Week 7: Family & Community Violence

Introduction

  • Impact of Family and Domestic Violence

    • Affects an estimated 10 million people annually in the U.S.

    • Recognized as a national health concern and a priority for intervention.

  • Types of Abuse Included

    • Economic, physical, sexual, emotional, and psychological abuse.

    • Affects all age groups: children, adults, and elders.

    • Most abuse is perpetrated by someone known to the victim.

  • Long-term Effects of Abuse

    • Results in long-term emotional trauma.

    • Associated disorders include PTSD, dissociative disorders, substance use disorders, and depression.

Clinical Picture of Abuse and Violence

  • Physical and Psychological Injuries

    • Physical injuries may require medical attention.

    • Psychological injuries encompass a wide spectrum of responses.

  • Common Emotional Responses

    • Victims may show agitation and visible distress, or withdrawal and numbness.

  • Disclosure of Abuse

    • Often goes undisclosed due to fear.

    • Victims may suppress anger and resentment.

  • Impact on Children

    • Children may internalize blame, miss school, or develop ongoing problems.

  • Long-term Effects on Adults

    • Associated feelings of guilt, shame, low self-esteem, and possible depression or suicidal behavior.

Psychological Impact of Abuse

  • Trust Issues

    • Difficulty in trusting others, particularly authority figures.

      • Make these clients feel safe and in control!

  • Emotional Responses

    • Survivors may exhibit erratic or intense emotional responses.

  • Intimate Relationships

    • Personal closeness may trigger extreme emotional reactions, such as panic or anxiety.

  • Nurse's Approach: Ensuring clients feel safe, secure, and in control is critical.

Nurse's Role in Supporting Abused Clients

  • Building Respect and Acceptance

    • Use clients’ preferred names and pronouns.

  • Empowerment and Identity

    • Acknowledge how clients identify themselves (as victim or survivor).

    • Empowerment is rooted in the strength of the healing process.

  • Respecting Healing Journeys

    • Avoid labeling or judging clients at any stage of their recovery process.

      • Meeting them in their healing journey, therefore, respect them at all times.

Characteristics of Violent Families

  • Forms of Family Violence

    • Involves spousal/partner abuse, neglect, and abuse of children or elders.

    • It can include marital rape.

  • Common Characteristics

    • Social isolation, abuse of power and control, substance abuse, and intergenerational violence.

Social Isolation

  • Characteristics of Violent Families

    • Tend to be socially isolated, withholding invitations to outsiders.

    • Fear of revealing abuse is common, often enforced by threats.

Abuse of Power and Control

  • Manipulative Dynamics

    • Abusers typically exert control over physical, economic, and social aspects of life.

    • Tend to belittle victims while employing threats to maintain dominance.

    • Violent escalates with perceived independence or disobedience.

  • Homicide Risk

    • Female homicide victims are often killed by current or former partners, especially during relationship termination.

Alcohol and Other Drug Use

  • Relationship with Family Violence

    • Alcohol use disorder is frequently linked to domestic violence.

    • Increased risk and intensity of violence associated with substance use.

  • Date Rape Drugs

    • Use of substances like Rohypnol is on the rise in acquaintance/date rape incidents.

Intergenerational Transmission Process

  • Pattern Perpetuation

    • Violence and abuse patterns can be learned behaviors passed from one generation to the next.

    • Children who witness violence may learn it as a conflict resolution method.

      • Most abusive adults come from violent homes.

    • Not all exposed children become violent; exposure is not a sole explanatory factor.

Cultural Considerations

  • Impacts of Culture on Abuse

    • Domestic violence impacts individuals across all demographics, but is particularly prevalent among immigrant women facing unique challenges.

    • Cultural beliefs and fears of deportation can hinder access to services and support.

      • Immigrant females are most likely to experience this.

Intimate Partner Violence (IPV)

  • Definition

    • IPV refers to mistreatment or abuse occurring in emotionally intimate relationships.

  • Types of Abuse

    • Emotional/Psychological: Includes belittling and threats.

    • Physical: Ranges from shoving to severe injuries.

    • Sexual: Includes rape and sexual assault.  

      • Includes unwanted touching.

  • Statistics

    • 1 in 5 female adults and 1 in 7 male adults report severe physical violence.

    • 1 in 5 female adults and 1 in 12 male adults report sexual violence.

  • Pregnancy Considerations

    • Violence often increases during pregnancy, leading to adverse outcomes.

      • This is due to increased attention during pregnancy.

  • Same-Sex Relationships

    • IPV is reported at similar rates as heterosexual relationships but faces unique risks.

Assessments and Interventions

  • Nurse's Role

    • Identifying signs of abuse when clients present with injuries, often in emergency settings.

      • They do not often seek help for abuse but for physical injury.

    • Maintaining privacy, offering support, and making appropriate referrals.

Cycle of Abuse and Violence

  • Phases of the Abuse Cycle

    • The initial violence phase is followed by remorse and a honeymoon phase.

      • Followed with regret, apologies, and romantic behavior.

    • The tension-building phase includes conflicts that lead up to violence. 

      • Belittling and name-calling the victim during an argument.

    • Over time, violent incidents may become more frequent and severe.

Treatment and Intervention

  • Legal Measures

    • Police involvement can warrant restraining orders.

    • Addressing the limitations of legal actions in preventing repeat violence.

      • Arrest may not reduce repeat violence; thus, restraining orders are provided for those with limited protection.

  • Survivor Support

    • Shelters and therapy options for those affected.

    • Include psychotherapy, group therapy, and support groups.

Child Abuse

  • Definition and Scope

    • Encompasses physical abuse, neglect, and sexual assault, among other harms to children.

    • 1 in 4 children face abuse or neglect in their upbringing.

  • Perpetrators Often Include

    • Male parents, stepparents, and other male relatives.

    • Parents:

      • Minimal parenting knowledge/skills

      • May be financially or emotionally unequipped to understand a child.

    • Recognizing Cues:

      • Physical signs: burns, bruises with an identifiable shape, UTI (sexual abuse), and behavior outside of what is normally expected for age.

      • Bruises may look like belt buckles or teeth marks.

      • May be reported as the “child fell” or “rolled off the couch”.

    • Nurses do not decide for certain if abuse occured but reporting is mandatory and can remain anonymous.

    • Interventions/Taking Actions:

      • Psychiatric evaluation is required.

      • Long-term treatment may involve professionals from several disciplines (social work, psychology, etc.).

      • Parents may also need therapy or substance use treatment.

        • Family therapy may be done if reuniting with family is feasible. Or else foster care would be the next option.

Elder Abuse

  • Definition and Scope

    • Maltreatment of older adults includes physical, financial, and psychological abuse.

    • Statistically impacts 1 in 10 individuals over the age of 60.

  • Risk Factors:    

    • Multiple chronic health problems.

    • Dependence on others for daily needs.

  • Recognizing Cues:

    • Physical: bruises, fractures, lack of eyeglasses or hearing aids. Denial of food, fluids, medications, or restraint.

      • Note for bruising in various healing stages.

      • In addition to fractures in different areas or healing stages.

    • Financial: unable to afford basic needs due to the abuser.

    • Medical neglect: withholding medical care for acute/chronic illness.

    • Self-neglect: failure to care for oneself.

  • Treatment/Intervention:

    • Providing additional resources for those with caregiver stress.

    • Removal of the older adult or caregiver is necessary for intentional neglect/abuse.

    • The legal system is set for defining, reporting, investigating, and providing services for abuse.

Rape and Sexual Assault

  • Definitions

    • Rape: Nonconsensual intercourse achieved through coercion.

      • Rape as power and control, infliction of pain/punishment.

    • Sexual assault: A crime marked by humiliation and power exertion over the victim.

    • Crime of violence and humiliation,

    • Includes sodomy and forced acts of oral sex.

  • Statistical Context

    • Alcohol involvement is noted in many rape cases.

  • Inability to consent: consider mental deficiency or age below consent.

  • Rape Trauma Syndrome: a psychological condition experienced by survivors of sexual assault, which can manifest through symptoms such as depression, anxiety, and post-traumatic stress disorder (PTSD).

  • Physical examination is done before showering or brushing teeth, etc.

    • Rape kits and protocols are placed in emergency settings.

    • Sexual Assault Nurse Examiners (SANE RN)

      • Prophylactic treatments may be given for STI/D prevention, HIV testing, and pregnancy prevention medication.

Community Violence

  • School Crime Statistics

    • Less than 3% of lethal incidents occur at schools.

    • Title IX.

    • Active shooter training for students and increased school security.

  • Bullying and Hazing

    • Factors contributing to mental health issues in adolescents, including self-harm and isolation.

      • Correlated with adolescent suicide, substance use, self-harm, and depression.

      • Social media impact is as damaging as real-world ostracism.

    • Hazing: alcohol consumption, humiliation, isolation, sleep deprivation, and sexual acts.

  • Stress-related symptoms: Increase with the amount of violence witnessed

  • Long-term effects: Aggression, depression, relationship issues, achievement problems, and substance abuse

Summary

  • National Health Concern

    • The U.S. Department of Health and Human Services recognizes violence and abuse as critical public health issues.

    • Effective treatment and early intervention are essential for improving long-term outcomes for survivors of violence.