Chapter 28: Child, Older Adult, and Intimate Partner Violence

Types of Abuse

• Physical abuse.

• Sexual abuse.

• Emotional abuse.

• Neglect.

• Economic abuse.

Crisis Situations

A stressful event that may trigger violence in a family with a violent member

Perpetrator

Household member who is violent toward another.

Vulnerable Person

• Person who is abused.

• May also be called:

  • Victim.

  • Survivor.

  • Victim/survivor.

• “Survivor” emphasizes recovery and healing.

Child Abuse: Acts of Commission

• Deliberate and intentional acts.

• Include:

  • Physical abuse.

  • Sexual abuse.

  • Emotional abuse.

Child Abuse: Acts of Omission

• Neglect.

• Occurs when basic needs are not met or child is not protected.

• Includes:

  • Physical neglect.

  • Emotional neglect.

  • Medical neglect.

  • Dental neglect.

  • Educational neglect.

  • Inadequate supervision.

  • Exposure to violence.

Epidemiology of Child Abuse

• Millions of referrals occur yearly.

• Neglect is most common.

• Physical abuse and medical neglect also occur.

• Young children are at highest risk for death.

• Most perpetrators are parents.

Comorbidity and Effects

• One type of abuse predicts risk for another type.

• Long-term effects may include:

  • Anxiety.

  • Depression.

  • Suicidal ideation.

  • Major depressive disorder.

  • PTSD.

Child Abuse Risk Factors

• Child is seen as different.

• Child is seen as fragile.

• Child reminds parent of someone disliked.

• Child does not meet parent fantasy.

• Child resulted from unwanted pregnancy.

• Emotional bonding was interrupted by prematurity or prolonged illness.

Characteristics of Abusive Parents

• History of childhood abuse or neglect.

• Family authoritarianism.

• Harsh punishments.

• Low self-esteem.

• Social isolation.

• Poor coping skills.

• Low frustration tolerance.

• Current crisis.

• Unrealistic expectations of child.

• Severe mental illness.

• Substance use disorder.

• Poor impulse control.

• Violent temper.

Intimate Partner Violence: Epidemiology

• About 25% of women and 10% of men experience abuse.

• Teen dating violence occurs among both females and males.

• Partner stalking affects women more often than men.

• Same-sex relationships have similar rates to heterosexual relationships.

• A portion of homicides involve spouse or partner murder.

Intimate Partner Violence: Risk Factors for male perpetrators

• Belief in male dominance.

• Need to be in charge.

• Belief that aggression gives power.

• Pathological jealousy.

• Substance or alcohol use.

• Resentment toward pregnancy or baby.

• Escalation when partner seeks independence or tries to leave.

Cycle of Violence: Tension-Building Stage

• Stress and conflict increase.

• Victim may feel like they are “walking on eggshells.”

• Abuser may become more controlling or irritable.

Cycle of Violence: Acute Battering Stage

• Violent incident occurs.

• May involve physical, sexual, emotional, or verbal abuse.

Cycle of Violence: Honeymoon Stage

• Abuser may apologize.

• Promises change.

• May give gifts or show affection.

• Victim may hope abuse will stop.

Cycle of Violence: Repetition

• Cycle repeats.

• Calm and safety periods often become shorter over time.

Older Adult Abuse: Types

• Mistreatment.

• Failure to provide basic needs.

• Failure to protect.

• Physical abuse.

• Sexual abuse.

• Financial abuse.

• Self-neglect.

Older Adult Abuse: Epidemiology

• About 1 in 10 adults older than 60 living at home may experience abuse.

• Many cases go unreported.

• Family members are often perpetrators.

Older Adult Abuse: Epidemiology - Underreporting may to be due to

• Isolation.

• Dependency.

• Fear of retaliation

Older Adult Abuse: Epidemiology - Abuse occurs in

• Family Settings

• Institutional settings

Older adults are at higher risk when they

• Have poor mental or physical health.

• Are disruptive due to Alzheimer’s disease or another disorder.

• Depend on perpetrator.

• Are female, older than 75, white, living with impaired status and relative.

• Are cared for by children or spouses they abused earlier in life.

Nursing Assessment for Abuse

• Physical injuries.

• Explanation of injuries.

• Delay in seeking care.

• Inconsistency between history and injury.

• Fearfulness.

• Eye contact patterns.

• Caregiver behavior.

• Control by another person.

• Emotional state.

• Safety at home.

• Access to money, food, medication, and transportation.

• Sexual abuse indicators.

• Neglect indicators.

• Mandatory reporting requirements.

Indicators of Physical Abuse

• Bruises in different stages of healing.

• Burns.

• Fractures.

• Injuries inconsistent with explanation.

• Injuries shaped like objects.

• Repeated ED visits.

• Fear of caregiver.

Indicators of Sexual Abuse

• Genital injury.

• Sexually transmitted infections.

• Pregnancy in a child or vulnerable person.

• Sexualized behavior in children.

• Fear of certain people.

• Sleep disturbance or regression.

Indicators of Neglect

• Poor hygiene.

• Malnutrition.

• Dehydration.

• Untreated medical problems.

• Lack of supervision.

• Inappropriate clothing.

• Missed school.

• Unsafe living conditions.

Indicators of Emotional Abuse

• Extreme fearfulness.

• Low self-esteem.

• Withdrawal.

• Depression.

• Anxiety.

• Developmental delay.

• Excessive compliance.

• Aggression.

Nursing Diagnoses for Abuse Survivors

• Risk for injury.

• Post-trauma response.

• Fear.

• Anxiety.

• Ineffective coping.

• Powerlessness.

• Chronic low self-esteem.

• Impaired family processes.

• Risk for suicide.

• Social isolation.

Abuse: Nursing Interventions

• Ensure immediate safety.

• Treat physical injuries.

• Interview patient privately when possible.

• Use calm, nonjudgmental communication.

• Avoid blaming.

• Validate the patient’s experience.

• Document objectively.

• Report according to law and policy.

• Coordinate with social work.

• Provide resources.

• Help develop a safety plan.

• Respect autonomy when legally possible.

• Support trauma-informed care.