Chapter12-Abuse & Violence (1).pptx

Chapter 12 Abuse and Violence Clinical Picture of Abuse and Violence Abuse: wrongful use and maltreatment of another Perpetrator typically someone the victim knows Victims across life span: spouses, partners, Children-especially feel guilt and shame, miss school, problems as adults, low self-esteem...

Chapter 12 Abuse and Violence Clinical Picture of Abuse and Violence Abuse: wrongful use and maltreatment of another Perpetrator typically someone the victim knows Victims across life span: spouses, partners, Children-especially feel guilt and shame, miss school, problems as adults, low self-esteem elderly parentsTypes of injuries Physical Psychological Effect on survivors Difficulty trusting others (authority figures) In relationships, emotional reactions are intense, erratic, and unpredictable Intimate relationships may trigger extreme emotional responses Copyright © 2023 Wolters Kluwer All Rights Reserved Characteristics of Violent Families Family Family violence: violence: spouse spouse battering; battering; neglect neglect and and physical, physical, emotional, emotional, or or sexual sexual abuse abuse of of children; children; elder elder abuse; abuse; marital marital rape rape Common Common characteristics characteristics Social isolation Do not invite others to home Abuse of power and control Physical, economic, social control Alcohol and other drug abuse Esp. alcoholism associated with family violence (diminishes inhibitions and make violent behavior more intense or frequent) Date rape drugs Intergenerational transmission process Patterns of violence are perpetrated from one generation to another Violence is a learned trait from parent to child However this single factor does not explain violent behavior-not all children become abusive if they grew up in a violent home Copyright © 2023 Wolters Kluwer All Rights Reserved Cultural Considerations Domestic violence spanning families of all ages and from all ethnic, racial, religious, socioeconomic, national, and sexual orientation backgrounds Battered immigrant women at particular risk o Face legal, social, and economic problems different from the U.S. citizens Copyright © 2023 Wolters Kluwer All Rights Reserved Intimate Partner Violence #1 Mistreatment or misuse of one person by another in context of emotionally intimate relationship Psychological abuse (emotional abuse) can be overt or subtle. Physical abuse: shoving, pushing, battering, choking Increased rates during pregnancy Rates higher among women Partner’s jealousy, insecurity and lessen physical and emotional availability Sexual: assaults during sexual relations, rape Domestic violence occurs in same-sex relationships with same statistical frequency. Victims have fewer protections. Seven states exclude same-sex victims Copyright © 2023 Wolters Kluwer All Rights Reserved Intimate Partner Violence #2 Clinical picture o Abuse often perpetrated by husband against wife o Abuser’s view of wife as belonging to him; strong feelings of inadequacy, low self-esteem; poor problem-solving and social skills o Increasing violence, abuse with any signs of independence o Dependency trait most commonly found in abused women who stay with their husbands Copyright © 2023 Wolters Kluwer All Rights Reserved Intimate Partner Violence #3  Cycle of abuse and violence o Violent episode → honeymoon period → tension-building phase → violent episode  Often cited as reason women have difficulty leaving relationship Copyright © 2023 Wolters Kluwer All Rights Reserved Intimate Partner Violence #4 Victims do not commonly seek direct help for abuse. Some may be seeking treatment for other conditions. Assessment Ask all clients if they feel safe (not just those who are “likely victim”) Ask questions about safety (see Box 12.2) Nurse is not expected to deal with the problem alone Can make referrals to appropriate professionals Nurse must be supportive and caring throughout Stress/Safety Afraid/Abused Friend/Family Emergency plan Copyright © 2023 Wolters Kluwer All Rights Reserved Intimate Partner Violence #5 Treatment and interventions o Laws related to domestic violence; arrest  Abuser can retaliate making it more difficult for womrn to call police o Restraining order/protection order  Limited protection o Recognition of stalking o Shelters  Crowded, waiting lists o Individual psychotherapy/counseling, group therapy, support and self-help groups o Treatment for posttraumatic stress disorder Copyright © 2023 Wolters Kluwer All Rights Reserved (PTSD) Child Abuse #1 Intentional injury of a child o Physical abuse or injuries o Neglect or failure to prevent harm o Failure to provide adequate physical or emotional care or supervision o Abandonment o Sexual assault or intrusion o Overt torture or maiming (permanent damage) Copyright © 2023 Wolters Kluwer All Rights Reserved Child Abuse #2 Clinical picture of parents o Minimal parenting knowledge and skills o Emotionally immature, needy, incapable of meeting own needs o Frequently view children as property o Cycle of family violence: adults raising children in same way they were raised  Adults who were victims of abuse frequently abuse their own children. Copyright © 2023 Wolters Kluwer All Rights Reserved Child Abuse #3 Detection and accurate identification are the first steps (see Box 12.3). Report suspected child abuse (mandatory reporting laws) Nurse does not have to decide with certainty that abuse occurred. Nurse should not pursue investigation with the child (may do more harm) Treatment and intervention Child’s safety and well-being is a priority. Removing child from home Psychiatric evaluation Therapy may be indicated over significant period. Approach depends on the age of a child. Social services involvement Family therapy/requirements for parents Copyright © 2023 Wolters Kluwer All Rights Reserved Elder Abuse #1  Maltreatment of older adults o Physical, sexual, psychological abuse o Neglect or self-neglect o Financial exploitation o Denial of adequate medical treatment  An estimated 10% of population over age 65 are abused by caregivers. Copyright © 2023 Wolters Kluwer All Rights Reserved Elder Abuse #2 People who abuse older adults are almost always in caretaker role or older adults depend on them in some way. Most cases involve one older spouse taking care of another Bullying between residents in senior living facilities Older adults often reluctant to report abuse Want to protect family members Fear losing support Clinical picture: variable depending on the type of abuse Copyright © 2023 Wolters Kluwer All Rights Reserved Elder Abuse #3 Assessment (possible indicators, see Box 12.4) o Physical, psychosocial, material abuse, neglect, etc Treatment and intervention o Caregiver stress relief (not always intentional)  Respite care o Additional resources o Possible removal of older adult or caregiver when abuse is intentional Copyright © 2023 Wolters Kluwer All Rights Reserved Rape and Sexual Assault #1 Perpetration of act of sexual intercourse with person against their will and without consent o Will overcome by force, fear of force, drugs, intoxicants Crime of violence and humiliation of victim expressed through sexual means Also rape if victim cannot exercise rational judgment o Intoxication and can’t provide consent or lack of judgement o Younger than age of consent Only slight penetration necessary o Full erection or ejaculation not necessary Copyright © 2023 Wolters Kluwer All Rights Reserved Rape and Sexual Assault #2 Committed by strangers (only 26%), acquaintances, married people, people of same sex Date rape (acquaintance rape) o More common around Universities o More common with increased consumption of alcohol Highly underreported crime o Less than 50% o Feeling of chame and guilt o Feeling of no recourse in the legal system Most commonly occurs in victim’s Copyright © 2023 Wolters Kluwer All Rights Reservedneighborhood, Rape and Sexual Assault #3  Most rapes are premeditated.  Male rape is significantly underacknowledged and underreported. o More common in jail institutions and high security hospitals o Particularly violent Categories of Male rapists o Power Assertive Rapists  Desires to control and dominate victim o Anger Retaliation Rapist  Wants to punish victims, hates women o Power Reassurance or Opportunity Rapist  Commits rape when opportunity presents itself, lonely, low self-esteem o Anger Excitement or Sadistic Rapist  Wants to hurt victim, often kill them, acts out fantasies Copyright © 2023 Wolters Kluwer All Rights Reserved Rape and Sexual Assault #4 Dynamics of rape o Generally accepted that rape is not sexual crime  Exertion of power, control, infliction of pain, or punishment o Feminist theory: women historically objects of aggression  Women and children were men’s property in past  Until 1982, 1st man convicted of raping wife o Primary motivation of victim is to stay alive. o Severe physical and psychological trauma Copyright © 2023 Wolters Kluwer All Rights Reserved Rape and Sexual Assault #5 Assessment o Physical examination to preserve evidence o Description of what happened o Rape kits, rape protocols Treatment and intervention o Immediate support o Education (see Box 12.6) o Give control back to victim o Prophylactic treatment for sexually transmitted diseases, pregnancy Copyright © 2023 Wolters Kluwer All Rights Reserved Community Violence School violence (homicides, shootings) Bullying (worse now with internet) o Ostracism (ignoring/excluding an individual) Hazing Effects on children, young adults Violence on a larger scale (e.g., terrorism) o PTSD and depression Copyright © 2023 Wolters Kluwer All Rights Reserved Self-Awareness Issues Be aware of own beliefs. Contain feelings of horror or revulsion; focus on client’s needs. o Validate the client’s feelings. Ask all women about abuse. Help client focus on the present. Copyright © 2023 Wolters Kluwer All Rights Reserved