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Comboset 4- (C228) ATI-Community Health <Chapter 6, 7, 12, 18, 27, 30>

Terms in this set (155)

◯ The female partner is the victim in the majority of family violence, but the male partner may also be a victim of violence.
◯ Victims are at the greatest risk for violence when they try to leave the relationship.
◯ Pregnancy tends to increase the likelihood of violence toward the domestic partner.
The reason for this is unclear.
◯ Factors that make abuse against children more likely include:
■ The child is under 3 years of age.
■ The child is perceived by the perpetrator as being different (the child is the result of an unwanted pregnancy, is physically disabled, or has some other trait that makes him particularly
vulnerable).

◯ Older adults within the home may be abused because they are in poor health or because they exhibit disruptive behavior and because they are dependent on a caregiver. The potential for violence against an older adult is highest in families where violence has already occurred.
◯ Violence is most common within family groups, and most violence is aimed at family and friends rather than strangers.
■ Family violence occurs across all economic and educational backgrounds and racial/ethnic groups in the United States and is often termed "maltreatment."
■ Family violence/maltreatment can occur against children, domestic partners, or older adult family members.
■ Within the family, a cycle of violence can occur between domestic (intimate) partners:
☐ Tension-building phase - The abuser has minor episodes of anger and may be verbally abusive and responsible for some minor physical violence. The victim is tense during this stage and tends to accept the blame for what is happening.
☐ Serious battering phase - The tension becomes too much to bear and a serious incident takes place. The victim may try to cover up the injury or may get help.
☐ Honeymoon phase - The situation is defused for awhile after the violent episode. The abuser becomes loving, promises to change, and is sorry for the behavior. The victim wants to believe this and hopes for a change. Eventually, the cycle begins again.
☐ Periods of escalation and de-escalation usually continue with shorter and shorter periods of time between the two. Repeated episodes of violence lead to feelings of powerlessness.
Cultural differences can influence whether or not the nursing assessment data is valid, how the client responds to interventions, and the appropriateness of nursing interactions with the client.

Physical violence occurs when pain or harm results:
■ Toward an infant or child, as is the case with shaken baby syndrome (caused by violent shaking of young infants)
■ Toward a domestic partner, such as striking or strangling the partner ■ Toward an older adult in the home (elder abuse), such as pushing an older adult
parent and causing her to fall
Sexual violence occurs when sexual contact takes place without consent, whether the victim is able or unable to give that consent.







Emotional violence, which includes behavior that minimizes an individual's feelings of self-worth or humiliates, threatens, or intimidates a family member.
Neglect, which includes the failure to provide:
■ Physical care, such as feeding
■ The emotional care, such as interacting with a child, and/or stimulation necessary for a child to develop normally
■ An education for a child, such as enrolling a young child in school ■ Needed health or dental care Economic maltreatment, which includes: ■ Failure to provide the needs of a victim when adequate funds are available ■ Unpaid bills, resulting in disconnection of heat or electricity
Victim characteristics
■ Demonstration of low self-esteem and feelings of helplessness, hopelessness, powerlessness, guilt, and shame
■ Attempts to protect the perpetrator and accept responsibility for the abuse ■ Possible denial of the severity of the situation and feelings of anger and terror Perpetrator characteristics ■ Possible use of threats and intimidation to control the victim ■ Is usually an extreme disciplinarian who believes in physical punishment ■ Possible history of substance abuse ■ Is likely to have experienced family violence as a child



Infants
■ Shaken baby syndrome - Shaking may cause intracranial hemorrhage. Assess for respiratory distress, bulging fontanelles, and increased head circumference. Retinal hemorrhage may be present.
■ Any bruising on an infant before age 6 months is suspicious. ■ Preschoolers to adolescents
☐ Assess for unusual bruising, such as on abdomen, back, or buttocks. Bruising is common on arms and legs in these age groups.
☐ Assess the mechanism of injury, which may not be congruent with the physical appearance of the injury. Numerous bruises at different stages of healing may indicate continued beatings. Be suspicious of bruises or welts that have taken on the shape of a belt buckle or other object.
☐ Assess for burns. Burns covering "glove" or "stocking" areas of the hands or feet may indicate forced immersion into boiling water. Small, round burns may be caused by lit cigarettes.



☐ Assess for fractures with unusual features, such as forearm spiral fractures, which could be caused by twisting the extremity forcefully. The presence of multiple fractures is suspicious.
☐ Assess for human bite marks. ☐ Assess for head injuries - level of consciousness, equal and reactive pupils,
nausea/vomiting.


Older adults
☐ Assess for any bruises, lacerations, abrasions, or fractures in which the physical appearance does not match the history or mechanism of injury.
All states have mandatory reporting laws that require nurses to report suspected abuse; there are civil and criminal penalties for not reporting suspicions of abuse.
Nursing interventions for child or older adult abuse must include the following:
■ Mandatory reporting of suspected or actual cases of child or older adult abuse
■ Complete, accurate documentation of subjective and objective data obtained during assessment
Conduct a nursing history.
■ Provide privacy when conducting interviews about family abuse.
■ Be direct, honest, and professional.
■ Use language the client understands.
■ Be understanding and attentive.
■ Use therapeutic techniques that demonstrate understanding.
■ Use open-ended questions to elicit descriptive responses.
■ Inform the client if a referral must be made to children's or adult

Provide basic care to treat injuries. Make appropriate referrals. Nursing interventions for community-wide or mass casualty incidents include:

Early intervention
Provide psych' first aid, which includes:
Making sure the clients are physically and psychologically safe from harm
Reducing stress-related symptoms, such as using techniques to alleviate a panic attack
Providing interventions to restore rest/sleep and provide links to social supports and information about critical resources

☐ Depending on their level of expertise and training, mental health nurses may provide assessment, consultation, therapeutic communication and support, triage, and psychological/physical care.

Critical incident stress debriefing
☐ This is a crisis intervention strategy used to assist individuals who have experienced a traumatic event, usually involving violence (staff experiencing client violence, school children and personnel experiencing the violent death of a student, rescue workers after an earthquake) in a safe environment.
☐ Debriefing may take place in group meetings with a facilitator that and allows for a safe environment where thoughts and feelings may be expressed.
☐ The facilitator will acknowledge reactions, provide anticipatory guidance for symptoms that may still occur, teach stress management techniques, and provide referrals.
☐ The group may choose to meet on an ongoing basis or disband after resolution of the crisis.




Care After Discharge
Nursing Actions
■ Help client develop a safety plan, identify behaviors and situations that might trigger violence and provide information regarding safe places to live.
■ Encourage participation in support groups. ■ Use case management to coordinate community, medical, criminal justice, and
social services.
■ Use crisis intervention techniques to help resolve family or community situations where violence has been devastating.
Client Education ■ Instruct clients regarding normal growth and development. ■ Teach clients self-care and empowerment skills. ■ Teach clients ways to manage stress.

Client Outcomes

Client will develop safety plan. Client will participate in self-help or support group. Client will identify strategies to manage stress. Client will be free from injury.