Chapter 25 Community Questions

Describe the physical and mental health problems that abused women may exhibit.

Abused women may exhibit low self-esteem and have a variety of mental health problems, including depression. Physical problems include chronic pain (back, head, abdominal), neurological problems, problems sleeping, gynecological symptoms, urinary tract infections, and chronic gastrointestinal problems.

What general category is the greatest risk factor for individual victimization through violence?

Age. Youths are at significantly higher risk.

What is the best question for the nurse in community health to ask a female client who has a black eye or bruises about the mouth?

Ask, "Who hit you?" Asking this question implies that the nurse is comfortable and knowledgeable about violence. This question can reduce a client's need to fabricate a socially acceptable cause of the injury.

What intrafamilial system factors may indicate that a family is at risk for violence?

Autocratic and hierarchical family government, strict disciplinary beliefs, rigid role assignments, role reversal, social isolation, resistance to change, role modeling of abusive parenting from one generation to another

Why is violence against the family difficult to accurately measure?

Because of a lack of accurate reporting or because of embarrassment, fear, and other emotions; families are often hesitant to report violence and abuse.

Describe how the nurse in community health can recognize actual or potential older adult abuse.

Financial mismanagement, withdrawal and passivity, depression, unexplained or repeated physical injuries, untreated health problems (e.g., decubitus ulcers), poor nutrition, unexplained genital infections, physical neglect and unmet basic needs, social isolation, rejection of assistance by caregiver, lack of compliance to health regimens; see "How To Identify Potential or Actual Older Adult Abuse" box in the textbook.

Victims of emotional abuse tend to hold in their feelings to avoid incurring additional scorn. Name five physical symptoms of stress from physical, sexual, or emotional abuse.

Hyperactivity, withdrawal, overeating, dermatological problems, vague physical complaints, and exacerbation of stress-related physical problems, such as asthma, stuttering, enuresis (bladder incontinence), and encopresis (bowel incontinence)

Identify societal factors that may affect a family's potential for violence.

Inadequate and prejudicial legislation for women, children, and older adults; inferior education, training, and status of minorities; the influence of public schools through the use of abusive discipline patterns; societal acceptance of violence (e.g., in media, religion); patriarchal socioeconomic and sociopolitical structure

As the nurse in community health interacts with a survivor of rape, what common responses should the nurse expect?

Individual responses vary, but many persons experience self-blame. Other responses are individualized to the client; they vary from crying and lashing out to withdrawal and fear.

Name four ways that families can reduce their vulnerability to intrusions that could threaten their safety.

Keep doors and windows locked; trim shrubs around the home; keep lights on during high crime periods; organize/join a neighborhood watch program; install a home security system; learn self-defense measures and handgun safety.

List the leading risk factors for adolescent suicide.

Leading risk factors for adolescent suicide are mental health, unintended pregnancy, and STD, especially HIV. Leading risk factors for suicide are depression and other mental disorders, substance abuse disorders, and intimate partner problems. Other risk factors include a prior suicide attempt, a family history of suicide, mental disorder, substance abuse or violence, firearms in the home, incarceration, and exposure to the suicidal behavior of others, that is, family, peers, or media figures.

Identify factors that nurses may observe in persons who are alleged or actual perpetrators of violence.

Low self-esteem; fear and distrust of others; poor self-control; isolated; inadequate social skills; immature motivation for marriage or childbearing; weak coping skills

Describe what is included in abuse of older adults.

Often includes actual physical mistreatment as well as neglect; rough handling; imposing unrealistic toileting demands; ignoring special needs and previous living patterns; giving foods they cannot chew or otherwise eat; giving medications to induce confusion or drowsiness

Differentiate between child neglect and physical abuse.

Physical neglect is the failure to provide adequate food, clothing, shelter, hygiene, or necessary medical care; emotional neglect implies the omission of basic nurturing, acceptance, and caring. In contrast, physical abuse refers to one or more episodes of violence, such as beating, burning, kicking, or shaking.

Describe a primary prevention program for rape.

Provides information about the dangers in going places with strangers and about avoiding high-risk locations; discusses safeguarding the home against possible entry; teaches self-defense

List four types of community facilities that can offer residents an outlet for release of angry and hostile feelings.

Recreational areas; organized and informal sports; movie theaters; tennis courts; parks; the YMCA and other groups with health clubs and organized exercise programs; spectator sports; educational, cultural, and religious institutions

What is the most common form of psychological abuse of older adults?

Rejecting or simply ignoring older adults

. Identify three types of family violence.

Sexual abuse, emotional abuse, physical abuse

True or False: Experiencing a violent event is traumatic for the victim because it can produce feelings of helplessness, lack of control, and vulnerability.

True

True or False: Nurses in community health have a "duty to warn" of the possibility of homicide when severe abuse is present.

True

True or False: The level of violence in a community relates directly to the potential for level of violence against self or others.

True

True or False: The most inclusive description of all kinds of violence between partners is intimate partner violence.

True

Describe at least 10 characteristics that the nurse in community health may observe that potentially or actually indicate child abuse.

Unexplained injury (i.e., skin, fractures, trauma to genitalia); dehydration or malnourishment without obvious cause; provision of inappropriate food or drugs; evidence of poor general care; unusually fearful of nurse and others; considered to be a "bad" child; inappropriately dressed for season/weather; reports or shows evidence of sexual abuse; injuries that are not mentioned in history; seems to need to take care of the parent and speak for the parent; maternal depression; maladjustment of older siblings. See "How to Recognize Actual or Potential Child Abuse" box in the textbook.

Describe emotional abuse.

Extreme debasement of a person's feelings so that the person feels inadequate, inept, unloved, and worthless

True or False: Economically and educationally disadvantaged persons are more likely to commit suicide.

False

True or False: Most homicides are committed by a stranger.

False

True or False: Physical neglect is the omission of basic nurturing, acceptance, and caring essential for healthy development.

False

Name three primary prevention community approaches to preventing violence.

(1) School-based curricula to teach children and youth how to cope with anger, stress, and frustration and that also teach communication and mediation skills; (2) family programs that teach parents how to deal with their children more effectively; (3) preschool programs to develop intellectual and social skills; (4) public education programs that can educate communities about different forms of violence and ways to get help and intervene; (5) nurse home visitation programs with families at risk may prevent child abuse and neglect; (6) lobbying for passage of legislation to outlaw physical punishment in schools and marital rape.

Caring for an older person in the home can often be taxing for caregivers. What kinds of resources are available in your community that might ease the family stress?

Home-related services include home health aides, nursing care in the home, meal delivery, home repair services, daycare and respite care centers, monetary assistance, counseling, and educational programs focusing on the needs of older adults

Describe social and community factors that influence the level of violence and human abuse.

Social conditions of work, education, media, organized religion, population, and community structure and facilities can affect the level of violence. Undesirable, boring jobs or the lack of employment can create frustration and anger that lead to violence. Schools have assumed many of the responsibilities traditionally assigned to the family. Larger classes exist, in which teachers expend more time and energy monitoring/disciplining children; nonconforming children are removed from class rather than learning alternative behavior. Media influences violence; countless acts of violence (presented in the form of kicking, hitting, stabbing, and shooting) are depicted as ways to handle conflict, anger, and frustration. Religion generally teaches nonviolent conflict resolution, but contradictory issues are associated with some religious doctrine. Some religious groups disapprove of divorce; parents may follow the adage of "spare the rod, spoil the child." Structure in communities (i.e., overcrowding resulting in high-density populations) may influence violence. Although some groups many feel cohesion other groups experience social alienation with feelings of hopelessness, a sense of inadequacy, and social isolation. Diversity in communities also can be a source for potential violence. A lack of understanding of different groups and their beliefs may occur, along with ineffective communication among different group members, resulting in groups that are antagonistic, hostile, distrustful, and biased. Communities that offer health-promoting facilities project an idea that they are desirable places to live, work, and raise a family; recreational facilities serve as useful outlets for feelings, including aggression.

Select one population at risk in your community for becoming victims of violence. Then develop a comprehensive plan for primary, secondary, and tertiary prevention relative to the violence to this group.

The answer should be a synthesis of measures described throughout the chapter.

Identify key areas that the nurse in community health should assess when working with clients who may be potentially violent.

The nurse should assess the client's upbringing, living conditions, and level of stress. Many abusers have a positive family history of abuse. They may demonstrate a hostile personality style and can be verbally aggressive. They may develop a "shell" to protect themselves from worthless feelings or rejection and become adults who are hostile and distrustful. Overt behaviors show low tolerance for frustration, emotional instability, onset of aggressive feelings with minimal provocation, and being overly critical.