Violence Study Guide

Objective 1: Understand and categorize the various forms of violence, including physical, emotional, sexual, economic, and neglect.

Slides 4–12

Domestic violence

The lecture defines domestic violence as a pattern of abusive behavior used by one intimate partner to gain or maintain control over another.

Types of violence

The lecture lists these categories but does not provide separate, detailed definitions of each.

Walker's Cycle of Violence

Three stages identified in Walker's Cycle of Violence, slide 5.

The stages are:

1. Tension building

2. Acute battering

3. Honeymoon

The diagram on slide 5 also labels an "open window phase" near the period when abuse takes place, but the lecture does not explain that phase further.

Categories of family violence

1. Intimate Partner Violence (IPV)

The CDC definition provided in the lecture describes IPV as physical, sexual, or psychological harm by a current or former partner or spouse.

Important characteristics:

• May include sexual abuse, psychological abuse, isolation, and stalking.

• Can escalate in severity and frequency over time.

• Occurs in both women and men.

• Is not limited to heterosexual couples.

The lecture reports that IPV affects 1 in 3 women and 1 in 4 men.

2. Child abuse

The Child Abuse Prevention and Treatment Act (CAPTA) definition presented in the lecture includes actions or failures to act by a parent or caretaker resulting in serious harm, sexual abuse, exploitation, or death.

Four main categories:

• Neglect

• Emotional abuse

• Sexual abuse

• Physical abuse

Potential long-term effects include:

• Sleep problems

• Behavioral issues

• Psychosomatic complaints

• School failure

• Aggression

• Post-traumatic stress disorder (PTSD)

3. Elder mistreatment

Includes:

• Neglect

• Physical abuse

• Sexual abuse

• Financial abuse

• Psychological abuse

• Abandonment

Assessment may be difficult because of social isolation related to fear, immobility, or cognitive impairment.

Elder mistreatment can result in both physical and psychological effects.

Other forms of violence

Bullying may involve verbal behaviors (teasing, threats, taunting), social behaviors (spreading rumors or exclusion), and physical behaviors (hitting, kicking, tripping, spitting).

For human trafficking, the lecture identifies potential indicators involving work and living conditions, poor physical or mental health, and lack of control.

Key takeaway: Recognize the different categories of violence, the three stages of Walker's Cycle of Violence, and the forms of family violence.

Objective 2: Demonstrate skills in interviewing and assessing clients who have experienced domestic violence, focusing on safety and trust-building.

Slides 14–20

Preparing for the interview

Before interviewing the client, the nurse should:

• Recognize personal feelings, beliefs, and biases about violence.

• Be aware of potential red flags.

• Create a safe environment.

• Protect both the client and themselves.

Interviewing techniques

Collecting subjective data

History of present illness and past health history

• Review the client's past health history.

• Ask questions that may indicate abuse.

• Interview without the partner, parent, or caregiver present.

• Explain that the questions are part of routine screening.

Personal and family history

Assess for a history of:

• Child abuse

• Elder abuse

• Partner abuse

Lifestyle and health practices

Explore:

• Difficulties with activities of daily living (ADLs)

• Stress

• Participation in activities outside the home

Interviewing specific populations

Children

• Remain calm and accepting.

• Avoid showing surprise or distaste.

• Do not offer rewards to obtain answers.

• Ask direct, non-leading questions.

• Use open-ended questions rather than yes/no questions.

Older adults

The lecture suggests exploring:

• Whether the client signs papers.

• What a typical day looks like.

• Whether anyone has refused to help the client.

Mandatory reporting

According to the lecture, Delaware law requires immediate oral reporting of known or suspected child abuse or neglect to the Division of Family Services, with requested written follow-up reports.

The slides also identify Adult Protective Services resources.

Key takeaway: Safety, confidentiality, trust, direct questioning, active listening, and awareness of reporting requirements are central to interviewing clients who may have experienced violence.

Objective 3: Explain the different forms of workplace violence that nurses may encounter and discuss strategies for prevention and management.

Slide 15

Definition of workplace violence

The lecture uses the National Institute for Occupational Safety and Health definition, which includes violent acts directed at individuals while working or on duty.

Forms of workplace violence

• Physical assaults

• Threats of assault

• Verbal abuse, as discussed in the lecture's survey findings

Workplace violence statistics

The lecture cites a 2014 American Nurses Association survey reporting:

21%

• Physically assaulted

• Registered nurses and nursing students surveyed

50%+

• Verbally abused

• Registered nurses and nursing students surveyed

Both statistics refer to experiences reported during a 12-month period.

Prevention and management strategies

The lecture emphasizes:

1. Creating a safe environment.

2. Protecting yourself.

3. Recognizing that an injured IPV client may be accompanied by the individual responsible for the injury.

4. Avoiding screening when there are safety concerns for the client or nurse.

Key takeaway: Workplace violence may involve physical assault, threats, or verbal abuse. Nurses must prioritize a safe environment and personal protection.

The lecture does not provide additional detailed workplace violence prevention protocols.

Objective 4: Discuss screening tools available to assess for domestic violence.

Slides 9, 12–13, 18, 22

Screening recommendations in the lecture

• Universal screening for family violence is recommended for females through age 64.

• Pregnant women should be screened during the initial prenatal visit and periodically.

Screening tools

HITS

A four-item self-report tool used to screen for intimate partner violence.

• Hurt

• Insult

• Threaten

• Scream

Referenced as Assessment Tool 10-1, page 167.

EASI — Elder Abuse Suspicion Index

• Five questions asked to the client.

• One question asked to the provider.

• Used to assess possible elder mistreatment.

Abuse Assessment Screen

• Identified as an assessment tool for IPV.

• Referenced on slide 18 as Tool 10-2.

Danger Assessment Questionnaire

• Used when a client screens positive for IPV.

• Referenced as Box 10-5.

• A positive result is followed by ensuring the client has a safety plan.

PTSD Screening

• Identified in the context of war crimes.

• Referenced as Assessment Tool 10-2, page 165.

Key takeaway: Know HITS and its four components, EASI and its six-question structure, and the use of the Danger Assessment Questionnaire following a positive IPV screening.

The slides reference textbook pages for the complete assessment tools but do not reproduce their full questionnaires or scoring instructions.

Objective 5: Describe the essential components of a physical assessment for clients who may have experienced violence.

Slides 21–22

Preparing the client

• Make the client as comfortable as possible.

• Ensure privacy.

• Remain nonjudgmental.

• A parent may stay with a child younger than 3.

• If rape is suspected, consult a Sexual Assault Nurse Examiner (SANE).

• Physical evidence may need to be gathered.

Physical assessment components

Follow-up for a positive IPV screening

Positive IPV screening

Complete Danger Assessment Questionnaire

If positive, ensure a safety plan is in place

Key takeaway: Prioritize privacy, client comfort, a nonjudgmental approach, a general survey, and examination of the identified body systems.

Objective 6: Outline key teaching points to help clients develop effective safety plans to protect themselves from further violence.

Slides 23–24

Safety plan checklist

General safety planning

• Have a packed bag ready, hidden but easy to grab quickly.

• Tell neighbors about the abuse and ask them to call police if they hear a disturbance.

• Establish a code word with children, family, and friends to signal that help is needed.

• Know where to go if leaving becomes necessary.

• Remove weapons from the home.

Safety planning for children

• Know a safe place to go.

• Know which safe person to tell when feeling unsafe.

• Know how and when to call 911.

If the client plans to leave

• Recognize that planning to leave is a dangerous time requiring awareness and preparation.

• Review the destination, shelter options, and the need to be around others to curtail violence.

• Review the client's right to possessions and prepare a list of possessions to take.

Important teaching point

The lecture specifically emphasizes that planning to leave an abusive situation is a dangerous time requiring awareness and planning.

Key takeaway: Safety plans should address emergency preparation, support from others, a safe destination, children’s safety, and the additional risks associated with leaving.

Objective 7: Analyze data from the client interview and physical assessment to make clinical judgments.

Slide 25

The lecture organizes clinical judgments into three categories.

1. Opportunity to Improve Health

- Opportunity to improve family safety

2. Risk

• Risk for PTSD

• Risk for violent behavior

3. Actual

• Lack of hope

• Anxiety

• Poor self-esteem associated with lack of self-confidence

Clinical judgment classification

Key takeaway: Use subjective and objective findings to recognize opportunities for improving safety, potential risks, and actual client concerns.

Final Exam Review: High-Yield Concepts