9 - Abuse And Violence

ABUSE AND VIOLENCE

BSN3C-Group 9 Morgado, Hannah Teresa F. Olivar, Andrea Mae V. Padilla, Rowell T. Padolina, Joanna Fe L. Abuse Behavior, in which an individual misuses, attacks or injures another individual. Can be sexual, physical, and emotional.

CHILD ABUSE
Maltreatment Any recent act of failure to act resulting in imminent risk of serious physical harm or death, emotional harm, sexual abuse, neglector, exploitation of a child under the age of 18 years by a parent, caretaker, or other person ETIOLOGY OF CHILD ABUSE: Can occur: Within the family, where the abusers are parents. In institution settinggs In society, w/c allows children to live in poverty. As a result of war. Children, who experienced trauma that can interrupt their development, trigger psychiatric disorders. CHARACTERISTICS OF AN ABUSED CHILD:

Anyone problems, financial difficulties, parent-child conflict. CHARACTERISTICS OF POTENTIALLY ABUSIVE PARENTS WARNING SIGNS: Denial pregnancy Depression during pregnancy Fear of delivery Lack of support Undue concern about unborn child's gender Fear that child will be one of too many children Inability to tolerate the childs crying Birth of unwanted child Resentment toward the child by a jealous parents A. Younger than 6 years, are more vulnerable to abuse than others and may have physical or mental handicap.

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B. Emotionally disturbed, temperamental, hyperactive or adopted children demonstrate a higher incidence of abuse. C. Congenital anomalies or chronic medical conditions are at risk D. Children, in attempt to get attention Failure to thrive Poor attention span, inability to concentrate Use of drugs or alcohol Sexual misconduct

CHILD ABUSE: Physical ABUSE

PHYSICAL ABUSE: - Infliction o bodily injury that results from punching, beating, kicking, burning, shaking, or otherwise harming a child. PHYSICAL INDICATORS: Bruises Burns Lacerations, abrasions, welts, scars Missing or loosened teeth Skeletal injuries BEHAVIORAL AND ENVIRONMENTAL INCATORS Fear of parents and fear physical contact with adults. Extremes in behavior such as passivity progressiveness or crying very often. Sudden onset of regressive behavior such thumb sucking. truancy from school or tardiness Fatigue causing child to sleep in class. Inappropriate dress, resulting in frostbite or illness. Violence toward other children or animals. Sporadic temper tantrums.

CHILD ABUSE: EMOTIONAL ABUSE AND NEGLECT

EMOTIONAL ABUSE: Verbal assaults or threat that provoke fear; poor communication that may send double meaning; ad blaming, confusing or demeaning messages. Example: Children may be told to be unwanted, unloved, or unworthy o care. The child may become a scapegoat of the family. EMOTIONAL NEGLECT Parents or other adults responsible for the child fail to provide an emotional climate that foster feeling of love, belongings, recognition and enhancement self-esteem. Example: Ignoring of child, providing minimal human contact and failing to provide opportunities to foster growth and development. May develop serious behavioral, cognitive, emotional or mental disorder

CHILD ABUSE: CHILD SEXUAL ABUSE

Sexual abuse of a child includes Fondling of a child's genitalia Intercourse Incest Sexual intercourse or behaviors between family member Rape Actual penetration of an orifice of a childs body during sexual activity Sodomy Any contact between the genitals of one person, and the mouth or anus of other.

CHILD ABUSE: CHILD NEGLECT

CHILD NEGLECT: Failure to provide for a childs basic physical, medical or educational needs. Physical Indicators: Weight loss, Dental caries, Child ma look unkempt and lack adequate clothing. Symptoms of an undiagnosed medical condition like anemia Behavioral and Environmental Indicators:

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Exhibitionism - Mental disorder characterized by a compulsion to display ones genitals to an unsuspected Stranger, Commercial exploitation through prostitution or the production of pornography materials. Consequences: STD, unwanted pregnancies, default establish intimate relationship later in life HIGH RISK FOR SEXUAL ABUSE: 3 years of age or younger Suffer from a develop mental delay Live in home where substance abuse occurs Have adolescent parents or a single parent Are in foster care Primary caretakers who were sexually abused themselves. Primary caretakers who are morally ill or who have a developmental delay. EPISODES OF CHILDHOOD SEXUAL ABUSE: ACUTE EPISODE Sexual abuse occurs within previous 72 hrs. of examination by clinician Evidence of moderate to severe injury such as virginal bleeding or genital lacerations SUB ACUTE EPISODES Sexual abuse occurs more than 72 hrs before an examination by a clinician. symptoms like minor abrasions or dysuria NON ACUTE EPISODES Sexual abuse more than 72 hrs before clinicians examination. Groups at risk: Women who are emotionally involved with the batterer. Children (silent victims) Elder partners Men Same sex couples Male living with make intimate partners Factors contributing to Domestic Violence Neurologic impairment Agitated depression No significant injuries or symptoms. PHYSICAL INDICATORS: Itching, pain bruises or bleeding in the external genitalia, vagina or anal area. Torn, stained or bloody undergarments Stretched hymen at a very young age Presence of semen oral sexually transmitted disease. Pregnancy in an older child and blade infection. BEHAVIOR INDICATORS: Fear of being touched and difficult of walking or sitting Reluctance to participate in recreational or physical activities. Poor peer relationship Delinquency, truancy, acting out or running away. Change in sleeping patterns; nightmare; or sudden fear of falling asleep. Bed wetting or thumb sucking Preoccupation with sexual organs of self or others.

Domestic Violence
Mistreatment/misuse of one person by another in the context of an intimate relation. It includes repeated battering and injury, psychological abuse, sexual assault, progressive social isolation, stalking, deprivation and intimidation. Designed to manipulate, control, and dominate the partner to achieve compliance and dependence. Antisocial or borderline behaviour Drugs and alcohol Lack of nurturing and mothering during childhood Poor socio economic conditions Loss of job Death of a significant family member Geographic move Onset of physical or mental illness. Developmental change or family change such as pregnancy.

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Forms of Domestic Violence A. Intimidation B. Threats C. Sexual abuse D. Isolation E. Emotional abuse F. Use of children G. Male privilege Cycle of Abuse and Violence Tension Building Violent Behaviour Period of Remorse / Contrition TENSION-BUILDING PHASE Disagreements occur within couple as battered person withdraws rather than making any attempts to display anger verbally or non-verbally. The baterrer becomes possessive, jealous, and fearful sensing that the battered partners anger. Emotional distancing occurs. ACUTE BATTERING PHASE (Violent Behaviour) Batterrer loses control of behaviour because of blind rage. Batterrer person also loses control and is unable to stop the physical abusiveness experienced. Both persons are in state of shock immediately. Batterrer is unable to recall his or her behaviours; battered person depersonalizes during abusive incident and is unable to recall in detail what occurred. LOVING PHASE (Period of Remorse/ Contrition) As both calm down, the batterer may exhibit feelings of remorse, beg forgiveness, promise not to abuse in the future and state that he or she cannot live without the battered partner. During this phase, the abused person believes the batterrers promises and forgives the batterrer because the partner feels less hopeless. H. Economic abuse I. Dynamics of Domestic Violence J. Barriers to leaving a violent relationship. K. Lack of resources L. Lack of institutional responses M. Traditional ideology

ADULT SEXUAL ABUSE

Sexual Harassment Unwelcomed advance or conduct on the job that creates an intimidating or offensive working environment. Stalking Pattern of unwanted communication, such as harassing or menacing behavior, coupled with a threat to do harm. Sexual Coercion One person dominates another by force or compels the other to performs sexual act.

RAPE
Forced vaginal penetration of a woman by a male assailant Legal term for male rape is sodomy or sexual assault by an intimate partner Essential Elements for Rape Use of force, threat, intimidation or duress Vaginal, oral or anal penetration Non consent by victims Rape Statues Attempted Rape Assault in which oral vaginal or anal penetration is intended but does not occur. Statutory Rape Act of sexual intercourse or sexual assault on an individual younger than the age of consent (16 years). Men who commit rape are usually from single parent homes, younger than 25 years and often married. High Risk of Rape

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Single females between ages 11 and 25 years. From low socio economic background. Lesbians and homosexual male at risk by their intimate partners. Individuals with mild developmental delays usually want to be accepted and to fit in with normal society. Motives for Rape Anger Rape Means of expressing anger, hatred and contempt toward the victim. Exhibits brutality by beating, kicking and choking. Power rape Committed by persons with low self esteem and a history of poor relationships with women and is done to prove manhood and strength. Intimidation, physical force or threats may occur. Sadistic Rape Person feels to inflict pain and torment on his victim to achieve sexual satisfaction. Rapist misinterprets victims emotional anguish as excitation rather than a refusal on his advantage. Impulsive or Opportunistic Rape Conjunction with another antisocial act such as robbery. An antisocial takes what he want whenever he desires it; rape therefore becomes a form of stealing. Sub Classifications of Rape Blitz Rape Unexpected surprise attack occurs in absence of prior interactions with victim. Confidence Rape Offender and victim has a prior interaction Marked Victim Rape Offender assaults a woman he has been acquainted in some way. Accessory-to-Sex Rape Vulnerable victims inability to give consent Date Rape Exploitation of an individuals friendliness of behaviour during a date. Four Categories of Male Rapist Sexual sadist Aroused by pain from victim Exploitive predators Use victims as objects for gratification Inadequate men Obsessed with fantasies about sex Men for whom rape is a displaced expression of anger and rage Emotional Reactions to Rape Rape Trauma Syndrome Acute Phase Victim is disrupted by crisis and displays emotional reactions of anger, guilt, embarrassment, humiliation, denial, shock, disbelief or fear of death. Reorganization Changing of daily life patterns, experience recurring dreams and nightmares, seek support from friends and family, initiate or refusing counseling or develop irrational fears (phobias). A. Fear of being indoors if rape occurred at home B. Fear of being outdoors C. Fear of crowds D. Fear of being alone E. Fear of people around the victim while the person engages in daily activities F. Fear of sexual activity Silent Rape Syndrome Victims fails to close information about rape to anyone, is unable to resolve feelings about sexual assault, experiences anxiety and may develop a sudden phobic reaction. Behaviour changes may include depression, suicidal

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behavior, somatization and acting out. Maltreatment of older adults by family members of caregivers

ELDER ABUSE
Etiology: Dependency on adult children or caretaker Financial dependency Personality conflicts with adult children or caretaker Societal attitudes toward aging Frustration on the part of the adult children or caretaker MAJOR TYPES OF ELDER ABUSE: Physical Abuse Sexual Abuse Emotional or Psychological Abuse Abandonment (Neglect) Financial or Material Exploitation Self-Neglect Physical Abuse - Direct beating, slapping, kicking, or shaking; overmedication Physical Abuse Indicators: Frequent, unexplained injuries accompanied by a habit of seeking medical assistance from various locations Reluctance to seek medical treatment for injuries, or denial of their existence Disorientation or grogginess indicating misuse of medications Fear or edginess in the presence of family member or caregiver Sexual Abuse - Sexual assault of physically or cognitively impaired elder Emotional or Psychological Abuse - Verbal assaults or threats Emotional or Psychological Abuse Indicators Helplessness Hesitance to talk openly Anger or agitation Withdrawal or depression Abandonment (Neglect) Leaving elderly unsupervised; allowing elderly to live in unsanitary conditions Abandonment (Neglect) Indicators Dirt, fecal or urine smell, or other health hazards in the elders living environment Rashes, sores, or lice on the elder Elder has an untreated medical condition or is malnourished or dehydrated not related to a known illness Inadequate clothing Financial or Material Exploitation - Misuse of money or property by children or legal guardian; stealing social security checks, credit cards, etc. Financial or Material Exploitation Indicators Unusual or inappropriate activity in bank accounts Signatures on checks that differ from the elders Recent changes in will or power of attorney when elder is not capable of making those decisions Missing valuable belongings that are not just misplaced Lack of television, clothes, or personal items that are easily affordable Unusual concern by the caregiver over the expense of the elders treatment when it is not the caregivers money being spent Self-Neglect - Elder threatens own health through failure to take medication or to eat inadequate amounts of food Self-Neglect Indicators Inability to manage personal finances, such as hoarding, squandering, or giving away money while not paying bills Inability to manage activities of daily living such as personal care, shopping, housework

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Wandering, refusing needed medical attention, isolation, substance use Failure to keep needed medical appointments Confusion, memory loss, unresponsiveness Lack of toilet facilities, living quarters infested with animals or vermin Defensiveness Conflicting accounts of elders abilities, problems, and so forth Previous history of abuse or problems with alcohol or drugs

Warning Indicators from Caregiver Elder is not given opportunity to speak for self, to have visitors, or to see anyone without the presence of the caregiver Attitudes of indifference or anger toward the elder Blaming the elder for his or her illness or limitations

Emotional Response to Elder Abuse Barriers to self-reporting of abuse by elderly victims: Cognitive impairment Inability to communicate clearly or accurately Fear of rejection Low self-esteem Loyalty to caretakers Lack of contact with helping persons Reluctance to report due to fear of retaliation by abuser

VIOLENCE
Intentional use of physical force or power, threatened or actual, against oneself, other person or against a group or community, which either results in or has a high likelihood of resulting in injury, death, psychological harm, maldevelopment or deprivation It is among the leading causes of death for people ages 15 to 44 years worldwide

Exposure to violence at home Exposure to media portrayals of violence Workplace Violence - Defined as any physical assault, threatening behaviors, erbal abuse, stalking, and psychological trauma in workplace Predictors: Angry customers dissatisfied with their treatment Clients with certain mental illness such as substance abuse, schizophrenia, delusional disorder, or depression Domestic batterers who may follow spouse to work Women who experience severe cases of premenstrual tension Disgruntled older male employees who fear a potential loss of their job Juvenile delinquents Career criminals Classification of Incidents Type 1: Incidents of violent acts performed by someone who has no legitimate relationship to the workplace and who commits robbery or another criminally motivated act Type 2:

Hate Crimes Crimes that are motivated by feelings of hostility against any identifiable group of people within a society Youth Violence Violence involving young persons, typically children, adolescents, and young adults between the ages of 10 and 24. The young person can be the victim, the perpetrator, or both. includes aggressive behaviors such as verbal abuse, bullying, hitting, slapping, or fist fighting Etiology: Increased access to and use of firearms Status within and among gangs and threats to gang status Family problems

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Incidents of violent acts or threats by someone who receives services from the workplace or from the victim Type 3: Incidents of violent acts or threats by a current or former employee, supervisor, manager, spouse, lover, relative, or someone who has dispute with the employee Emotional Response of Victims May develop psychological trauma and PTSD with hypervigilance, sleep disturbance, exaggerated startle response, intrusive memories, and avoidance of others Victims who are stalked experience a significant disruption in their everyday living, including work, as they alter routines to avoid detection by the offender Assessment of Abuse and Violence in Children and Adolescents Bio-psychosocial Data physical examination x-ray examination Including: inspection of the genitals and anus. If sexual abuse is suspected, cultures of the oral, rectal, or vaginal area may be performed to determine the presence or absence of STDs. Play therapy and art therapy can serve as assessment tools when child abuse is suspected. For mature patients, empathetic approach is used. Focusing on physical, behavioral, and environmental indicators of abuse as well as family dynamics. Documentation of the Assessment: Assessment findings must be well documented with emphasis on the childs or adolescents physical status, emotional status, developmental level or stage, interpersonal skills, and behavioral response to the family. Photographs taken before medical treatment help to document the initial appearance of the injuries. Assessment of Adult Victims of Physical Abuse or Violence Bio-psychosocial Data Determining the emotional status of the victim is imperative. Obtaining a medical history is also important to acquire additional clues to abuse and to make a tentative medical, psychological, and nursing diagnosis. Interview questions directed at victims of possible abuse must be carried out in a supportive and sensitive manner. Inquiries focus on any suspiciouslooking injuries; how the injuries occurred; whether the victim is living with the abuser, Etc. Documentation of Data During the assessment process, colored photographs are taken to complement the data noted on the body map. Assessment of Victims of Sexual Abuse or Rape The victim may be reluctant to disclose information, feel guilty that he or she allowed the abuse or rape to happen, or

Community Violence
Refers to exposure, as a witness or through actual experience, to acts of interpersonal violence perpetrated by individuals who are not intimately related to the victim When children witness violence, they experience stress-related symptoms that increase with the amount of violence they see. Future problems with aggression, depression, relationships, achievement, and abuse of drugs and alcohol.

Bullying
An act wherein a person or group repeatedly tries to harm someone who is weaker or who they think is weaker Includes verbal aggression, physical acts from shoving to breaking bones, targeting a student to be shunned or ignored by others, and cyber bullying involving unwanted emails, text message, or pictures posted on the internet

Hazing or Initiation Rites

A rite of passage ceremony marking entrance or acceptance into a group or society

NURSING PROCESS
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feel that he or she didnt offer enough resistance. The victim may also be exhibiting symptoms of rape-trauma syndrome. Guidelines for Collecting Data The assessment should entail a detailed trauma history, including information about the lifetime number and types of trauma experienced by the victim, as well as an evaluation of trauma characteristics, such as whether the person experienced life threat or injury during the rape--factors that are associated with increased post traumatic stress disorder. It is important that trauma-screening questions are direct and behaviorally specific. It is also essential that clinicians assess for disorders that co-occur with stress disorder, such as major depression, panic disorder, and substance abuse. Finally, it is important to assess factors that may influence adjustment, such as social support, coping skills, and available resources. Medical Data Performed to determine if any physical or life-threatening danger exists. Emergency medical care may be given concurrently with assessment if multiple bruises or injuries are present. Keep in mind that the victim may have somatic complaints or symptoms associated with trauma that are not readily observable. Behavioral and Emotional Response May vary according to the clients age and developmental stage Common behavioral responses of victims of all ages include nightmares, refusal to be left alone with certain individuals, poor social interactions, and problems in school or at work Disabled family coping r/t impaired ability to manage stressors constructively secondary to history of abusive relationship with own parents Fear r/t vulnerability to crime secondary to living in ghetto Rape-trauma syndrome r/t traumatic event of forced rape by stranger

Planning
Variety of setting To develop patients trust Immediate care should focus on meeting in the clients physical and emotional needs, promoting homeostasis and comfort, and reducing fear

INTERVENTIONS FOR VICTIMS OF CHILD ABUSE

Nursing personnel generally respond to child abuse with feelings of shock, anger, rage, or revulsion Always keep in mind that abusive parents, as well as abuse children, have severe unmet dependency needs, and accept abusive parents as vulnerable human beings How nurses can help the victim? Let victims make decisions Listen with patience Active listening Provide victims with information and referral

Psychotherapeutic Management (Nurse Patient Relationship)

The rape sexual-assault victim needs continual empathy and support The best approach in collecting evidence and providing nursing care is to move slowly and supportively, and to give rationales for each procedure The victims needs to be assessed for and helped with any new problems, such as anxiety, excessive anger and guilt, depression, acting out, isolation and etc. They more likely to attempt suicide. Long-term counseling is a necessity and hospitalization may become essential

Possible Nursing Diagnoses

Anxiety r/t actual threat to biologic integrity secondary to physical assault Impaired verbal communication r/t psychological barrier secondary to sexual assault Ineffective denial r/t need to escape personal secondary to intimate partner abuse

Roles of the Nurse

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Perform a physical examination to inspect and evaluate the body of the victim Provide the victim with referrals for medical and psychological care and support Provide support during the examination process

INTERVENTIONS FOR VICTIMS OF PHYSICAL ABUSE AND VIOLENCE

Important interventions focus on providing a safe environment, including emergency medical care when necessary; empowering the victim through supportive therapies; and exploring continuum of care to assist the victim to regain control of his or her own life Safe environment & Supportive therapies Have a referral to a local or domestic violence shelter Crisis Counseling Medications Encourage to verbalize feelings

INTERVENTIONS for Victims Of Sexual Abuse

Provide a safe environment Plan appropriate interventions Crisis intervention

INTERVENTIONS for Victims Of Youth or Workplace Violence and Hate Crimes

Developing an awareness of the problem Trauma/crisis counseling or criticalincident stress debriefing Providing assistance to trouble individuals

EVALUATION PROCESS
Evaluation focuses on the ability of the victim to regain control of his/her life and to live in an environment free of violence Clients emotional and physical well being

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