with love and when the abuser is not under the influence of drugs or alcohol o Usually the male is the abuser:  Children and women are property 14  Divorce is a death sentence  Family violence against children, spouses, and elderly 1. Violence Against Children:  Types: 1) Physical punishment or battering 2) Mental or emotional abuse 3) Sexual exploitation, including incest 4) Neglect: physical, emotional, medical or educational needs 5) Special situations - Shaken Baby Syndrome and Munchausen’s Syndrome by Proxy 6) Others - Internet crimes, child abduction, school violence, and babysitter abuse  Violence Against Children 1. Physical Abuse: Intentional harm to a child by another person that results in pain, physical injury, or death  Indicators: o Child is frightened o Passive, overly compliant OR excessively aggressive, destructive, excessively violent. o Hide injuries o Frightened of going home o Bruises, bites, burns, fractures 2. Emotional Abuse: Occurs when parents intentionally cause a child to become emotionally disturbed, that is, via an act of commission (Verbal or verbal threats)  Indicators: antisocial; enuresis; substance abuse; depressed and withdrawn 3. Neglect: Types: a) Physical (e.g., failure to provide necessary food or shelter, or lack of good supervision) b) Medical (e.g., failure to provide necessary medical or mental health treatment)  Violence Against Children 3. Neglect: Types: c) Educational (e.g., failure to educate a child or attend to special education needs) d) Emotional: occurs when parents refuse to allow an emotionally disturbed child to receive treatment, representing an act of omission (e.g., inattention to a child’s emotional needs, failure to provide psychological care)  Indicators of neglect:  child is sleepy, hungry, and often dirty  malnourished  School absence & not doing his homework 4. Sexual Abuse: Acts of sexual assault or sexual exploitation of a minor. May consist of a single incident or many acts over a long period  May include:  Sexual exploitation  Incest: sexual abuse among members who are related by blood  Intrafamilial sexual abuse: sexual abuse among members who are NOT related by blood  Indicators: o Pain during walking or urination o Bedwetting, STD, Genital discharge/trauma o School problems  Violence Against Children 5. Special situations A: Shaken Baby Syndrome  Intentionally abusive action of violently shaking an infant or toddler: mainly < 18 months  The type of damage that occurs to these infants very seldom occurs through play Indicators (within minutes to hours after injury): 1. Subdural or subarachnoid hematomas 2. Bilateral retinal hemorrhage 3. Absence of other external signs of abuse 4. Breathing difficulties, seizures, dilated pupils, lethargy, irritability, vomiting, & unconsciousness  Violence Against Children 5. Special situations: B: Munchausen syndrome by proxy Munchausen syndrome: is a psychological disorder in which a client fabricates (may intentionally injure him/herself or induce illness) the symptoms of a disease in order to undergo medical tests, hospitalization, or medical or surgical treatment. Munchausen syndrome by proxy: a parent or caretaker attempts to bring the attention to herself by injuring or inducing illness in her child (make a child appear mentally or physically ill by either fabricating symptoms or actually causing harm to the child)  Violence Against Spouses  A leading cause of morbidity/mortality in women Adult violence is rooted in childhood violence.  Used as a tactic to maintain power and control over another.  Can be either sex but 95% are women  Pregnant women are at greater risk  Can include: physical, sexual, emotional and economic abuse The violence occurs in a cycle called cycle of violence which is a repetitive, cyclic pattern of abuse seen in domestic violence situations Violence Against Spouses: The Cycle of Violence  The cycle Phases: 1.Tension building phase: The woman senses her partner’s increasing tension (may not know what is wrong) 2.Acute battering incident phase: violence happens 3.Loving reconciliation: may begin a few hours to several days following the battering when both partners have a profound sense of relief Increases over time in frequency and severity “Learned helplessness”  The Cycle of Violence: Batterer (abuser) Characteristics  Low self-esteem  Blame the victim  Traditionalist = male supremacy  Have severe stress reaction  Jealous  Dual personality  Use violence as a problem-solving method, control mechanism, or self-esteem enhancement method  Have a history of family violence  Preoccupied with weapon 24  Violence against elderly 3. Violence against elderly or Elder Abuse Research on elder abuse is new and challenging  Adult children are the most frequent abusers (Often men, have unresolved issue/conflict with the victim) Spouses-previous batterers do not stop at age 65 Is a global public health problem Has many types  Violence against elderly  Types:  Physical: rough handling, hitting, slapping  Emotional: shout at or threaten the elderly.  Neglect: to meet their needs, unwashed, malnutrition, dehydrated  Economical: retirement money, savings, investment  Sexual  Violence against elderly  Risk Factors : 1. Invisibility - decreased contact with the community 2. Increased dependence and vulnerability 3. Impairment and isolation 4. Poverty and pathologic caregivers 5. Learned helplessness and living in a violent subculture 6. Deteriorating housing and crime-ridden neighborhoods  Other Forms of Family Violence 1. Suicide: taking action that causes one’s own death 2. Homicide: Non-war-related action taken to cause death of another person 3. Rape: is a type of sexual assault usually involves sexual intercourse or other forms of sexual penetration carried out against a person without that person's consent (or who is incapable of giving valid consent e.g. person who unconscious, has intellectual disability, or is below the legal age of consent). 28  Violence and the levels of prevention A. Primary Prevention Strategies: Holistic health promotion provides families with the skills and resources to prevent violent situations by: 1. Increase problem solving skills 2. Improve self-esteem with education to increase occupational success and parenting effectiveness 3. Identify needs with home visit assessments 4. Empower families (give them knowledge and increase the families awareness about their strengths)  Violence and the levels of prevention B. Secondary Prevention Strategies: Identifying violence cases Provide immediate intervention and services, such as medical attention, emotional support, and police involvement Utilize crisis intervention models Help clients reestablish a sense of safety and security while allowing them to ventilate their feelings and be validated Promote access to special services C. Tertiary prevention: Rehabilitation of the family (Separation, incarceration) Role of the CHN in Caring for Families in Crisis 31 32  Readings Chapter 20: Allender, J. & Spradley, B. (2014). Community Health nursing promoting and protecting health of aggregates. Philadelphia: Lippincott. 33