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Maternity Ch 9 Violence & Abuse

Terms in this set (84)

Rape
Penetration, no matter how slight, of the vagina or anus with any body part or object, or oral penetration by a sex organ of another person, without the consent of the victim
Intimate Partner Violence
actual or threatened physical or sexual violence or psychological/emotional abuse
IPV among LGBT individuals
are equal to or greater than rates observed among heterosexual individuals
Risk factor Categories
*individual factors,
*relationship factors,
*community factors,
*societal factors
Generation to Generation
Violence is a learned behavior that, without intervention, is self-perpetuating
*Children who witness one parent abuse another are more likely to become delinquents or batterers themselves because they see abuse as an integral part of a close relationship
*at risk for developing psychiatric disorders, post-traumatic stress disorder (PTSD), developmental problems, school failure, violence against others, and low self-esteem
*Women who were physically or sexually abused as children have an increased risk of victimization and fear of crime, poor general health, and in addition experience adverse mental health conditions such as depression, anxiety, and low self-esteem
Myths about Violence
Battering of women occurs only in lower socioeconomic classes
*Substance abuse causes the violence
*Men have the right to discipline their partners. Battering is not a crime
*Violence occurs to only a small percentage of women
*Intimate partner violence (IPV) is typically a one time, isolated occurrence
*Women can easily choose to leave an abusive relationship
*Only men with mental health problems commit violence against women
*Pregnant women are protected from abuse by their partners
Women provoke their partners to abuse them Violent tendencies have gone on for generations and are accepted *IPV is only a heterosexual issue
Facts about violence
Violence occurs in all socioeconomic classes *Violence is a learned behavior and can be changed. The presence of drugs and alcohol can make a bad problem worse
*In the past, our patriarchal legal system afforded men the right to physically chastise their wives and children; we no longer live under that system. Women and children are no longer considered the property of men, and violence against them is a crime in every state
One in four women will be victims of violence Battering is a pattern of coercion and control that one person exerts over another.
*It is repeated using a number of tactics, including intimidation, threats, physical injury, economic deprivation, isolation, and sexual abuse.
*The various forms of abuse utilized by batterers help maintain power and control over their victims
*Women stay in the abusive relationship because they feel they have no options
*Abusers often seem normal and do not appear to suffer from personality disorders or other forms of mental illness
*One in five women is physically abused during pregnancy.
*The effects of violence on infant outcomes can include preterm delivery, fetal distress, low birth weight, and child abuse
*Women may be willing to blame themselves for someone else's bad behavior, but nobody deserves to be beaten
*The police, justice system, and society are beginning to make IPV socially unacceptable
*There is as much IPV in the lesbian/gay/bisexual/transgender population as in heterosexual relationships with the added psychological abuse of "outing" (when one partner threatens to disclose the others sexual preference in an effort to maintain power and control)
The cycle of violence
three distinct phases: the tension-building phase, the acute battering phase, and the honeymoon phase *cyclical behavior begins with a time of tension-building arguments, progresses to violence, and settles into a making-up or calm period.
*This cycle of violence increases in frequency and severity as it is repeated over and over again
*The cycle can cover a long or short period of time
Phase 1: Tension Building
During the first—and usually the longest—phase of the cycle, tension escalates between the couple
*The woman might sense that her partner is reacting to her more negatively, that he is on edge and reacts heatedly to any trivial frustration
*A woman often will accept her partner's building anger as legitimately directed toward her
*In her mind, if she does her job well, he remains calm, but if she fails, the resulting violence is her fault
Phase 2: Acute Battering
explosion of violence
*The batterer loses control both physically and emotionally
*when the victim may be assaulted or murdered
*They often deny the seriousness of their injuries and refuse to seek medical treatment
Phase 3: Reconciliation (honeymoon/calm)
a period of calm, loving, and contrite behavior on the part of the batterer
*attempts to make up for his brutal behavior and believes he can control himself and never hurt the woman he loves
*She feels responsible, at least in part, for causing the incident, and she feels responsible for her partner's well-being
Types of abuse
emotional
*physical
*financial
*sexual abuse
Emotional abuse
Promising, swearing, or threatening to hit the victim Forcing the victim to perform degrading or humiliating acts
Threatening to harm children, pets, or close friends Humiliating the woman by name-calling and insults *Threatening to leave her and the children
*Isolation from family and friends
*Destroying valued possessions
*Controlling the victim's every move
Physical abuse
Hitting or grabbing the victim so hard that it leaves marks
*Throwing things at the victim
*Slapping, spitting at, biting, burning, pushing, choking, or shoving the victim
*Kicking or punching the victim, or slamming her against things
*Attacking the victim with a knife, gun, rope, or electrical cord
*Controlling access to health care
Financial abuse
Preventing the woman from getting a job
*Sabotaging a current job
*Controlling how all money is spent
*Failing to contribute financially
Sexual abuse
Forcing the woman to have vaginal, oral, or anal intercourse against her will
*Biting the victim's breasts or genitals
Shoving objects into the victim's vagina or anus Forcing the woman to do something sexual that she finds degrading or humiliating
*Forcing the victim to perform sexual acts on other people or animals
Victims
In battered woman syndrome, the woman has experienced deliberate and repeated physical or sexual assault by an intimate partner
She is terrified and feels trapped, helpless, and alone She reacts to any expression of anger or threat by avoidance and withdrawal behavior
*Many victims were abused as children and may have poor self-esteem, poor health, PTSD, depression, insomnia, low education achievement, or a history of suicide attempts, injury, or drug and alcohol abuse
Abusers
expresses his feelings of inadequacy through violence or aggression toward others
*refuse to share power and choose violence to control their victims.
*They often exhibit childlike aggression or antisocial behaviors.
*They may fail to accept responsibility or blame others for their own problems
*might also have a history of substance abuse problems, trouble with the justice system, few close relationships, being sensitive to criticism, having a tendency to hold grudges, involved in power struggles, emotionally dysregulated, lacking in insight, prone to feeling misunderstood, mistreated, or victimized, mental illness, arrests, troubled relationships, obsessive jealousy, controlling behaviors, generally violent behavior, erratic employment history, and financial problems
Violence against pregnant women
Women are at a higher risk for violence during pregnancy
Factors leading to violence against pregnant women
Inability of the couple to cope with the stressors of pregnancy
*Young age at time of pregnancy
*Having less than a high school education for both partners
Unemployment for either or both in partnership Violence in the family of origin
*Cohabitation and single marital status
Sexual proprietariness on the part of the male partner Heavy drinking by partner
*Resentment toward the interference of the growing fetus and change in the woman's shape
*Doubts about paternity or the expectant mothers fidelity during pregnancy
Perception that the baby will be a competitor Outside attention the pregnancy brings to the woman *Unwanted pregnancy
*The woman's new interest in herself and her unborn baby
*Insecurity and jealousy about the pregnancy and the responsibilities it brings
*Financial burden related to expense of pregnancy and loss of income
*Stress of role transition from adult man to becoming the father of a child
*Physical and emotional changes of pregnancy that make the woman vulnerable
*Previous isolation from family and friends that limit the couple's support system
Abuse during pregnancy
threatens the well-being of the mother and fetus *Physical violence may involve injuries to the head, face, neck, thorax, breasts, and abdomen
*the relationship between abuse and poor mental health, especially depression and PTSD; poor quality of life; increased distress, fearfulness, anxiousness, and stressfulness; and increased use of tobacco, alcohol, and/or illicit drugs
*many of these conditions most often manifest during the postpartum period.
Myths about Rape
Women who are raped get over it quickly
*Most rape victims tell someone about it
*Once the rape is over, a survivor can again feel safe in her life
*If a woman does not want to be raped, it cannot happen
*Women who feel guilty after having sex then say they were raped
*Victims should report the violence to the police and judicial system
*Women blame themselves for the rape, believing they did something to provoke the rape
*When it comes to sex, men can be provoked to "a point of no return"
*Women who wear tight, short clothes are "asking for it"
Women have rape fantasies and want to be raped Only attractive women are raped
*Medication can help women forget about the rape
Facts about Rape
It can take several years to recover emotionally and physically from rape
*The majority of women never tell anyone about it. In fact, almost two thirds of victims never report it to the police
*The victim feels vulnerable, betrayed, and insecure afterward
*A woman can be forced and overpowered by most men
*Few women falsely cry "rape." It is very traumatizing to be a victim
*Only 1% of rapists are arrested and convicted. Factoring unreported rapes together with the odds of being arrested and getting a felony conviction, only 6% of rapists will ever spend a day in jail. In other words, 15 of 16 rapists walk free
*Women should never blame themselves for being the victim of someone else's violence
*Men are physically able to stop at any point during sexual activity. Rape is not an act of impulsive, uncontrolled passion; it is a premeditated act of violence
*No victim invites sexual assault, and what she wears is irrelevant
Reality and fantasy are different, Dreams have nothing to do with the brutal violation of rape Anyone can be raped. Children, the elderly, and people with physical and mental disabilities are easy targets of rape because of their vulnerability
*Initially medication can help, but counseling is needed
Women assaulted during pregnancy are at risk for
*Injuries to themselves and the fetus
*Depression
*Panic disorder
*Fetal and maternal deaths
*Chronic anxiety
Miscarriage Stillbirth
*Poor nutrition
*Insomnia
Placental abruption Uterine rupture
*Excessive weight gain or loss
*Smoking and substance abuse
*Delayed or no prenatal care
*Preterm labor
*Higher rate of surgical births
Chorioamnionitis Vaginitis
*Sexually transmitted infections (STIs)
*Urinary tract infections
*Premature and low-birth-weight infants
Signs of abuse during pregnancy
may include poor attendance at prenatal visits *unrealistic fears
*weight fluctuations
*difficulty with pelvic examinations
*nonadherence to treatment
Elder mistreatment (i.e., abuse and neglect)
is defined as intentional actions that cause harm or create a serious risk of harm to a vulnerable elder by a caregiver or other person who stands in a trust relationship to the elder
*female elders are abused at a higher rate than males and that the older one is, the more likely one is to be abused
Types of elder abuse
abuse neglect emotional abuse sexual abuse, financial/exploitation abuse
Physical and emotional sequalae of IPV
depression
*insomnia
*chronic pain
*difficulty trusting others,
*low self-esteem
*thoughts of suicide
*substance abuse
*anger issues
*atypical chest pain
*other kinds of somatic symptoms
Screening: Injuries
Bruises on their chest and abdomen
*scars from blunt trauma
*minor lacerations
*or weapon wounds on the face
*head, and neck
Screening: Injury sequelae
Headaches
*hearing loss from ruptured ear drums
*joint pain
*sinus infections
*teeth marks
*clumps of hair missing
*dental trauma
*pelvic pain
*breast or genital injuries
Screening: Mental health problems
Depression, anxiety, substance abuse, eating disorders, suicidal ideation or suicide attempts, anger toward health care provider, and PTSD
*Frequent tranquilizer or sedative use
*Delay in seeking medical attention and patterns of repeated injury
*Bruises to the upper arm, neck and face, abdomen, or breasts
*Comments about emotional or physical abuse of "a friend"
*STIs or pelvic inflammatory disease
*Appears nervous, ashamed, or evasive when asked questions
*Frequent health care visits for chronic, stress-related disorders such as chest pain, headaches, back or pelvic pain, insomnia, injuries, anxiety, and gastrointestinal disturbances.
*Partner's behavior at the health care visit: appears overly solicitous or overprotective, is unwilling to leave her alone with the health care provider, answers questions for her, and attempts to control the situation
Take Note
If abuse is detected, immediately isolate the woman and provide privacy to prevent potential retaliation from the abuser
SAVE MODEL
SCREEN
ASK
VALIDATE
EVALUATE
SCREEN all of your clients for violence by asking:
*Within the last year, have you been physically hurt by someone?
*Do you feel you are in control of your life?
*Within the last year, has anyone forced you to engage in sexual activities?
*Can you talk about your abuse with me now?
*In general, how would you describe your present relationship?
ASK direct questions in a nonjudgmental way:
*Begin by normalizing the topic to the woman
*Make continuous eye contact with the woman
*Stay calm; avoid emotional reactions to what she tells you.
Never blame the woman, even if she blames herself. Do not dismiss or minimize what she tells you, even if she does.
*Wait for each answer patiently. Do not rush to the next question.
Do not use formal, technical, or medical language. Avoid using leading questions; be direct and to the point.
*Use a nonthreatening, accepting approach
VALIDATE the client by telling her
*You believe her story
*You do not blame her for what happened
*It is brave of her to tell you this
*Help is available for her
*Talking with you is a hopeful sign and a first big step.
EVALUATE, educate, and refer this client by asking her
*What type of violence was it?
*Is she now in any danger?
*How is she feeling now?
*Does she know that there are consequences to violence?
*Is she aware of community resources available to help her?
Documentation
must include details about the frequency and severity of abuse; the location, extent, and outcome of injuries; and any treatments or interventions
*use direct quotes and be very specific: "He choked me."
*Describe any visible injuries and use a body map (outline of a woman's body) to show where the injuries are.
*Obtain photos (with informed consent) or document her refusal if the woman declines photos
Interventions
listening
*communicating belief
*validating the decision to disclose
*emphasizing
Primary prevention
aimed at breaking the abuse cycle through community educational initiatives by nurses, physicians, law enforcement, teachers, and clergy
Secondary Prevention
focuses on screening high-risk individuals and dealing with victims and abusers in early stages, with the goal of preventing progression of abuse
Tertiary Prevention
activities are geared toward helping severely abused women and children recover and become productive members of society and rehabilitating abusers to stop the cycle of violence. These activities are typically long term and expensive
Leaving
is a process and not an event
Safety Plan for Leaving an Abuse Relationship
Driver's license or photo ID
Social Security number or green card/work permit Birth certificates for you and your children
Phone numbers for social services or women's shelter The deed or lease to your home or apartment
*Any court papers or orders
*A change of clothing for you and your children
*Pay stubs, checkbook, credit cards, and cash
*Health insurance cards
*If you need to leave a domestic violence situation immediately, turn to authorities for assistance in gathering this material.
Develop a "game plan" for leaving and rehearse it. Don't use phone cards—they leave a trail to follow
Sexual violence
includes IPV
*human trafficking
*incest
*FGC
*forced prostitution
*bondage
*exploitation,
*neglect
*infanticide
*sexual assault
Psychologic, Physical & Cognitive Symptoms
include chronic pelvic pain
*headaches
*backache
*STIs
*pregnancy
*anxiety,
*denial
*fear
*withdrawal
*sleep disturbances,
*guilt
*nervousness
*phobias,
*substance abuse,
*depression,
*sexual dysfunction,
*PTSD
*Many contemplate suicide
Characteristics of Assailants
Such men become angry and experience feelings of powerlessness
*They become jealous easily
*do not view women as equals
*frequently are hot tempered
*have a need to be reassured of their manhood
*do not handle stress in their lives well
**They commit a sexual assault as an expression of power and control
Sexual abuse
occurs when a woman is forced to have sexual contact of any kind (vaginal, oral, or anal) without her consent
*the peak ages of such abuse are from 8 to 12 years of age
*females are more likely to be sexually abused by father, brother, family member, neighbor, boyfriend, husband, partner, or ex-partner than by a stranger or anonymous assailant
Childhood sexual abuse
is any type of sexual exploitation that involves a child younger than 18 years old
*might include disrobing, nudity, masturbation, fondling, digital penetration, forced performance of sexual acts on the perpetrator, and intercourse
*are at a heightened risk for repeat abuse
Interventions for sexually abused children or women
should include referral for mental health counseling *Follow up for any medical problems (e.g., genitourinary complaints) should be arranged with the child's or woman's primary care physician.
*If the community has an abuse referral center, refer the victim there for follow-up care according to local protocol
Medical consequences of sexual abuse
require the prophylaxis and treatment of STIs *emergency contraception,
treatment of any injuries that resulted from the abuse *post-assault bleeding require an emergent evaluation and may need emergency treatment by a gynecologist for repair of genital injury
Incest
is defined as sexual activity between persons so closely related that marriage between them is legally or culturally prohibited
Childhood incest abuse
involves any kind of sexual exploitation between a child and another person that violates the social taboos of family roles; children cannot yet understand these activities and cannot give informed consent
Signs & Symptoms
serious injuries,
*internal damage
*STIs, or pregnancy
*eating disorders
*sexual problems in adult life
*difficulty in interpersonal relationships
*anxiety
*PTSD
*intense guilt and shame,
*low self-esteem
*depression
*self-destructive behavior
Rape
is an expression of violence, not a sexual act
*Rape distorts one of the most intimate forms of human interaction
*is not an act of lust or an overzealous release of passion: it is a violent, aggressive assault on the victim's body and integrity
reasons basically involve the motives of anger, power, eroticized cruelty, and opportunistic mating *Rape is a legal rather than a medical term. It denotes penile penetration of the vagina, mouth, or rectum of the female or male without consent
*It may or may not include the use of a weapon
Statutory rape
is sexual activity between an adult and a person under the age of 18 and is considered to have occurred even if the underage person was willing
Four phases of rape recovery
Acute phase (disorganization)
*outward adjustment phase (denial)
*reorganization
*integration & recovery
Acute phase (disorganization)
Shock, fear, disbelief, anger, shame, guilt, feelings of uncleanliness; insomnia, nightmares, and sobbing
Outward adjustment phase (denial)
Appears outwardly composed and returns to work or school
*refuses to discuss the assault and denies need for counseling
Reorganization
Denial and suppression do not work, and the survivor attempts to make life adjustments by moving or changing jobs and uses emotional distancing to cope
Integration and recovery
Survivor begin to feel safe and starts to trust others *She may become an advocate for other rape victims
acquaintance rape
someone is forced to have sex by a person he or she knows
*Rape by a coworker, a teacher, a husband's friend, or a boss is considered acquaintance rape
Date rape
an assault that occurs within a dating relationship or marriage without consent of one of the participants, is a form of acquaintance rape
Date rape drugs
are also known as "club drugs" because they are often used at dance clubs, fraternity parties, and all-night raves.
rohypnol
(also known as "roofies," "forget pills," "mind erasers," or the "drop drug")
*comes in the form of a liquid or pill that quickly dissolves in liquid with no odor, taste, or color.
This drug is 10 times as strong as diazepam (Valium) The effects can be felt within 30 minutes and produces memory loss for up to 8 hours
**the MOST common
Gamma hydroxybutyrate
(GHB; called "liquid ecstasy" or "easy lay")
*produces euphoria, an out-of-body high, sleepiness, increased sex drive, and memory loss
*GHB takes effects in about 15 minutes and can last 3 to 4 hours
*comes in a white powder or liquid and may cause unconsciousness, depression, and coma.
ketamine
(known as "Special K," "vitamin K," or "super acid")
*acts on the central nervous system very quickly to separate perception and sensation
*Combining ketamine with other drugs can be fatal
Take Note
rape is viewed as a situational crisis that the survivor is an unforeseen event
Symptoms of PTSD
are divided into 3 groups
*intrusion
*avoidance
*hyperarousal
Intrusion
(reexperiencing the trauma, including nightmares, flashbacks, recurrent thoughts)
Avoidance
(avoiding trauma-related stimuli, social withdrawal, emotional numbing)
Hyperarousal
(increased emotional arousal, exaggerated startle response, irritability)
Sexual Assault Nurse Examiners (SANE)
a registered nurse specially trained to conduct sexual assault evidentiary examinations for rape victims
*In addition to the collection of forensic evidence, they also provide access to crisis intervention, STI testing, and emergency contraception
Collecting Evidence,
the victim should not shower or bathe before presenting for care
Assessing for STI's
a pelvic examination will be done to collect vaginal secretions to rule out any STIs
Preventing pregnancy
essential element in the care of rape survivors involves offering them pregnancy prevention
*emergency contraceptive pill, sometimes called postcoital contraception
*Emergency contraception works by preventing ovulation, fertilization, or implantation
*most effective if it is taken within 12 hours of the rape
Female Genital Cutting (FGC)
also referred to as female genital mutilation (FGM) or female circumcision
*defined as a procedure involving any injury of the external female genitalia for cultural or nontherapeutic reasons
*it is associated with feminine beauty and often signifies a rite of passage from childhood to adulthood.
*Female cutting is performed to decrease a woman's sexual desires and to ensure her chastity until marriage and receipt of a dowry from the prospective groom
Complications of FGC
It is frequently performed without anesthesia under nonsterile conditions.
*Cutting tools can be anything from razors blades to knives to pieces of glass or tin can lids.
*Complications can include infertility, dysmenorrhea, dyspareunia, sexual dysfunction, infection, hemorrhage after the procedure, vaginal stenosis, chronic vaginitis, pelvic inflammatory disease, chronic urinary tract infections, incontinence, genital fistulas, recurrent abscesses, transmission of HIV and hepatitis during the procedure, severe pain and shock after the procedure, difficulty walking or using stairs due to severe scarring, urinary retention, inability to experience orgasm, and difficulty in giving birth.
*Long-term complications related to FGC include chronic pain, dyspareunia, and difficult childbirth.
**The most common long-term complication is the formation of inclusion clitoral dermoid cysts and labial fusion
FGC Type I
Excision of the prepuce with excision of part or the entire clitoris
FGC Type II
Excision of the clitoris and part or all of the labia minora
FGC Type III (Infibulation)
Excision of all or part of the external genitalia and stitching/narrowing of the vaginal opening
FGC Type IV
Pricking, piercing, or incision of the clitoris or labia *Stretching of the clitoris and/or labia
*Cauterizing by burning the clitoris and surrounding tissues
*Scraping or cutting the vaginal orifice
Introduction of a corrosive substance into the vagina Placing herbs into the vagina to narrow it
Human Trafficking
as the recruitment, transportation, transfer, harboring or receipt of persons, by means of the threat or use of force, of abduction, of fraud, or deception to achieve the consent of a person having control over another person, for the purpose of exploitation
Health risks of human trafficking
such as rape
*physical injury such as cigarette burns
*fractures
*bruises
*torture
*HIV/AIDS
*STIs
*cervical cancer
*violence
*hazardous work environments
*poor nutrition
*drug and alcohol addiction
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