ABUSE, AGGRESSION, AND VIOLENCE

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abuse

involves systematic strategies used to obtain dominance and control over others and can be displayed in a variety of ways (physical, emotional, s3xual, neglect, and economic). individuals who have experienced this are at higher risk for developing substance use disorders, anxiety disorders, depressive disorders, EDs, BPD, and PTSD.

physical abuse

the intentional inflection of bodily harm or pain on others. perpetrators of this may use force, including kicking, hitting, slapping, pushing, strangling, or biting to control how others behave and think. warning signs of this include body findings (lacerations, bruising, burn marks, fractured bones, puncture wounds, and wounds in various stages of healing) and general appearance factors (ripped or torn clothing, broken eyewear, disheveled hair and clothing).

emotional abuse

the intentional infliction of mental anguish through means of intimidation and humiliation. the person responsible for this may use threats, insults, and intimidation to exert control. may be hard for the nurse to recognize as there is no physical evidence. warning signs can include changes in usual behavior (social withdrawal, non-responsive communication), a loss of self esteem, anxiety provoked by the presence of certain people, and a client reporting enduring verbal or mental mistreatment.

SA

any forced, inappropriate, or unwanted s3xual contact and actual or threatened s3xual violence. ex include explicit photos, indecent exposure, unwanted touching, r4pe, etc. can also include grooming (preparing the enviornment or others for this abuse), luring (use of internet to enable this), and exposure to unwanted explicit content. potential warning signs include sudden changes in behavior within the client such as fear of people or places, explicit behavior, regression, a developmentally inappropriate interest in s3xuality, bruising around privates, unexplained STIs, and client reports.

neglect

the failure of a caregiver to provide needed food, clothing, shelter, medical care, or supervision to the degree that the child’s health, safety, and well-being are threatened with harm.

abandonment

when an individual has been left in circumstances in which they suffer serious harm, a caregiver’s identity or whereabouts are unknown, or the caregiver has failed to maintain contact or provide reasonable support for a specified period of time.

neglect/abandonment warning signs

can include unattended or untreated health problems, dehydration, malnutrition, untreated pressure injuries, poor personal hygiene, hazardous living conditions, desertion of a vulnerable individual, and client report.

economic abuse

the misuse of another person’s financial resources, with or without permission. is also known as exploitation. examples include stealing, forging checks, promising to pay bills but keeping money for yourself, etc. warning signs can include sudden banking and accounting changes, abrupt changes in availability of funds, possessions, wills or other financial documents; when an individual does not remember signing financial records, and client reports.

aggression

actions intended to harm others/the deliberate attempt to harm or destroy. can be physical, psychological, or both. is different from anger, which can evoke positive changes when expressed in a appropriate manner. alterations in serotonin function, such as changes in levels, transport, or receptor activity, have been linked to this along with impulsive actions. manifestations of this via serotonin disruptions can be observed in schizophrenia, ASD, PTSD, and ADHD.

violence

the ultimate form of aggression that can include murder, r4pe, or other forms of physical assault. individuals who have substance use disorders, TBIs, PTSD, bipolar 1, impulse control disorders, and ADHD are the most prone to acting out in this manner.

risks for abuse, aggression, and violence

includes a hx of violence, being the victim of a crime, witnessing abuse or violence, poor self esteem and inadequate coping skills, no presence of positive role models during childhood, and ACEs.

brunner syndrome

a genetic condition characterized by impulsivity, aggression, mild cognitive impairment, and violence. occurs due to deficient variations of the MAO-A gene, which increases serotonin 5-HT levels. transmission is X-linked and supports the possibility of underlying genetics influences of aggressive behavior.

clinical presentation of abuse, aggression, and violence

clients often use the defense mechanisms of displacement and undoing to shield themselves from disagreeable or objectionable thoughts and sensations. presentation can differ depending on a variety of factors, but the following warning signs can be present: declining to eat or drink, attempting to leave an area prematurely, being verbally antagonistic, self harm, staring, pacing, and destroying inanimate objects.

intimate partner violence (IPV)

described as physical violence, s3xual violence, stalking, or psychological aggression by a current or former partner or spouse. does not require s3xual intimacy. often occurs during teenage years, with a higher risk among the LGBTQ population. survivors may develop subsequent medical issues related to reproductive, cardiac, digestive, neuromuscular, and skeletal systems, in addition to PTSD or a depressive disorder. survivors are also more likely to engage in risky behaviors.

cycle of violence

includes the build up phase (communication breakdown occurs, environment becomes tenser, perpetrator initiates more arguments, can last years), the acute phase (abusive acts are filled with rage and intensity, police may become involved), and the honeymoon/reconciliation/respite phase (perpetrator becomes very affectionate and apologetic, regretful of actions and promises to change).

elements of verbal de-escalation

includes engaging (respect personal space and remain calm), establishing verbal contact (introducing self and saying client’s name), staying simple and concise, identifying wants and feelings, setting clear limits (ensure client understands what is acceptable and what is not), and offering choices and optimism (empowers the client).

pharm interventions

for long term control, antipsychotics can be used, along with benzos, mood stabilizers, anticonvulsants, and antidepressants. when an aggressive act cannot be mediated though de-escalation or an oral dose of one of the previously mentioned medications, the client may receive B52 (50mg of Benadryl, 5mg of haloperidol, and 2mg of lorazepam), olazapine, diazepam, chlorpromazine, midazolam, droperidol, lorazepam, promethazine, and ziprasidone.

forensic nurse

may work with survivors of SA or survivors of IPV, child maltreatment/abuse, older adult abuse, death investigations, or work in correctional facilities and assist with investigations following mass casualty events or disasters. provide consultation and testimony for civil and criminal proceedings relative to their findings.

SA nurse examiner (SANE)

a RN who has advanced education in forensic exams of SA survivors. responsibilities include focused exams of privates, preserving specimens and collecting evidence, debriefing potentially traumatizing situations, and administering meds to treat STIs. may also provide expert testimony during legal proceedings. also apparently offers the client choices to assist them in making informed decisions about the care they receive.

contingency management

involves rewarding desired behavior (abstinence form illicit drugs, refraining from property destruction, maintaining a calm demeanor, etc.) with quantifiable rewards. rewards do not need to be extravagant for the clients to produce the desired behavior. is used effectively in the treatment of clients with substance use disorder.

nonsuicidal self-harm (NSSH)

intentionally harming oneself; involves acts such as cutting, scratching, biting, carving, hair pulling, etc. clients do this to cope with emotional pain and distress. a loss of situational control, anger, anxiety, depression, and stress are common risk factors. frequently noted in those with BPD, substance use disorders, and EDs. it is uncommon for these clients to seek medical treatment. may lead to dependence and normalization. a dependable forecaster of a future suicide attempt. important for nurse to recognize behaviors early, provide available and affordable resources for treatment, as well as provide educational and supportive services.