Violence & Advocacy STUDENT VERSION PDF

Violence & Advocacy 1 Jessica Grinnell, MSN, RN, CEN [email protected]  Learning Outcomes 1 Examine common characteristics of victims and victimizers. Describe physical and psychological effects of abuse and 2 assaultive behaviors on victims. Identify n...

Violence & Advocacy 1 Jessica Grinnell, MSN, RN, CEN [email protected]  Learning Outcomes 1 Examine common characteristics of victims and victimizers. Describe physical and psychological effects of abuse and 2 assaultive behaviors on victims. Identify nursing diagnoses, goals of care, and interventions 3 for victims and victimizers of abuse and assault. 4 Examine resources for victims 2 of abuse and assault. 5 Evaluate the effectiveness of intervention strategies. Explore nursing advocacy and ethical dilemmas related to 6 violence and assault.  Pre-Class Readings Townsend Perry (10th 3 (7th edition) edition) Chapter 15: Anger & Chapter 33: Child Maltreatment Aggression Management (pages 900-907) Chapter 34: Survivors of Abuse or Neglect  The topics we will be covering today may be triggering. You may have experiences with traumatic personal events related to these topics and this discussion may bring up some strong emotions. If you need to step out during the discussion, feel free. Please do so quietly. I have attached some resources if you need to reach out. Please email me if you need access to resources that are not listed on the 4 next slide. IF YOU ARE LIVING IN AN UNSAFE SITUATION, PLEASE REACH OUT FOR HELP!  List of Topics Assault Sexual Abuse Rape-Trauma Syndrome Intimate Partner Abuse 5 Elder Abuse Child Abuse Advocacy  Resource CFCC Counseling s Office: 910-362-7017 If you prefer something outside of the school, here are some additional resources: The Suicide Lifeline 1-800-273-8255 Crisis Text Line Text HOME to 741741 Domestic Violence Shelter & Services, Inc. 2901 Market St., WIlmington, NC 28401 910-343-0703 National Domestic Violence Hotline6 800-799-7233 or 800-787-3224 (TTY) Rape Crisis Center of Coastal Horizons Center, Inc. 910-392-7460 (New Hanover) 910-754-7949 Rape, Abuse, & Incest National Network 800-656-HOPE (4673) *Live Help for sexual assault victims and their family/friends. Free. Confidential. Secure.  Anger Vs Aggression. A negative way to Normal, healthy emotion Response to hurt, express anger Threatening or injurious frustration 7 Results in physiological behavior arousal Goal is to inflict punishment or pain  Predisposing Factors to Aggression Modeling ⚬ One of the strongest forms of learning ⚬ Children model behaviors of caregivers. Operant Conditioning ⚬ Positive and negative reinforcement influencing behavior. Neurophysiological 8 ⚬ Disorders affecting the brain. Socioeconomic ⚬ Poverty, stress within families. Environmental ⚬ High-risk neighborhoods, peer influence.  Influential Factors for Violence Psychodynamic Theories Social Learning People are instinctively Peers aggressive High risk groups for violence When basic needs are not met, aggression ensues Sociological Theory Cultural norms Neurobiological Theory 9 Family norms Neurochemical imbalance Head injury Psychosocial Issues Seizure disorders Stress Malnutrition Isolation Brain lesions/tumors Substance abuse  Risk Factors for Violence Age Culture Socioeconomic Factors ⚬ Families ⚬ Neighborhoods ⚬ Schools ⚬ Value/Beliefs 10 ⚬ Substance Abuse ⚬ Community Services  Assault An intentional act by one person that creates an apprehension in another of an imminent harmful or offensive contract. May be an act of violence by physical force. Excludes unintentional acts of violence. 11 Aggravated assault involves a weapon. Extreme forms of assault result in homicide.  Types of Abuse Intimate Child Elder Sexual Partner Abuse Abuse Assault Spouse abuse Physical Financial Rape Statutory Marital Domestic violence Emotional Physical Date Husband/wife Sexual 12 Psychological/ battering Verbal Neglect Neglect Sexual Intimate Partner Violence (IPV) Spousal abuse Domestic violence Battering Statistics for IPV (CDC, 2020) ⚬ 1 in 5 women have been 13 victims ⚬ 1 in 7 men have been victims  Profile of the Victim Rationalizes abuse Fears leaving due to threats Views relationships as male dominant Isolates from friends & family Feelings of inadequacy/self-blame Acts so as not to provoke partner Feelings of powerlessness ETOH/Drugs 14 Depression & Suicidal thoughts Anxiety Nightmares Profile of the Abuser (Victimizer) Frequently was abused as a child Low self-esteem Extremely jealous & possessive Socially isolated Poor impulse control Poor coping measures 15 ⚬ Drug or ETOH abuse Rigid & obsessive regarding retaining control Narcissitic  Cycle of Battering Tension-Building Phase Lasts week, months, or years Minor battering may occur Tension-Building Phase Jealousy & possessiveness mount Acute Battering Phase g r in Ho Pha Ph tte ne se Most violent (loses control) e ym Ba as Lasts up to 24 hours oo e 16 ut n Ac Honeymoon Phase Batterer is contrite, loving Victim wants to believe in partner Physical Signs of Battered Women Injuries on the head, neck, & shoulders Black eyes Injuries during pregnancy Sprains, dislocations or broken bones Object pattern left on body Repeated ER/healthcare facility visits 17 Multiple injuries in various stages of healing Traumatic Brain Injury Why Do They Stay? Fear of retaliation Fear of losing custody of children Physical/Financial dependence Lack of support network Cultural/Religious beliefs Hopefulness 18 Lack of attention to danger  Nursing Interventions Immediate safety measures Address physical injuries Ensure privacy Allow to verbalize feelings Teach coping skills 19 Provide referrals/resources HOW DO WE ASK ABOUT VIOLENCE IN THE  Safe Houses/Shelters Can provide various services: Shelter Peer support Therapy Financial assistance Help obtaining social services Childcare 20 Legal help Length of stay varies Child Abuse Physical Non-accidental physical injury Emotional/Psychological Belittling Ignoring Blaming 21 Sexual Child used for sexual pleasure by an adult Neglect Failure to provide physical or emotional needs of Child Abuse Profile of Child Abuser Suffered abuse as child Expects child to fulfill their emotional needs Prone to depression Frequent outbursts of anger/rage Low frustration tolerance 22 Substance abuse common Poor knowledge of child development Poor impulse control  Physical Signs of Abuse in Children & Physical Adolescence Sexual Wounds or bruising in various stages Bedwetting or nightmares of healing Red/swollen labia & rectum Cigarette burns STI’s Burns to hands (stove) or body (hot Chronic UTI’s water) Pregnancy Sprains, dislocations, fractures Hyperactive gag reflex Internal injuries ⚬ Shaken baby syndrome 23 Neglect Unclean Hungry Inappropriate clothing for weather Lacking medical/emotional attention  Father-Daughter Profile of Father Incest Domineering Physically abusive Fears exposure Victimized oldest 24 Profile of Mother Passive, submissive Competitive/caring Denial of incest  Adult Survivor of Incest Common Characterisitcs: Lack of trust Low self-esteem Poor sense of identity Feelings of guilt Sexual dysfunction 25 Depression; anxiety Search for intimacy Abusive adult relationships  Medical Child Abuse May be parent with Munchausen by Proxy ⚬ Now referred to as “factitious disorder” May be a parent withholding medical care for an illness ⚬ Can be due to religion, personal belief systems, etc. 26 These can be complicated situations for medical providers to handle ethically  Behavioral & Psychological Characteristics of Child & Adolescent Physical/Emotional/ Victims Sexual: Psychological: Unusual interest or avoidance of Fearful of caregiver all things of a sexual nature Developmental delays Sleep problems, nightmares May not cry when approached by Unusual sexual knowledge for examiner or during painful age procedure 27 Say their bodies are dirty or Poor academic performance damaged Acts overly adult OR infantile Fear of something being wrong Self-injury/suicidal thoughs w/their genitals Runs away Aspects of molestation in Drugs & ETOH drawings, games or fantasies  Behavioral & Psychological Characteristics of Child & Adolescent ACEs (Adverse Childhood Victims Experiences) increase risk for physical & mental health issues Long Term Issues: ⚬ Depression ⚬ Eating Disorders ⚬ Anxiety 28 ⚬ 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 29 Multiple injuries in various stages of healing May lack needed items: ⚬ Medications, glasses, hearing aids, etc.  Behavioral & Psychological Characteristics in Elderly Victims May have physical or mental impairment Aggressive or very submissive behavior Fearful of reporting abuse Dependent on caregiver 30 May make excuses for the perpetrator Low self-esteem Hopelessness Financial issues  Sexual Assault 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, 31 Not one of passion  Stranger Rape Profiles Perpetrator Victim Ages 25-44 Ages 16-34 54% Caucasian Single women 32% African-American Close to home Married/cohabiting Not chosen for any reason 62% use weapons “Just there” ⚬ Want to terrorize the victim, 32 but not really cause injury.  Acquaintance Rape AKA “Date The rapist is acquantied with theRape” victim ⚬ First date ⚬ Dating for months ⚬ Just friends Many on college campuses Many go unreported 33 Marital Rape Illegal in all states as of 1993 Many states still 34 have some form of exemption for husbands Rape vs. Statutory Rape 35  Manifestation of Rape Initial Emotional Reaction: Long Term Reactions: (occurs within hours after rape) Compounded Reaction Expressed Response ⚬ Additional symptoms emerge ⚬ Crying ￭ Depression ⚬ Sobbing ￭ Suicide ⚬ Restlessness ￭ Substance Abuse ⚬ Tension 36 ￭ Psychotic Behaviors Controlled Response Silent Rape Reaction ⚬ Calm ⚬ Victim tells no one of the assault ⚬ Composed ⚬ Subdued affect  Rape-Trauma Syndrome Major Symptoms Phases Re-experiencing the trauma Acute Social Withdrawal Outward Adjustment Avoidance of behaviors and Underground 37 actions Reorganization Increased physiological Renormalization arousal characteristics Nursing Diagnoses for Sexual Assault Powerlessness Risk for delayed development Rape-trauma syndrome Ineffective coping Interrupted family processes 38 Hopelessness Risk for self abuse  Nursing Care for Sexual Assault Provide privacy Create a non-judgmental relationship Allow the patient to have a sense of control ⚬ EX: they may only want a female nurse 39 Care Plans for Survivors of Abuse - p. 777-779  Interviewing the Sexual Assault Patient Interviewing directs care Should include: Medical History Guides evidence collection ⚬ Allergies ⚬ LMP Should be completed at beginning of ⚬ Recent consensual intercourse visit with law enforcement 40 Barriers Patient comfort should be priority Emotional response Fully dressed if possible Medical History Support person at bedside Prior experiences  Trauma-Informed Care The foundation to all treatment modalities for survivors of abuse or neglect. Requires universal screening ⚬ Anyone can be a victim Trauma recovery = essential aspect of overall care By ignoring or minimizing trauma, we can add to that trauma 41 ⚬ Revictimization ⚬ Retraumatization 42 The Nursing Process 43  Assessment Assess physical, psychological, & behavioral characteristics Do interactions between patient and significant other indicate conflict? Interview in private Inconsistencies between injuries & explanation Prone to injuries Delay in seeking treatment History of abuse or substance abuse 44 Stress in family Cultural assessment As the RN: Be aware of non-verbal signs of tension escalation  Mandated Reporting Nurses have a legal obligation to report their findings in accordance with state laws. Mandated Reports: Child Abuse & Neglect Elder Abuse & Neglect Abuse or Neglect of a dependent individual Reporter is immune from civil or criminal repercussions when acting in 45 good-faith  Nursing Preservation of Evidence Priority Intervention is medical stabilization. Crime-related evidence is ESSENTIAL! ⚬ Must be safe-guarded in a manner consistent with the investigation. Common types of evidence ⚬ Clothing, bullets, gunshot powder on skin ⚬ Bloodstains 46 ⚬ Hairs, fibers, grass ⚬ Other debris found on individual ￭ Glass fragments ￭ Paint ￭ Wood  Preservation of Evidence (continued) 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. ⚬ NEVER USE PLASTIC BAGS! Clothing removed from a victim should not be shaken. 47 When trauma is sexual assault, a SANE may be called to the ER Treatment & evaluation of STI’s Pregnancy risk evaluation and prevention Crisis intervention and arrangements for follow-up counseling  Types of Evidence Physical Transient Touchable Trace 48  Investigation of Wounds When clients present in the ED with wounds from undiagnosed trauma, it’s important for the clinical forensic nurse specialist to make a detailed documentation of the injuries. Failure to do so may interfere with the administration of 49 justice should legal implications later arise.  Nursing Diagnosis For Victim/Survivor: For Abuser Anxiety Ineffective individual coping Ineffective individual coping Knowledge deficit Ineffective denial Noncompliance Fear Altered role performance Altered G&D Self esteem disturbance Hopelessness Impaired social interaction Risk for injury Risk for violence 50 Pain Spiritual distress Post trauma response Rape-trauma syndrome Low self esteem Impair skin integrity Risk for trauma  Planning “Pt will maintain safe home environment” “Pt will receive treatment for injuries” “Family will remain free from violence” “Family will accept assistance & follow through with referrals” “Abuser will establish & maintain impulse control & coping strategies” 51 “Abuser will cooperate with recommended/court ordered treatment programs” “Abuser will refrain from violence against others”  Implementation Safety ⚬ Separate victim from perpetrator Help patient develop a escape plan Report to law enforcement as required Follow guidelines for collection & preservation of evidence Ensure sensitive, compassionate care Thoroughly document Collaborate with team for interagency referrals 52 ⚬ Assist with locating therapy, other resources As the RN: always be near an exit  Evaluation Safety maintained Victim demonstrated self-empowerment & improved self-esteem Utilizations of community resources to improve coping 53 Abuser accepted responsibility for violent behavior Abuser refrained from violence against others  Any Questions? 54 55