Child, Partner, and Elder Violence

Interventions: Abused Child and the Child's Family

Adopt a nonthreatening, nonjudgmental relationship with the parents. Understand that children do not want to betray their parents. Provide (or have a physician provide) a complete physical assessment of the child. Using dolls might help the child tell how the "accident" happened. Early diagnosis results in a better outcome. Forensic examination of the sexually assaulted child should be conducted according to specific protocols

Self-Assessment

Be non-judgmental Ask permission to treat Watch body language and facial expressions

Interventions and Outcomes

Check the individual state for laws regarding elder abuse. Involve APS if abuse is suspected. Suggest family members meet on a regular basis to identify stressors. Notify community agencies: ØSupport group for elder and abuser ØMeals on Wheels ØDaycare for seniors and respite services ØVisiting nurse services ØEncourage abuser's use of counseling

Audience Response Question Chloe is now being seen by the ED physician. Her husband, Chad, is quietly demanding to see his wife. As the triage nurse, what are your best actions? (Select all that apply.) A.Have a staff member regularly touch base with Chad in the waiting room to reassure him that Chloe "is fine" but no room for visitors is provided. B.Immediately call hospital security. C.Move Chloe to secluded area in the ED so that you can interview her in private and advise her of safe shelters and offer brochures. D.Insist that Chloe admit she is being abused by Chad and immediately report the abuse to the police department.

Chloe is now being seen by the ED physician. Her husband, Chad, is quietly demanding to see his wife. As the triage nurse, what are your best actions? (Select all that apply.) *A. Have a staff member regularly touch base with Chad in the waiting room to reassure him that Chloe "is fine" but no room for visitors is provided.* B. Immediately call hospital security. *C. Move Chloe to secluded area in the ED so that you can interview her in private and advise her of safe shelters and offer brochures.* D. Insist that Chloe admit she is being abused by Chad and immediately report the abuse to the police department.

Interview Assessment Guidelines: Parent or Caregiver DO's

DO's Conduct a private interview. Be direct, honest, and professional. Be attentive and understanding. Inform the person if you must make a referral to Child Protective Services, and explain the process.

Interview Assessment Guidelines: Parent or Caregiver DON'Ts

DON'Ts Try to "prove" accusations or demands. Display horror, anger, or disapproval of parents or situation. Place blame on or make judgments about the parent(s) or child.

Characteristics of Intimate Partner Violence: The Batterer

Denial and blame: Denies that the abuse occurs; shifts the responsibility to the partner Emotional abuse: Belittles, criticizes, insults, uses name calling, and undermines Control through isolation: Limits the family or friends, controls activities and social events, tracks the time or mileage on the car, monitors activities, stalks the partner at work, takes the partner to and from work or school, and may demand permission to leave house

Elder Violence

Elder abuse is serious and rapidly growing. Wave of baby boomers—an overwhelming number of older adults, 65 years of age or older, will affect the next decade and beyond. Health care system is unprepared. Six percent of older adults are mistreated annually. Between 70% and 80% of incidents of elder abuse are never reported. Numbers of elder abuse will increase.

Child, Partner, and Elder Violence

Family violence is prevalent among all social strata: ethnic, religious, age, and social and socioeconomic groups. Besides family abuse, trusted authority figures are part of the picture of violence in our society. Four Abuse Categories ◦Emotional ◦Physical ◦Sexual ◦Neglect

Characteristics of Abusive Parents

History of violence, neglect, or emotional deprivation as a child Low self-esteem, depression Poor coping skills Involved in a crisis situation— unemployment, divorce, financial difficulties Unrealistic expectations of a child Frequently uses harsh punishment History of severe mental illness Violent temper outbursts History of drug or alcohol abuse Feels little or no control over life Low tolerance for frustration Poor impulse control

Assessment

If injury does not match the explanation or if the patient minimizes the abuse, then suspect IPV. If IPV is suspected, then complete a physical history, including an x-ray study and a neurologic examination. Rape may be part of the abuse—evaluate, especially if the woman is pregnant, exposed to sexually transmitted diseases (STDs), or has signs of infection or trauma.

Intimate Partner Violence

Is the number one cause of ED visits by women. Is drastically underreported. Between 22% and 39% of all U.S. women experience battering; worldwide rate: 69% (2015). Prevalence of DV by women against men has increased. Also occurs in lesbian, gay, bisexual, and transgender (LGBT) communities. Is the leading cause of homelessness among women. IVP is the leading cause of injury-related deaths during pregnancy.

Theory: Psychologic Factors

Personality traits "cause" abusiveness. Legal or illegal drugs and alcohol may co-exist with family violence. Some abusers argue a "loss of control," but this is not supported by behavior as evidenced by: ◦Perpetrators of violence most likely choose not to hit bosses or policeman, no matter how angry. ◦Abusers often plan where (in the home), when (no one is around), and how (leave no visible marks) they inflict violence.

Child Abuse

Physical Abuse and Deaths: Ø80% were younger than 4 years of age. ØMajority of these were infants of 1 year of age or younger. ØParents are usually the perpetrators, but siblings can be also. Neglect: 59% of all cases Overindulgence results in: ØLack of empathy ØSocial/emotional impairment ØObesity Sexual abuse: Ø1 in 4 girls; 1 in 6 boys

Five Kinds of Elder Abuse

Physical abuse: Infliction of physical pain orinjury (e.g., slapping, bruising, sexually molesting, restraining) 2. Emotional abuse: Infliction of mental anguish (e.g., humiliating, intimidating, threatening) 3. Financial abuse or exploitation: Misuse of someone's property and resources by another person 4. Neglect: Failure to fulfill a caretaking obligation to provide goods and services; may also include self-neglect; "granny dumping" 5. Sexual abuse: Nonconsensual (either by refusal or incapacity to refuse) sexual contact

Assessing the Child

Reassure children that they did not do anything wrong. Children should not feel pressured to talk. Experience should be nonthreatening and supportive. Interview should not resemble trial or inquisition. Children may express experiences through playing out the incident with dolls or drawings. Do not suggest answers. Do not promise that everything is confidential (abuse must be reported). Do not react with shock to anything; do not force a child to undress or be examined.

Nursing Diagnosis: Intimate Partner Violence

Risk for violence Risk for injury Acute or chronic pain Risk for trauma Risk for self-directed or other-directed violence

Diagnosis—Outcomes Identification: Child

Safety, injury, and risk for injury are primary! Other nursing diagnoses might include: ◦Disabled family coping ◦Posttrauma syndrome ◦Anxiety ◦Fear ◦Impaired parenting ◦Acute pain ◦Delayed growth and development ◦Imbalanced nutrition: less than body requirements

Characteristics of Elder Abuse

Seniors are vulnerable to abuse and other crimes. Age-related syndromes often result in frailty, making older adults more at risk for abuse and neglect. Frailty places older adults at a greater risk for sexual abuse. When reported, it is often disbelieved. Elder abuse is most often diagnosed in patients with depression, alcohol or drug abuse, dementia, or psychiatric illness, which compounds the person's vulnerability and draws attention to their vulnerable situation.

Diagnosis—Outcomes Identification: Child 2

Short-term goals for the child experiencing abuse: 1.Receive medical care for injuries within an hour. 2.Notify proper state authorities to ensure continued safety for the child after abuse is suspected: Visit www.childwelfare.gov/ or call (800) 422-4453. 3.Provide safety until adequate home or family assessment is made. The outcome should be"Physical abuse, sexual abuse, or neglect has ceased."

Assessment: Elder Abuse (Cont.)

Signs of abuse are very similar to the victim of IPV. Additional red flags include the following: ◦Fear of being alone with caregiver ◦Obvious malnutrition ◦Bedsores or skin lesions ◦Begging for food ◦Needs medical and/or dental care ◦Left unattended for long periods ◦Reports of abuse and neglect ◦Passive, withdrawn, and emotionless ◦Concern over finances and missing valuables

Assessment (Cont.)

Signs of abuse may include burns, bruises, scars, and other wounds in various stages of healing, particularly around the head and neck. Physical examination includes assessing: ◦Internal injuries—concussions, perforated eardrums, abdominal injuries, eye injuries, and strangulation marks on the neck ◦Broken (fractured) bones—arms, pelvis, ribs, clavicle, legs, or jaw Examination might reveal burns from cigarettes, acids, scalding liquids, or appliances.

Theory

Social learning theory ◦Learning theory or intergenerational violence theory of family violence relies on role modeling, identification, and human interaction. ◦Child learns violence as a behavioral norm. ◦ Societal and cultural factors ◦Poverty or unemployment ◦Communities with inadequate resources ◦Overcrowding ◦Social isolation of families

Teen Dating Violence

Teen dating violence (TDV) is a disturbing trend. Between 25% and 33% of adolescents report verbal, physical, emotional, or sexual abuse from a dating partner each year. In teen relationships, girls and boys abuse each other about equally. Violence is from both past and present partners. About 25% of all high school and college women have been physically or sexually abused by a dating partner.

Establish Safety Plan for IPV

Tell the neighbors about the abuse, and ask them to call the police when they hear a disturbance. Have a code word to use with the kids, family, and friends. Have a safe place selected in case you have to leave. Pack a bag beforehand with: ◦Essential clothes and valuables. ◦Prepaid phone card, cell phone, address book, and a 1-month supply of medications. ◦Keep this packed bag hidden but easy to grab quickly. Include legal documents: ◦Birth certificates, social security card, photo identification, passports, etc

Characteristics of Intimate Partner Violence: The Battered Partner

The battered partner: ◦Does not ask to be beaten and does not enjoy it. ◦Lives in terror. ◦Does not usually initiate the violence, but when aggressive toward a violent mate, it is usually in self-defense. ◦Has feelings of powerlessness and low self-esteem. ◦Loses her or his sense of self. Violence and pain remain secret. Approximately 93% of women who kill their mates have been battered by them.

Centers for Disease Controland Prevention: Violence

The following CDC interactive web site takes a few minutes to load but is well worth the time! http://www.vetoviolence.org/POP/education-training.html The following CDC web site is excellent. www.cdc.gov/Features/CDCMuseumExhibit International Council of Nurses. Elder abuse.www.icn.ch/matters_elder.htm

Assessment: Intimate Partner Violence

Three questions are usually sufficientto reveal IPV: 1.Have you been hit, kicked, punched, or otherwise hurt by someone within the past year? If so, by whom? 2.Do you feel safe in your current relationship? 3.Is there a partner from a previous relationship who is making you feel unsafe now?

Audience Response Question Which is most true about elder abuse? A. Abusive caretakers are mentally ill. B.Most abused older adults were abusive themselves as parents. C.Often an abusive caretaker is financially dependent on the older adult in their care. D.It is against the law for a caretaker to have any access to an older adult's bank account.

Which is most true about elder abuse? A. Abusive caretakers are mentally ill. (Most—though not all—are individuals under extreme stress.) B. Most abused older adults were abusive themselves as parents. (Most have become very vulnerable and dependent.) *C. Often an abusive caretaker is financially dependent on the older adult in their care. (They are often caring family members who feel overwhelmed by both financial and day-to-day responsibilities.)* D. It is against the law for a caretaker to have any access to an older adult's bank account. (Often, the need to manage finances is an added stressor for a caretaker.)