Family and Community Violence

Priority Interventions: IPV & Sexual Assault

1. Ensure immediate physical and psychological safety (private room, security)[cite: 3]. 2. Assess and treat acute injuries/medical emergencies (including strangulation/TBI)[cite: 3]. 3. Facilitate SANE exam, forensic evidence collection, and obtain informed consent[cite: 3]. 4. Administer prophylactic STI antibiotics and emergency contraception[cite: 3]. 5. Assess suicidal ideation and develop a collaborative safety plan (shelters, safe houses)[cite: 3].

Mandated Reporting: Minors (0–17 years)

Mandatory to report any suspected abuse, neglect, or sexual assault to protective services or law enforcement; civil and criminal penalties apply for failing to report[cite: 3].

Mandated Reporting: Competent Adults (18–64 years)

Nurses cannot report abuse to law enforcement without client consent due to HIPAA regulations and client autonomy, unless required by specific state firearm/weapon injury laws[cite: 3].

Mandated Reporting: Older Adults (65+ years) & Dependent Adults

Mandatory to report suspected physical, emotional, sexual abuse, neglect, or financial exploitation of adults aged 65 and older or individuals with cognitive/physical disabilities affecting decision-making[cite: 3].

Cycle of Abuse: Tension-Building Phase

Characterized by minor episodes of anger, tension, friction, and verbal breakdown; the victim often feels like they are 'walking on eggshells,' attempts to placate the abuser, or accepts blame to prevent escalation[cite: 3].

Cycle of Abuse: Acute Battering Phase

The tension peaks into a severe explosion of serious physical, emotional, or sexual violence; the victim is powerless to stop it, resulting in the most severe physical injuries or risk of lethality[cite: 3].

Cycle of Abuse: Honeymoon Phase

The abuser displays remorse, loving behavior, gifts, and promises to change ('periods of escalation and de-escalation'); the victim feels hope and relief, perpetuating the cycle of violence[cite: 3].

Characteristics of Perpetrators of Violence

Threats and intimidation to maintain control, low self-esteem, poor impulse control, history of childhood family violence, substance abuse, and authoritarian discipline beliefs[cite: 3].

Characteristics of Vulnerable Persons (Victims)

Feelings of powerlessness, guilt, low self-esteem, attempts to protect or make excuses for the abuser, and highest risk of severe violence when attempting to leave the relationship[cite: 3].

Manifestations of Strangulation in IPV

Petechiae on eyelids/facial skin, neck bruising/scratches/ligature marks, raspy/hoarse voice, difficulty swallowing, dyspnea, internal mouth petechiae, and neurological deficits (loss of consciousness, memory loss)[cite: 3].

Rape-Trauma Syndrome: Phase 1 (Acute/Impact Phase)

Occurs immediately up to 1 month post-assault; manifested as either expressed behavior (crying, sobbing, hysteria) or controlled behavior (numbness, shock, flat affect); nursing priority is physical safety, SANE exam, and crisis intervention[cite: 3].

Rape-Trauma Syndrome: Phase 2 (Outward Adjustment/Recoil)

Occurs beyond 1 month; survivor appears to return to normal functioning using denial and suppression, but experiences nightmares, hyperarousal, avoidance, phobias, and somatic symptoms (GI upset, headaches)[cite: 3].

Rape-Trauma Syndrome: Phase 3 (Reorganization Phase)

Lasts months to years; survivor integrates the assault into their life story, works through feelings of guilt and fear, and achieves recovery; unresolved trauma can lead to chronic PTSD or depression[cite: 3].

Silent Rape Reaction

Silent reaction presents with suppressed trauma, sudden phobias, abrupt relationship/sexual changes, and high interview anxiety without verbalizing the rape; c