Chapter 28

Child, Older Adult & Intimate Partner Violence

Family Violence / Domestic Violence

• Most important public health issue in the US

• Nurses respond to, education, identify, evaluate and treat both victims and perpetrators of violence.

Physical Abuse

• Infliction of physical pain or bodily harm

• Slapping, punching, hitting, choking, pushing, restraining, biting, throwing, and burning

Sexual Abuse

• Any form of sexual contact or exposure without consent or when the victim is incapable of giving consent

• Also referred to as sexual assualt or rape

Emotional Abuse

• Undermining of a person’s self worth

• May include constant criticism, humiliation, diminishing, name-calling, intimidating, isolating, and damaging the victim’s relationships with others

Neglect

Failure to provide for physical, emotion education and medical needs

Economic Abuse

• Controlling a person’s access to economic resources

• Makes an individual financially dependent on abuser

• Forbidding school attendance or employment

Crisis Situation

• A situation that puts stress on a family with a violent member

• Increases the risk of abuse occurring

• A person with effective impulse control, problem-solving, and a good support systme are less likely to result to violence in crisis

• Stressful life events can leave perpetrators incapable of dealing with the situation and often use up coping skills

• Social isolation is a big contributer to ineffective coping during crisis

Perpetrator

• Any member of a household who is violent toward another member

• Parents, partners, siblings, and extended family members

• Often consider their own needs to be more important than anyone elses

• Perceive themselves as having poor social skills and typically lacks supportive relationships

Vulnerable Person

• Family member upon whom abuse is perpetrated

• AKA victim, survivor, or victim/survivor

• Survivor is preferred because it recognizes the recovery and healing process that follows being victimized

Child Abuse

• Most common form is neglect (73%), physical (46%), and medical (8%)

• Youngest children are the most vulnerable for mistreatment

• Sexual abuse is hard because children are often unable to describe their experience (increases in age), adults are repsonsible for these cases

• 92% of perpetrators are the child’s parents

• Comorbidity: occurence of one type of abuse is strong predictor of another, secondary effects of abuse included anxiety, depression, SI, MDD, PTSD

• Risk Factors: behavioral traits, congential abnormalities, chronic disease, parent hx of abuse, parents with unrealistic expections, premature birth, NICU stays

Acts of Commission

• Deliberate and intentional acts

• Physical, emotional or sexual abuse

Acts of Omission

• Neglect

• Occurs when basic physical, emotional or educational needs are not and the victim is not protecteded from harm

• Include physical, emotional, medical, and educational neglect as well as inadequate supervision and exposure to violence

Intimate Partner Violence (IPV)

• Abuse within the context of an intimate partner relationship where one partner asserts power and control over the other

• Includes physical violence, rape, stalking, and pscyhological aggression by a current or former intimate partner

• About 25% of women and 10% of men have experienced IPV in their lifetime

• Females between 18-34 experience the highest rates of IPV

• Nearly half of married couples have instances of abuse

• One out of 10 homicides is due to spousal murder

• Risk Factors: dominance/power control desires, parental figures, peer groups, influences of media, jealousy, substance abuse

Characteristics of Abusive Parents

• history of abuse, neglect, or emotional deprivation as a child

• Family authoritarianism

• Low self-esteem, depression, feelings of worthlessness

• Poor coping skills

• social isolation

• invomvent in a crisis situation

• unrealistic child behavior expectaion

• history of severe mental illness

• violent temper outbursts

• expects the child to satisfy needs for love, support and reassurance

• projection of blame onto the child for parents’ issues

• inability to seek help from others

• perception of child as bad or evil

• history of drugs or alcohol misuse

• feeling of little or no control over life

• low tolerance for frustraiton

• poor impulse control

Cycle of Violence

• Tension-Building Stage: minor incidents such as pushing, shoving and verbal abuse. Victim often ignores or accepts the behavior due to fear of escalation, Abuses then rationalize that their behavior is acceptable — as tensions builds both try to reduce it — abuse may reduce with use of substances and victim may minimize incidents

• Acute Battering Stage: when tension peaks — triggered by an external event or the abuser’s emotional state

• Honeymoon Stage: after the abuse occurs — abuser usually demonstrates kindness and lvoing behaviors— abuser veelds remoseful and apologetic and may bring presents, make promises, and tell the victim how loved they are — victim usually feelds needed and loved and hopes for change — plans to leave may be abandoned

  • As cycle repeats the length of the honeymoon stage often becomes shorter and may eventually become nonexistent

Older Adult Abuse

• Intentional actions that cause harm or creates a risk of harm to a vulnerable person

• Includes failure to provide for the baisc needs, protect from harm

• Family members, custodians, and care facility personnel may inflict physical and sexual abuse

• Financial abuse is a problem — caretakers may steal from them

• 1/10 adults older than age 60 who live at home are victims of abuse — lack of reporting due to isolation, dependency and fear of retaliation

• Self-neglect can be a problem as older adults lose skills they once had to take care of themselves

• Risk Factors: poor mental/physical health, disruptive memory disorders, dependency, level of care needed, ability to move around

Common Presenting Problems of Victims of Abuse

• bleeding injuries especialy to head and face

• Internal injuries, concussion, perfed eardrum, ab injuries, severe brusing, eye injuries, strangulation marks

• back injuries

• Broken or fractured jaw, arms, pelvis, ribs, clavicle, legs

• Burns from cigarettes, appliances, scalding liquids, acids

• Psychological trauma, anxiety, hyperventilation, heart palpitations, severe crying, suicidal tendencies

• Miscarriage

• Talk of having “problems” with family member

• Bruises of specific shapes (belt, fingers)

• Recurrent vists attributed to being “accident-prone”

• any injury that is not consistent with the story given

Shaken Baby Syndrome

• The leading cause of death as a result of physical abuse, usually occurs in children younger than 2 years old

• Injuries are a result of brain mvoing int he opposite direction as the baby’s head

• A baby who has ben shaken may have respiratory problems, bulging fontalnels, retinal hemorrhage, and CNS damage (seizure, v, coma)

Primary Prevention of Abuse

• Measure taken to prevent the occurrence of abuse

• Id individuals and families at risk, provide teaching, and coordiate support services to prevent crises

• Strategies include: reducing stress, reducing influence of risk factors, increasing social support, increasing coping skills, increasing self-esteem

• Community health nurses are in a unique postion to assess family functioning in the home during visits for other medical problems

Secondary Prevention

• Early intervetion in abusiv situations to minimize their disabling or long-term effects

• Screeing programs, community services, treating injuries from violent episodes

• Reduce stress and depression through supportive therapy, support groups, meds and contact info for community resources

• Counseling and education

Tertiary Prevention

• Often in mental health settings

• Nurses facilitating the healing and rehabilitative process by counseling individuals and families, providing support for groups of survivors and assisting survivors of violence to achieve their optimal level of safety, health and well-being

• Legal advocacy

• Complimentary therapies

Treatments

Individual, family, couple, or group