Assessing for Violence Questions and Definitions

Intimate Partner Violence

(as defined by the CDC)- Physical, sexual, or psychological harm by a current or former partner or spouse. -Forms of harm may be psychological abuse, sexual assault, progressive isolation, stalking, deprivation, intimidation, and reproductive coercion. -Primarily effects women- regardless or age, economic status, race, religion, ethnicity, sexual orientation, or educational background. -Recent studies indicated that children who experienced violence in the home or who are exposed to violence inflicted on others have changes in their brain activity similar to combat veterans.

The Center for Hope and Safety organization the Cycle of Domestic Violence Model

-Abuse -Guilt -Rationalization -"normal" behavior -Fantasy: abuser fantasizes about the abuse -Planning: Planning begins to accomplish the fantasy -Set-up: The abuser sets up the victim to fail whatever he expects

economic abuse

-May be evidenced by preventing the victim from getting or keeping a job, controlling money and limiting access to funds, spending the victim's money, and controlling knowledge of family finances. -Improper exploitation of another person's personal assets, properties, or funds.

Factors contributing to bruising in older adults

-Medications -aspirin, NSAIDs, warfarin, heparin, valproic acid, prednisone, clopidogrel -Nutritional supplements: especially if already on blood thinner or platelet altering medications: bilberry, garlic, ginger, ginko -Abnormal blood values -Underlying hematological disorders

psychological abuse

-involves the use of constant insults or criticism, blaming the victim for things that are not the victim's fault, threats to hurt children or pets, isolation from supporters (family, friends, coworkers), deprivation, humiliation, stalking and intimidation, and manipulation of various kinds such as threats of suicide. -As defined by Vancouver Coastal Health: any act including confinement, isolation, verbal assault, humiliation, intimidation, infantilization, or any other treatment which may diminish the sense of identity, dignity, or self-worth.

10 warning sign of abuse and abusive relationships

1) controlling 2) restricting relationships 3) inequality of power 4) jealousy and possesiveness 5) Won't take no for an answer 6) explosive temper 7) Makes (and breaks) promises frequently 8) destruction of self worth 9) fear and threats 10) physical harm

McCue 2008: 5 theories related to domestic violence for why men batter women

1.Psychopathology theory: batterers suffer from personality disorders 2.Social learning theory: violence is a learned behavior from childhood 3.Biological theory: physiological changes from childhood trauma, head injuries, or through hereditary cause violent behavior 4.Family systems theory: violence grows through family system function→ some criticize this theory as blaming the victim. 5.Feminist theory: male/female inequity in patriarchal societies leads to violence

Assessing the risk for homicide: the Danger Assessment tool. How many 'yes' answers is required to be considered a higher risk for homicide?

7 yes answers

domestic violence

A pattern of abusive behavior in any relationship that is used by one partner to gain or maintain control over another intimate partner. (U.S. Department of Justice on Violence Against Women)

Routine screening tool for domestic violence?

AAS: abuse assessment tool

Physical Assessment Terminology: Puncture

Act of piercing or penetrating with pointed object or instrument

Child Abuse

As defined by the Child Abuse Prevention and Treatment Act- any recent act or failure to act on the part of the parent or caretaker which results in death, serious physical or emotional harm, sexual abuse, or exploitation...or an act or failure to act that presents imminent risk of serious harm. -Four major categories: neglect, emotional abuse, sexual abuse, and physical abuse. Some state that abandonment and parental substance abuse should be added.

Walker's Cycle of Violence: discusses the cyclic nature of violence

Explains how violence occurs in a predictable pattern -During the beginning of a relationship, couples are rarely apart and it is very intense. The abuser displays possessiveness and jealousy, and starts to separate the victim from supportive relationships. -Phase 1: Criticism is the sign of phase 1, the tension-building phase. The abuse makes unrealistic demands. When expectations are not satisfied, criticism and ridicule escalate into shoving or slapping. Victims often blame themselves for failing to satisfy the unrealistic demands of the abuser. -Phase 2: The acute battering stage, may be triggered by something minor but results in violence lasting up to 24 hours. The victim is rarely able to stop the abuse. -Phase 3: Honeymoon phase, is a period of reconciliation. This phase begins after an incident of battery. The abuser is loving and promises never to abuse the victim again, and is very attentive to the victim. -The cycle begins again

Physical Assessment Terminology: Ecchymosis

Hemorrhage spot, larger than petechiae, non elevated, blue or purple

Elder Abuse

Includes neglect, physical abuse, sexual abuse, financial abuse, psychological abuse (including humiliation, intimidation, and threats), exploitation, abandonment, or prejudicial attitudes that decrease quality of life and are demeaning to those over the age of 65 years. -The abuse is more frequently from omission

sexual violence

Involves forcing the victim to perform sexual acts against his or her will, pursuing sexual activity the victim has said no to, using violence during sex, and using weapons vaginally, orally, or anally. -Sexual abuse is not limited to family or intimate partners but can be stranger abuse such as assault and rape as well. -Most victims know their abuser

Physical Assessment Terminology: Hemorrhage

Localized collection of blood, usually in organ, space, or tissues.

All violence survivors should have what test performed?

Mental status exam (MSE)

Physical Assessment Terminology: Petechia

Minute, pinpoint, non-raised, perfectly round purple, red spots

Physical Assessment Terminology: Stab Wound

Penetrating, sharp, cutting injury that is deeper than it is wide

Physical Assessment Terminology: Bruise/Contusion

Superficial discoloration d/t hemorrhage into tissues from ruptured blood vessels beneath the skin

Physical Assessment Terminology: Avulsion

Tearing away of a structure or part

family violence

The controlling, coercive behaviors seen through the intentional acts of violence inflicted on those in familial or intimate relationships; includes intimate partner violence, child abuse, and elder mistreatment.

True False: 1 in 3 female homicide victims was killed by a current or former partner

True

True or False: Healthcare providers are required by law to report both suspected and acknowledged child and elder abuse, but not intimate partner violence.

True

violence

Violence is an execution of physical force used so as to injure or abuse.

Physical Assessment Terminology: Abrasion

Wound caused by rubbing skin or mucous membrane

Before beginning a client interview to assess for the presence of violence, necessary preparations include all except which of the following? a. assure confidentiality of all information revealed b. choose an environment where the conversation will not be overheard by others c. discuss legal mandatory reporting requirements d. provide an appropriate interpreter if the client does not speak english.

a. assure confidentiality of all information revealed

Which of the following is suggested for family abuse screening? a. universal screening for family and intimate partner violence is recommended. b. If there is no obvious signs of abuse, there is no need to screen client. c. Only childbearing aged and pregnant women should be screened for sexual abuse. d. Assess for physical abuse only at the beginning of a couple's new relationship

a. universal screening for family and intimate partner violence is recommended.

The nurse is interviewing Mr. Jenkins and , due particularly to his nervous affect and his reaction when his son is mentioned, suspects potential elder abuse. In assessing Mr. Jenkins, the nurse should: a. focus exclusively on the physical assessment, as elder abuse is primarily physical in nature. b. make sure the assessment includes questions to ensure that Mr. Jenkins has access to food and needed medication. c. ask to speak to Mr. Jenkins' son directly, to ask him candidly about potential abuse. d. keep in mind that elder abuse is usually reported, indicating that Mr. Jenkins is not likely a victim.

b. Make sure that the assessment includes questions to ensure that Mr. Jenkins has access to food and needed medication.

Which of the following is true about psychological abuse? a. psychological abuse is easy to define and diagnose b. an abuser may use psychological behaviors such as belittling, exploiting, denigrating, or remaining emotionally unresponsive. c. The majority of children experiencing psychological abuse do not use effective coping mechanisms. d. psychological abuse of children dies not affect long-term development

b. an abuser may use psychological behaviors such as belittling, exploiting, denigrating, or remaining emotionally unresponsive.

Elder abuse can include: a. nursing home admission b. economic exploitation c. using an elder day-care sitter d. uncontested divorce

b. economic exploitation

When interviewing a pediatric client and attempting to determine the presence of abuse, the nurse should: a. confine the interview to yes/no questions to keep the interview simple b. remain calm and accepting in response to any information the client discloses c. ask leading questions to convince the child to offer information d. offer a reward to the child for answering difficult questions

b. remain calm and accepting in response to any information the client discloses

Which of the following is true about violence against women? a. verbal attacks by husband are not considered violence against a wife b. wife abuse is an accepted behavior in some societies c. between married couples, there is no behavior that meets the criteria for rape. d. violence against women is a recent development in the U.S.

b. wife abuse is an accepted behavior in some societies

Physical Assessment Terminology: Lesion

broad term referring to any pathologic or traumatic discontinuity of tissue or loss of function of a part

A hispanic mother brings her 2-year old child to the clinic for a well-child checkup and age-appropriate vaccinations. Which of the following observations indicate possible abuse at home? a. bruising across lower back and upper buttocks laterally b. symmetrical nickel sized circular bruising across upper back c. hand or finger-patterned bruising around upper arm and leg. d. scraped and bruised knee

c. hand or finger-patterned bruising around upper arm and leg.

Johnny is a 5-year old boy who comes to the clinic for his scheduled injections. Which physical indications would leave you to suspect child abuse? a. bruising on upper portion of buttocks b. regular patter of circular, coin-sized reddened areas on his back. c. irregular pattern of small, circular reddened areas with healing blisters on various parts of his body d. crying when he sees the needle for his injection

c. irregular pattern of small, circular reddened areas with healing blisters on various parts of his body

Which of the following is a stage in Walker's cycle of violence? a. reporting the problem b. hiding the abuse c. period of reconciliation d. ending the relationship

c. period of reconciliation

At what age are women have the highest risk to suffer from domestic abuse? a. women in their 40s b. teens c. women in their 20s d. women in their 60s

c. women in their 20s

Physical Assessment Terminology: Patterned injury

caused by an object that leaves a distinct pattern: glove/sock burns

Physical Assessment Terminology: Incision

cut or wound made by sharp instrument, act of cutting

Which of the following is *not* a true statement about intimate partner violence? a. 1 in every 3 women worldwide is a victim of intimate partner violence at some point in her life. b. intimate partner violence is based on the abuser's need to maintain power and control over the victim c. The annual cost in the U.S. for intimate partner violence exceeds $4 billion for medical and health services, and over $1 billion for lost productivity. d. intimate partner violence is caused by the "victim" refusing her husband's desire for sex.

d. intimate partner violence is caused by the "victim" refusing her husband's desire for sex.

Physical Assessment Terminology: Wound

general term referring to bodily injury cause by physical means

Physical Assessment Terminology: Cut

incision

physical abuse

includes pushing, shoving, slapping, kicking, choking, punching, methods of restraint, attacking with household items of weapons, refusing to aid victim when injured or ill, and burning.

Physical Assessment Terminology: Pattern of injuries

injuries, bruises or fractures, in various stages of healing

Physical Assessment Terminology: Traumatic Alopecia

loss of hair from pulling and yanking or other traumatic means

Physical Assessment Terminology: Laceration

tearing or splitting of tissue, usually from blunt trauma over a bony surface

True False: 1 in 4 women will be victims of domestic violence

true