Violence and Abuse
Tension Building Phase
- Abuser has minor episodes of anger and may be verbally abusive - Responsible for some minor physical violence - Victim is tense during this stage and tends to accept the blame for what is happening.
Child Protective Services Agency
A county or state agency established to protect children from abuse by investigating reports of child abuse and intervening, when necessary. *social workers are responsible for investigating and managing*
Power and Control Wheel
A model depicting behaviors batterers use to control and dominate their intimate partners and/or children
Frustration Aggression Hypothesis
A theory that explains violence results from the frustration of societal conditions (poverty, unemployment, community with inadequate resources, socially isolated, overcrowding) So because of the frustration, aggression is the response
Rape Trauma Syndrome
A two-stage set of symptoms that follow the trauma of being raped, consisting of physical, emotional, and behavioral stress reactions
Elder Abuse
A type of abuse that is a violation of human rights and a significant cause of illness, injury, loss of productivity, isolation and despair
Battered Woman Syndrome
A woman who has experienced many years of physical abuse but feels unable to leave her partner *Woman often shows PTSD symptoms* *Learned helplessness* *Self-destructive coping responses to violence*
Honeymoon Phase
Abuser- may bring gifts, show kindness, apologize, and promise it won't happen again Victim- believes abuse is over, stays in the relationship
They are usually known and a trusted person
Abusers of elder abuse are usually what?
Infant Whiplash Syndrome
Also known as shaken baby syndrome, a very serious form of child abuse that results when a baby is shaken, causing the brain to roll around in the skull cavity, leading to brain damage or death. *Often due to adults becoming frustrated and angry*
Obtain written consent for the examination, photographs, laboratory tests, release of information, and laboratory samples
As the nurse, what must we obtain for an examination?
A crime
Battering is what?
Latchkey Children
Children who care for themselves after or before school; parents may or may not be present
Physical Child Abuse
Damage to tissues or bones by other than accidental means, discipline that leaves a mark
Intimate Partner Violence (IPV)
Defined as a pattern of assault and course of behaviors that may include physical injury, psychologic abuse, sexual assault, progressive social isolation, stalking, deprivation, intimidation, and threats between current or former partners of an intimate relationship, regardless of gender or marital status
Educational Neglect
Depriving a child of an education
Encourage the victim to develop a specific safety plan (a fast escape if the violence returns) and provide information where to obtain help (hotlines, safe houses, and shelters) ~ an abused person is usually reluctant to call the police
Even if a victim in domestic violence is not ready to leave their situation, as the nurse what must you still do?
Physical Neglect
Failure to provide health care to prevent or treat physical or emotional illnesses
Developmental Neglect
Failure to provide nurturing and stimulation needed to ensure meeting developmental milestones
Come up with a plan Keep location a secret Code word to let children, family, friends know that you're leaving Be ready to leave at a moments notice (car fueled & hide car keys, have emergency cash, clothing & important documents in a safe place) Have emergency contacts Rehearse leaving
How do we educate victims to leave their abusive relationship? What are education points?
Five seconds
How many seconds does it take of shaking a child to potentially end their life?
Economic Exploitation
Illegal or improper exploitation of money, funds, or other resources for one's personal gains (type of violence)
Statuatory Rape
Intercourse between an adult and a minor Act of sexual intercourse with a person younger than the age of legal consent, even if the minor consents
Sexual Child Abuse
Intercourse, oral sex, anal sex, exhibition, fondling, kissing with adults
Child Abuse Prevention and Treatment Act of 1974
Law enacted in 1974 that requires the reporting of child abuse or suspected abuse
Child Neglect
Parents fail to provide for basic needs such as food, shelter, clothing, medical care, supervision, education
Acquaintance Rape
Rape by a person who is known to the victim.
Kimberlin West Act 2002 Florida Law
Requires hospitals, birthing centers, or home birth providers to give new parents informational brochures about the danger of shaken babies (department of health must prepare and provide these brochures)
Five years old
Shaken baby syndrome is documented in children up to what age?
Serious Battering Phase
The tension becomes unbearable; the victim may provoke an incident to get it over with. -SERIOUS BATTERING INCIDENT OCCURS- The victim may try to cover up the injury or may look for help. (aka acting out phase)
Social Learning Theory
This theory explains that violence relies on role modeling, identification, human interaction; the child learns violence as a behavioral norm *also known as, intergenerational violence theory*
Patriarchal Theory
This theory says that male dominance in our political and economic structure enforces the differential status of men and women which leads to violence In many subcultures, women are viewed as "belonging" to men, they are subservient, and kept relatively powerless
Emotional Child Abuse
This type of child abuse is the hardest to prove but it is the most prevalent Children are repeatedly criticized and demeaned, having no love or nurturance, not allowing children to develop a sense of 'self
True
True or False The nurse is a mandated reporter of elder abuse
True
True or False Training sessions are completed to teach nurses to talk to new parents about shaken baby syndrome
Try to "prove" accusations or demands Display horror, anger, or disapproval of parents or situation Place blame or make judgments about the parents or child
What *should not* be done in an interview with a caregiver or parent of a child?
Conduct a private interview Be direct, honest, and professional Be attentive and understanding Inform the person that you have to make a referral to Child Protective Services and explain the process
What *should* be done in an interview with a caregiver or parent of a child?
Recurrent ED visits for injuries being attributed as an "accident" Signs of high anxiety (hyperventilation, hypertension, GI disturbances, depression, panic attacks) Chronic stress (insomnia, violent nightmares, extreme fatigue, eczema, loss of hair)
What are *indications* for family violence?
Let her know help is available Give her specific information about resources Document the battering with accurate medical records Acknowledge her experiences in a supportive manner Respect her right to make her own decisions
What are *nursing interventions* for intimate partner violence?
What arrangements do you make when you have to leave your child alone? How do you punish your child? When your infant cries for a long time, how do you get him or her to stop? What does the child do to make you cry? Do you get time for yourself? How are things between you and your partner?
What are *open ended* questions that can be asked in the interview with a parent or caregiver?
Bruising from being grabbed firmly Major head injury (cerebral edema, subdural hematoma) Blindness due to retinal hemorrhage Cerebral palsy Cognitive impairment Death
What are *signs* of shaken baby syndrome?
No one deserves to be harmed or abused The abuser is responsible for his/her behavior and needs help The victim is not alone Pushing, shoving, and/or slapping are acts of crimes Arguments are inevitable, but violence is a choice *NO JUDGMENT*
What are *take aways* to intimate partner violence?
Neglect Physical Sexual Emotional
What are *types* of child abuse?
Physical, Sexual, Emotional, or Neglect (failure to meet a depending persons needs)
What are *types* of violence?
Bruises, pressure ulcers, broken bones, abrasions, burns Unexplained withdrawal from normal activities, sudden change in alertness, unusual depression Bruises around the breasts and/or genital area Sudden changes in financial status Poor hygiene - unusual weight loss Belitting caregivers and threats Strained and tense relationships with caregivers
What are *warning signs* of elder abuse?
Many abusive partners seem absolutely perfect in the early stages of the relationship Possessive and controlling behaviors creep up and emerge slowly Showing jealousy of partner's friends and time spent away Keeping partner or discouraging them from seeing friends or family Preventing partner from working or attending school Intimidating with guns, knives or other weapons Pressuring partner to have sex when they don't want to or do things sexually that they are not comfortable with Destroying partner's property or threatening to hurt of kill their pets
What are general warning signs (red flags) of abusive partners?
Who takes care of you? What do you do after school? Who are your friends? What happens when you do something wrong?
What are good questions to ask when interviewing a child of suspected abuse?
Gently confirm the abuse and treat the problem Provide a totally safe atmosphere Assure that they will be protected Reframe that parents need guidance and help Educate about how many children go through this
What are nursing interventions of a child with suspected abuse?
Low self-esteem Poor problem-solving skills History of impulsive behavior Hypersensitivity (they seem themselves as the victim) Narcissistic (centered on themselves, lack compassion for others)
What are psychologic traits we usually see in abusers?
Are you afraid to go home? Are there weapons in the home? Have there been threats of homicide or suicide? Can you stay with family or friend? Do you need access to a shelter? Do you want police intervention?
What are questions for assessing one's immediate safety?
Tension Building Phase Acting Out Honeymoon
What are the *phases* of the cycle of violence?
Physical Emotional Abandonment (neglect) Exploitation Sexual abuse Self-neglect
What are types of elder abuse?
The abuser gives the victim gifts and positive attention to undo the negative behavior
What does *undoing behavior* mean?
Incest, molestation, exhibitionism, pornography, prostitution, pedophilia
What does sexual abuse encompass for a child?
Domestic violence, family violence, and intimate partner violence
What does violence encompass?
Reassure children that they did not do anything wrong 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
What is *important* when performing an assessment on a child for suspected child abuse?
Assess and treat the wounds
What is the *priority* nursing action for physical abuse of an older client?
Shaken Baby Syndrome
What is the leading cause of brain injury in infants?
Intimate Partner Violence (IPV)
What is the leading cause of homelessness among women?
Intimate Partner Violence (IPV)
What is the number one cause of ED visits by women?
Screen for intimate partner violence Conduct initial assessment in private Screen using direct questions - need to ask won't usually volunteer If violence is identified - make sure person knows they are not alone and that they do not deserve to be treated in this way Stress confidentiality
What is the nurses role in intimate partner violence?
Leaving
What is the victims' highest risk of being killed by a batterer?
Never tell them you are leaving
What should a victim *never* tell their abuser?
Surviving the assault is most important If the victim survived the rape, he or she did exactly what was necessary to stay alive
What should the nurse reinforce to a rape victim?
People with dementia or cognitive impairment Long term domestic violence Personal problems w/ abusers/caregivers Social isolation
Which elders are at risk for abuse?
To maintain power and control
Why does the abuser usually use violence or the behaviors that they use against the victim?
