Week 11-Chapter 16 Violence and Human Abuse

Most often, males are the victims as well as the perpetrators of homicides. ______ are affected most frequently; in fact, ______ are six times more likely than White males to be murder victims.

African-American(s)

Femicide

a term used to refer to a homicide of a female person that occurs in the context of intimate partner violence (IPV)

Lethality Assessment

an assessment that identifies high-risk factors for IPV

Human Rights

basic rights and freedoms to which all humans are entitled

Tertiary prevention strategies for IPV include:

caring for victims affected by, or currently experiencing, violence

______ is defined as any recent act, or failure to act, on the part of a parent or caretaker which results in death, serious physical or emotional harm, sexual abuse or exploitation; or an act or failure to act which present an imminent risk of serious harm.

child abuse (and neglect)

______ is defined as any recent act, or failure to act, on the part of a parent or caretaker which results in death, serious physical or emotional harm, sexual abuse or exploitation; or an act or failure to act which present an imminent risk of serious harm

child maltreatment (abuse or neglect)

______ is defined as intentional actions that cause harm or create a serious risk of harm (whether or not harm is intended) to a vulnerable elder by a caregiver or other person who stands in a trust relationship to the elder.

elder mistreatment (e.g., abuse or neglect)

______ nursing focuses not only on providing client care, but its practitioners also collect evidence, counsel clients, and communicate with professionals in legal systems.

forensic

Violence

framed in the context of "intentional" violence, or stated another way, that which is carried out by a person or persons against another person or persons when there is a conscious choice to act in a violent manner

Violence against women is a form of ______ violence that can result in physical, sexual, or psychological harm for both the direct victims and also their dependents (children).

gender-based

______ is fundamentally based on the desire for control on the part of the perpetrator.

intimate partner violence

Prevalence

number of cases of a disease, infected persons, or people with some other attribute present *during a particular interval of time*; often expressed as a rate

All forms of violent behavior can be attributed to the need for ______ and ______.

power and control

Thinking about the root causes of violence helps nurses develop ______ prevention strategies (raising *awareness* about violence), along with ______ (*identifying those at risk* for being abused or perpetrating abuse) and ______ prevention interventions (identified victim or perpetrator).

primary, secondary, tertiary

______ represents the first piece of national legislation in U.S. history to address the issue of abuse of persons with disabilities.

the Crime Victims with Disabilities Awareness Act

Nurses should remember that when they file a report for concern of child maltreatment, they are filing on behalf of ______, not against an individual person.

the child

Incidence

the number of cases of disease with an *onset* during a prescribed period of time; often expressed as a rate

Perpetrate

to be responsible for; commit, as in a crime

When is the nurse mandated to report abuse?

when any healthcare provider suspects that abuse of an *elderly person, a child, or a person with a disability* has occured

Factors that contribute to homicides related to guns include:

- low income - discrimination - lack of education - lack of employment opportunities

Individual risk factors associated with intimate partner violence include:

- low self-esteem - low income - low academic achievement - young age - aggressive behavior as a child - heavy alcohol/drug use - depression - anger and hostility - antisocial personality traits - borderline personality traits - history of being physically abused - few friends/isolation and abused - unemployment - emotional dependence and insecurity - belief in strict gender roles - desire for power and control - perpetrating psychological aggression in relationships - victim of physical pr psychological abuse as a child - experiencing poor parenting - experiencing physical discipline as a child

Community and societal risk factors associated with intimate partner violence include:

- poverty and associated factors (e.g., overcrowding) - low social capital - lack of institutions, relationships, and norms that shape a community's social interactions - weak community sanctions against IPV (e.g., unwillingness of neighbors to intervene when violence is witnessed) - traditional gender roles

Healthy People 2020 emphasizes a need to prevent violence and the sequelae known to result from exposure to violence, recognizing that violence leads to the following:

- premature death - disability - poor mental health - high medical costs - lost productivity

Many victims and perpetrators of IPV differ in their opinions of what constitutes abuse. Opinions may be dependent on many factors, including:

- prior exposures - cultural identification - family and peer opinions - education

What are the objectives of Violence Prevention identified by Healthy People 2020?

- reduce fatal and nonfatal injuries - reduce fatal and nonfatal traumatic brain injuries - reduce homicides - reduce firearm injuries - reduce physical and sexual assaults

Risk factors that indicate significant concern for the safety of the children include:

- threats to kill the caretaker, children, and/or self; caretaker fears for the children's safety - a child was physically injured in an incident where the caretaker was the target - a child was coerced to participate in or witness the abuse of the caretaker - a weapon was used or threats were made to use a weapon, and the caretaker believed that there was intention and ability to cause harm

Through networking and attending local conferences on domestic violence, one can begin to build a resource directory of community partners - knowing the following resources is imperative:

- women's shelters - churches/synagogues/temples - food banks - Women, Infants, and Children (WIC) program - mental health agencies - unemployment offices - law enforcement agencies - advocacy centers - justice centers - support groups - Batterer's intervention groups - forensic nurses

The injury prevention objectives of Healthy People 2020 include:

1. prevention and reduction of firearm-related deaths 2. identification of improper firearm storage in homes 3. surveillance of external causes of injury in emergency departments 4. decreased incidents of homicide, child maltreatment, and physical assaults 5. prevention and reduction of sexual assaults 6. elimination of weapon possession by adolescents on school property

21. The nurse cares for a woman who is in her 39th week of gestation and who recently revealed that she is being physically abused by her partner. Which conditions associated with intimate partner violence (IPV) should the nurse look for in this client and in her child now and in the coming weeks? (Select all that apply.) A) Depression in the mother B) Low-birth weight infant C) Down syndrome in the infant D) Gestational diabetes in the mother E) Cleft palate in the infant

Ans: A, B Feedback: Depression before, during, and after birth has been strongly correlated with IPV. Researchers have also found that pregnant women who are assaulted by an intimate partner are at increased risk of giving birth to infants of reduced weight. Down syndrome is a genetic disorder and is not associated with IPV. Gestational diabetes is an endocrine disorder and would not be caused by IPV. A cleft palate is a congenital birth defect not associated with IPV.

12. The nurse suspect a 16-year-old client is being physically abused by her boyfriend. Compared with adolescent girls with no abuse history, this client is at significantly increased risk for: (Select all that apply.) A) Smoking cigarettes B) Anorexia C) Becoming pregnant D) Assaulting her siblings E) Theft

Ans: A, B, C Feedback: Adolescent girls who reported experiencing sexual or physical assault were significantly more likely to report smoking, attempt suicide, use cocaine, become pregnant, and engage in unhealthy eating habits, compared with adolescents with no abuse history. There is no evidence of an association of assaulting one's siblings or theft with exposure to violence.

15. Which instance would be considered child abuse and neglect according to the federal Child Abuse and Prevention and Treatment Act? A) A father leaving a child in the back seat of a car on a hot August day B) A mother not feeding a 5-year-old child all day C) A mother allowing her boyfriend to punch her daughter D) A caregiver smacking away a toddler's hand when she reaches for a hot stove E) A neighbor touching the private parts of a 12-year-old boy

Ans: A, B, C, E Feedback: The federal Child Abuse Prevention and Treatment Act (CAPTA) (42 U.S.C.A. §5106g), as amended by the Keeping Children and Families Safe Act of 2003 (U.S. Department of Health and Human Services, 2003), defines child abuse and neglect as the following: any recent act, or failure to act, on the part of a parent or caretaker that results in death, serious physical or emotional harm, sexual abuse or exploitation, or an act or failure to act that presents an imminent risk of serious harm. A caregiver smacking away a toddler's hand would not result in serious physical or emotional harm. All of the other answers would.

8. Which statements by a caregiver would indicate the presence of risk factors for violence and should cause the nurse to have significant concern for the safety of children? (Select all that apply.) A) "My boyfriend says that one day he'll put a bullet through my head if I don't stop nagging him." B) "My 3-year-old daughter cries when my partner and I argue." C) "My husband sometimes makes our son come into our bedroom and watch as he hits me." D) "The last time we fought, he threatened to go pull out his shotgun." E) "My husband got upset with how much our daughter was texting and took her phone away from her for a month."

Ans: A, C, D Feedback: Risk factors that indicate significant concern for the safety of the children are as follows: (1) threats to kill the caretaker, children, and/or self or fears on the part of the caretaker for the children's safety; (2) a child was physically injured in an incident in which the caretaker was the target; (3) a child was coerced to participate in or witness the abuse of the caretaker; (4) a weapon was used or threats to use a weapon were made, and the caretaker believed that there was intention and ability to cause harm. A toddler crying because of an argument and a father taking away a daughter's phone for a month are not causes for significant concern regarding the safety of the children.

11. After examining a young woman, the nurse asks her questions about some bruises on her back. The client confides that her husband has started hitting her when they argue. The nurse makes recommendations about getting help; the client dismisses them and states, "It's just a few bruises. I think I can handle it." Which long-term consequences of exposure to violence, according to Healthy People 2020, should the nurse discuss with this client? (Select all that apply.) A) Premature death B) Breast cancer C) Disability D) Lost productivity E) Obesity

Ans: A, C, D Feedback: Healthy People 2020 emphasizes a need to prevent violence and the sequelae known to result from exposure to violence recognizing that violence leads to the following: premature death, disability, poor mental health, high medical costs, and lost productivity. Breast cancer and obesity are not known as long-term consequences of exposure to violence.

6. The nurse is completing a lethality assessment with a female client. Which are appropriate lethality risk questions? (Select all that apply.) A) Is there a gun in your house? B) Are you using drugs or drinking excessively? C) Has your partner ever been arrested? D) What is the worst thing your partner has ever done to you? E) Do you feel that the partner is capable of hurting you?

Ans: A, C, D, E Feedback: Appropriate questions to ask a client to assess for lethality risks associated with intimate partner violence include the following: (1) Is there a gun in the house? (2) Is the woman's partner unemployed? (3) What is the worst thing the partner has ever done to the victim? (4) Does the victim feel that the partner is capable of hurting her, of carrying out his threats? (5) Has the woman's partner ever been arrested? (6) Is the woman's partner (not the woman herself) using drugs or drinking excessively?

1. Which most accurately defines gender-based violence? A) A homicide of a female that occurs in the context of intimate partner violence B) Violence that targets people or groups of people on the basis of their gender C) A pattern of assaultive and coercive behaviors perpetrated against an individual by one who is, was, or wishes to be in an intimate relationship with the victim D) A type of violence typically committed by one gender but not the other

Ans: B Feedback: Gender-based violence is violence that targets people or groups of people on the basis of their gender. Femicide is the homicide of a female that occurs in the context of intimate partner violence (IPV). IPV is a pattern of assaultive and coercive behaviors perpetrated against an individual by one who is, was, or wishes to be in an intimate relationship with that individual and that may include inflicted physical injury, psychological abuse, sexual assault, progressive social isolation, deprivation, intimidation, and threats. Gender-based violence is based on the gender of the victim, not that of the perpetrator.

20. The nurse assesses a new client and performs a standard screening for intimate partner violence. Which is the most appropriate question to ask first? A) "Are you in danger now?" B) "It's normal for couples to disagree about things. What happens when you and your partner disagree?" C) "Do you ever think about hurting yourself, cutting, stopping eating, or purging food?" D) "Have you ever thought about or been granted a restraining order?"

Ans: B Feedback: The most appropriate question to ask first is, "It's normal for couples to disagree about things. What happens when you and your partner disagree?" This question is open-ended and allows the client to share information about behavior that she may not even recognize as abuse. The other questions listed are more appropriate to ask as follow-up questions, once the woman has stated that she is being abused.

17. Intimate partner violence is a pattern of assaultive and coercive behaviors. This definition includes: (Select all that apply.) A) Emotional injury B) Sexual assault C) Progressive social interaction D) Physical injury E) Deprivation

Ans: B, D, E Feedback: Intimate partner violence (IPV) is a pattern of assaultive and coercive behaviors that is perpetrated against an individual by one who is, was, or wishes to be in an intimate relationship with that individual and that may include inflicted physical injury, psychological abuse, sexual assault, progressive social isolation (not interaction), deprivation, intimidation, and threats. Emotional injury is not included in IPV.

9. A nurse is preparing to make a mandatory report of intimate partner violence (IPV) with regard to the caregiver of a pediatric client. Which actions are appropriate? (Select all that apply.) A) Tell the child about the possibility of filing a mandatory report B) Determine whether it will be safe to inform the child about the report C) Ask about the child's incidence of using drugs D) Ask the victim whether she has a plan to keep herself and the child safe E) Ask the victim if she would like to file a report at the same time as you file yours

Ans: B, D, E Feedback: The nurse should take the following actions when making a mandatory report of IPV: (1) Talk with the adult victim (not the child) about the possibility of filing a mandatory report. (2) Consider the safety concerns of filing. (3) Determine whether it will be safe to inform the children about the report. (4) Share concerns of safety with the Child Protective Agency. (5) Ask about the perpetrator's behaviors with questions such as the following: What is the worst thing he or she has done? Does he or she own a gun? Has he or she been arrested? Does he or she use drugs (not does the child use drugs)? Do you think he or she is capable of hurting you or your children? (6) Address safety planning with the nonoffending victim. (7) Consider filing in concert with the adult victim.

4. Preventing intimate partner violence (IPV) and recurrence of violence requires targeting efforts at all three levels of prevention: primary, secondary, and tertiary. Which is a secondary prevention strategy? A) Creating and broadcasting a public service announcement that raises awareness about IPV B) Putting up posters around the health provider's office that give tips on what to do if one is in an abusive relationship C) Screening a woman for evidence of abuse who has several risk factors for IPV D) Providing a woman who is being abused by her husband the number to an abuse hotline so that she can get help leaving him

Ans: C Feedback: Primary prevention includes screening and prevention efforts that target the general population. Secondary prevention occurs through generalized screening and inquiry with high-risk populations. Tertiary prevention involves caring for victims affected by or currently experiencing violence. Creating and broadcasting a public service announcement and putting up posters are examples of primary prevention, as they are aimed at the general public. Screening a woman for evidence of abuse who has several risk factors for IPV is an example of secondary prevention. Providing help to a woman who is being abused is an example of tertiary prevention.

18. An injury prevention objective of Healthy People 2020 is: A) Prevention of drug-related deaths B) Identification of improper chemical storage in homes C) Decreased incidents of homicide, child maltreatment, and physical assaults D) Elimination of alcohol possession by adolescents on school property

Ans: C Feedback: The injury prevention objectives of Healthy People 2020 include the following: (a) prevention and reduction of firearm-related (not drug-related) deaths; (b) identification of improper firearm (not chemical) storage in homes; (c) surveillance of external causes of injury in emergency departments; (d) decreased incidents of homicide, child maltreatment, and physical assaults; (e) prevention and reduction of sexual assaults; and (f) elimination of weapon (not alcohol) possession by adolescents on school property.

5. Pediatric providers face special issues in screening for intimate partner violence (IPV) in a caregiver who is accompanying a child. Which are appropriate strategies for addressing this screening issue? (Select all that apply.) A) Asking the mother directly, with the child present B) Asking the child directly, while the mother is out of the room C) Asking the mother indirectly, with a written questionnaire or computer survey D) Screening for the safety and dangerousness of the situation before deciding whether to ask the mother E) Informing parents about mandatory reporting law after asking questions

Ans: C, D Feedback: Appropriate strategies include the following: asking mothers indirectly (written questionnaire, computer survey), asking mothers directly, without (not with) the child present; informing parents about mandatory reporting laws before (not after) asking questions; screening for safety and dangerousness of the situation; and being aware of resources and referrals. It would not be appropriate to ask the child about IPV that the mother may have experienced.

13. A 50-year-old woman recently underwent a divorce and has two teenaged children. She has an associate's degree from her local community college and earns an annual salary of $22,000. Which risk factors place this woman at risk for intimate partner violence (IPV)? (Select all that apply.) A) Age of 50 years B) Education at associate's degree level C) Recent divorce D) Having two teenaged children E) Annual salary of $22,000

Ans: C, E Feedback: Risk factors include age less than 45 years, low income, lack of employment, recent separation or divorce, education at the high school (not associate's degree) level or less, and having young (not teenaged) children.

14. The nurse helps a client who is a victim of intimate partner violence (IPV) with safety planning. The client worries about what to do if her partner becomes violent again. A safety suggestion for the when the client is at home is for her to go to the: A) Kitchen because it is well-lit B) Bathroom because it is a small space C) Basement because there are places to hide D) Living room because there are windows

Ans: D Feedback: Components for safety planning include a crisis/"disaster" plan, a place to go, how to get there, and other considerations. Safety planning involves discussing measures that the client may not have considered. For example, if an argument occurs at home, the woman should stay away from (1) the kitchen because sharp instruments are there and (2) the bathroom because the space is small and contains many hard surfaces. She should go to a room with a window or door, carry her cell phone, with 911 set to speed dial, and tell family members and neighbors. The basement is not appropriate because it is less likely to have windows or doors.

2. Which is a relationship risk factor for intimate partner violence? A) Emotional dependence and insecurity B) Belief in strict gender roles C) Desire for power and control D) Unhealthy family interactions

Ans: D Feedback: Individual risk factors for intimate partner violence include emotional dependence and insecurity, belief in strict gender roles, and desire for power and control. Relationship risk factors include unhealthy family relationships and interactions.

3. Which is a societal risk factor for intimate partner violence? A) Experiencing poor parenting B) Marital instability C) Unwillingness of neighbors to intervene when violence is witnessed D) Traditional gender roles

Ans: D Feedback: Traditional gender roles is a societal risk factor, as it is primarily determined by the society one lives in, rather than by individual characteristics, relationship dynamics, or even local community factors. Experiencing poor parenting is an individual risk factor. Marital instability is a relationship factor. Unwillingness of neighbors to intervene when violence is witnessed is a community factor.

Is the following statement true or false? Data support the belief that women are generally the perpetrators of IPV.

False; men - women may also, though rarely, perpetrate violence against their intimate partner

Is the following statement true or false? Empowering victims of intentional violence to care for themselves and get help is assumed to be a welcomed opportunity. For many, however, it is a difficult context that has brought them to violent, abusive relationships, and it is a difficult context which will release them from the situation.

True

Is the following statement true or false? It is standard practice that all pregnant women are screened for IPV during each trimester of their pregnancy, following the birth of the infant, and in cases in which there are concerns.

True

Intimate Partner Violence (IPV)

a pattern of assaultive and coercive behaviors which may include inflicted physical injury, psychological abuse, sexual assault, progressive social isolation, deprivation, intimidation, and threats; these behaviors are perpetrated by someone who is, was, or wishes to be involved in an intimate or dating relationship with an adult or adolescent, and they are aimed at establishing control by one partner over the other

19. Which risk factors are associated with committing gun-related homicide? (Select all that apply.) A) Low income B) Lack of education C) Female gender D) Being a victim of discrimination E) Lack of employment opportunities

Ans: A, B, D, E Feedback: Factors that associated with committing gun-related homicides are as follows: low income, being a victim of discrimination, lack of education, and lack of employment opportunities. Most often, males are the victims as well as the perpetrators of homicides.

Gender-based Violence

a term used to distinguish violence which targets people, or groups of people, on the basis of their gender from other forms of violence; it includes any act that results in, or is likely to result in, physical, sexual, or psychological harm such as rape, torture, mutilation, sexual slavery, forced impregnation, and murder

Components of safety planning include:

- a crisis/disaster plan - a place to go and how to get there - if the abused victim stays and the abuser leaves - if the victim and abuser stay together - if the victim decides to leave *safety planning involves discussing measures that the client may not have considered.*

The DOVE (Domestic Violence Enhanced Home Visitation) Program intervention includes the following:

- a structured, tailored brochure with information regarding the cycle of violence, designed to meet each woman's special needs - risk factors associated with increased risk of homicide - options available to women - safety planning - IPV resources specific to their locale - national hotline numbers

A number of factors have contributed to the prevalence of violence in the United States. These factors include:

- acceptability of violence in U.S. culture - racism, classism, and sexism - availability and accessibility of firearms - lack of accountability

Research indicates that some women have a higher risk of IPV. Risk factors include:

- age less than 45 - low income - lack of employment - recent separation or divorce - education at the high school level or less - having young children

Review Box 16.5: Trauma-Sensitive Care: Principles

- demonstrate respect - establish and maintain rapport - share control - share information - respect boundaries - foster a mutual learning process - show compassion and avoid passing judgement

Relationship risk factors associated with intimate partner violence include:

- economic stress - martial conflicts (e.g., fights) - marital instability (e.g., divorce/separation) - dominance/control of relationship by one partner over another - unhealthy family relationships and interactions

16. Which accurately defines femicide? A) A homicide of a female that occurs in the context of intimate partner violence B) Violence that targets people or groups of people on the basis of their gender C) A pattern of assaultive and coercive behaviors D) A suicide by a female that occurs in the context of intimate partner violence

Ans: A Feedback: Femicide is a homicide (not a suicide) of a female that occurs in the context of intimate partner violence (IPV). Gender-based violence is violence that targets people or groups of people on the basis of their gender. IPV is a pattern of assaultive and coercive behaviors that is perpetrated against an individual by one who is, was, or wishes to be in an intimate relationship with that individual and that may include inflicted physical injury, psychological abuse, sexual assault, progressive social isolation, deprivation, intimidation, and threats.

10. Who is in the best position to recognize both children being victimized and children perpetrating violence? A) Pediatric primary care provider B) Parent C) School nurse D) Next door neighboR

Ans: C Feedback: School nurses play a pivotal role in recognizing both children who are being victimized and those who are perpetrating violence, as they are in daily contact with the children. The parents of the children might know whether their own child is a victim or a perpetrator, but they likely would know the other children involved. The child's primary care provider and next door neighbor are not as likely to know of violence experienced or perpetrated by children as the school nurse is, due to the nurse's more frequent contact with the children and location in the school setting.

7. Preventing intimate partner violence (IPV) and recurrence of violence requires targeting efforts at all three levels of prevention: primary, secondary, and tertiary. Which is a tertiary prevention strategy? A) Adding a question to the standard health history form that asks whether the client is currently experiencing abuse B) Putting up posters around the health provider's office that give tips on what to do if one is in an abusive relationship C) Screening a woman for evidence of abuse who has several risk factors for IPV D) Providing a woman who is being abused by her husband the number to an abuse hotline so that she can get help leaving him

Ans: D Feedback: Primary prevention includes screening and prevention efforts that target the general population. Secondary prevention occurs through generalized screening and inquiry with high-risk populations. Tertiary prevention involves caring for victims affected by or currently experiencing violence. Adding a question to the standard health history form and putting up posters are examples of primary prevention, as they are aimed at the general public. Screening a woman for evidence of abuse who has several risk factors for IPV is an example of secondary prevention. Providing help to a woman who is being abused is an example of tertiary prevention.

Is the following statement true or false? School nurses working with teachers, school administrators, and school psychologists are in a unique position to create an environment that promotes primary prevention and intervention.

True

Is the following statement true or false? Working with victims of violence is best approached using the principles of care and intervention that are based on trauma care, are client-centered, and are conducted in a nonjudgmental manner that respects the client's autonomy while ensuring that safety issues are being addressed.

True

Is the following statement true or false? Violence prevention should start at home and continue in school.

True; by addressing and discussing with students the root causes of violence through their educational curriculum, school nurses and educators might be able to shift the paradigm to a less violent one

Is the following statement true or false? Nurses are in key positions - in schools, clinics, offices, and hospitals - to inquire about guns in the home and provide anticipatory guidance on safety when a gun is stored in the home.

True

Is the following statement true or false? Nurses should be vigilant in assessing whether there is a gun present in the home and whether it is safely stored away from children.

True