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Mental health test 4: domestic violence

Terms in this set (44)

Mental health test 4: domestic violence
Mental health test 4: domestic violence
Why is violence so prevalent in our culture?
- sociocultural attitutdes towards women, children and the elderly, patriarchy, capitalism, religion, power, control
- value placed on violence to solve problems, ex. TV, movies, spanking, status quo
Which country has highest suicide/homicide rate?
U.s.
- highest murder rate of industrialized country also
- leading cause of death among adolescent males is GSW
- suicide is third leadign cause of death among children and adolescents
violence myth
- violence is usually committed by drug addicted males
- sexual perpetrators are usually strangers to their victims
- battered women are responsible for their batterers violence
violence facts
- battered women are afraid to leave their batterers
Definition of violence and abuse
- broad and holistic
- should include mental, physical, emotional and sexual abuse
- many argue that spanking of children should be included
- intentional harmful acts, whether or not they result in physical injury
What influences identification of the problem
- lack of assessment, intervention and responsiveness by physicians and nurses
- failure to inquire
- subtle blaming and rejection of battered women (personal values)
- lack of knowledge, stereotypes, prejudices and poor role models
- nurses themselves are victims of violence
incidence of intimate partner violence
- 5.3 m intimate partner victimizations per year in U.S. women ages 18 or older
- 3.2 m intimate partner victimizations/year in u.s. men
- more injuries are attributed to intimate partner violence than to all rapes, muggings and auto accidents combined
- significant public health problem
- national objective is to reduce rate by 20% by 2010
- abuse of female partners is the most common form of family violence
definition of battering
- a pattern of behavior used to establish power and control over another person through fear and intimidation, often including the threat or use of violence.
- battering happens when one person believes they are entitled to control another
definition of battered wife
- one who is physically emotionally or sexually assaulted
- she is often accused of behaving in ways that provoke the violence even though her actions are a real response to the constant fear of never knowing why or when she will be beaten
battered women stats
- the most common cause of injuyr to women in the u.s.
- 31% of u.s. women report abuse by their intimate partners at least once
- once started, battering almost always becomes more frequent and gets worse
- battering often begins in dating
- 1/10 women in any health care setting is a victim of abuse by her intimate mate
- 20-25% of female ER visits are due to battering but < 8% are id'd as abused in medical record
- up to 25% of pregnant women are physically abused
battered women myths debunked (these are true statements)
- can occur in all economic groups, cities and rural communities
- 250,000 GA women are beaten each year
- 10 women die per day due to domestic violence
controlling behaviors of the abuser
- economic abuse
- sexual abuse
- threats and intimidation
- isolation from support systems
- continual demeaning and insulting comments
- intentional breaking of objects to terrorize
the cycle of violence
1. tension building phase
2. violent act
3. honeymoon period
tension building phase
- typically no battering occures
- establishes control over victim
- repetitive infliction of psychological trauma or emotional abuse
- hostile barrages over minor offenses
- loss of freedom (monitor phone calls, mail, gas)
- assault on self esteem (insults, worthlessness)
eruption of violence
- tension can't be contained
- victim and children may be severely injured
- sometime the victim incites the violence due to inner terror and knowing that a phase of relative calm will follow the battering
honeymoon period
- perpetrator often acts kind, contrite, loving
- begs for forgiveness, promises to not repeat
- appears filled with remorse
- once this period nears an end, the tension builds once again and cycle repeats,
- cycles become more frequent and more violent over time
consequences
- acute stress d/o: sx < 1 month
- ptsd : sx > 1 month
- dissociative identity d/o
- substance abuse
- low self esteem, guilt, shame, anger, intimacy problems
why do women stay
- economic - worry about homelessness, no support for self and children
- belief that making marriage work is their responsibility
- fear of retaliation
- lack of support network
- religous reasons
- hopefulness: this time he really is sorry
Nursing issues/action
1. examine own beliefs/ biases
2. learn about cultural issues r/t role of women and abuse
3. develop a high index of suspicion during assessment
4. establish a trust/empathetic relationship with client
5. separate women from the abuser for private interview. not always easy
6. conduct a danger assessment
7. to ensure safety, you may have to contact authorities at your institution or in the community
Danger assessment
1. has physical violence increased in frequency or severity in the past year
2. does he ever try to choke you
3. is there a gun in the house
4. has he ever forced you into sex when you didn't want it
5. does he threaten to kill you
6. does he use illegal drugs
7. is he drunk every day or almost every day
8. does he control most of your daily activities
9. has he ever beaten you while you were pregnant
10. is he violent and constantly jealous
11. have you ever threatened or tried to comitt suicide
12. has he ever threatened to commit suicide
13. is he violent towards teh children
14. is he violent outside the home
when is the most dangerous time?
- separation time
- 65% of all women who are murdered were killed just after they left their abuser or while attempting to leave
- battered women need a safety plan
Child abuse and neglect
- any recent act or failure to act on the part of a parent or caretaker which results in death, serious physical or emotional harm, sexual abuse or exploitation
- an act or failure to act which presents an imminent risk of serious harm
- includes physical, emotional, sexual abuse
child neglect and abuse prevalence
- unknown
- laws are so different
- 3.3 million referrals to child protection agencies in 2006
- not all are referred, not all are investigated and not all are substantiated
child abuse stats
- age group 0 to 1 year had the highest rate of victimization
- boys = girls
- white children > AA > Hispanic
- most perpetrators are biological parents, more women than men perps.
- most perps were younger than age 40
Child neglect
- failure to provide food, clothing, shelter, medical care
- indicators - diaper dermatitis, lice, scabies, dirty appearance, inappropriate clothes for weather, unclean/unsafe living environment
Physical abuse
- severe spanking, hitting, kicking, shoving
- implements: fists, belts, cords, lit cigarettes, forks, knives, hot water
- the younger the age - increased risk for injury
child abusers abused as a child
higher risk of becoming an abuser if they were abused as a child, but doesn't have to happen
Sexual abuse
- incest, molestation, exhibitionism, child pornography, child prostitution, pedophilia
- girls and boys equally abused
- stepfathers most likely offenders for girls
- boys = unrelated males (coaches, pastors)
When to suspect abuse
- explanations are implausible
- different versions of the incident
- seeking treatment is delayed
Dynamics of parents abusers
- most likely abused as a child
- high level of family violence
- being abused by spouse
- may be abusing etoh/drugs
- poor self image distrust
- low impulse control
- unrealistic expectations of children
- negative view of children
- fear of spoiling child
Dynamics of the child
- disrupted bonding/attachment (unwanted pregnancy, unpreferred gender)
- prematurity babies: cry more, fussy eater
- disabled, special needs
- developmental delays, biting, resistant to toilet training
- outcome = rejection, worthless, objectionable behavior continues and so does the abuse!
effects of sexual abuse
- sexual acting out
- ptsd symptoms
- anxiety, fear, depression, somatic complaints, aggressive or antisocial behaviors, excessive masturbation, socially withdrawn, school learning problems, hyperactivity, disturbed sleep
- Play therapy is very helpful!!
Role of nurse
- Obligated to report to authorities!!
- planning: establish a trusting relationship with family to achieve goal development
- Implementation: secure physical/psychological safety and health of the child
- assist parent to understand the consequences of their behavior
- develop strategies with parents to prevent further abuse
What can you DO or SAY to help a child
- ask if any abuse has occurred
- tell the child you believe him/her
- acknowledge it is hard to talk about such things
- make it clear it is NOT the child's fault and they are not bad
- avoid pressing for details beyond what they freely disclose
- do not make promises you can't keep or promise confidentiality
Emotional abuse
1. rejecting
2. isolating
3. terrorizing
Rejecting
- refusing to acknowledge child's worth, legitimacy of needs
Isolating
- eliminating normal social experiences, no friends etc.
Terrorizing
- creating a climate of fear, teaching that the world is a hostile place
Munchausen's syndrome by proxy
- intentional production or feigning of physical or psychological s/s in another person (usually child) who is under their care for the purpose of indirectly assuming the sick role
sexual abuse and mental retardation
>90% of developmentally disabled will experience sexual abuse at some point in their lives
- extreme pressure t acquiesce out of fear
- a need for acceptaonce or dependent relationship to abuser
- lack of understanding of what is happening
why don't they tell
1. not realizing it is abusive, illegal
2. fear of not being believed
3. they have learned not to question caregivers
4. think they don't have the right to refuse
5. communication skill deficits
what do all victims have in common
1. feel shame and guilt
2. reluctant to disclose the abuse for fear of retribution and/or believe they provoked or deserved the abuse
3. have strong feelings of loyalty toward perpretrator
Nursing implications
- extreme patience and understanding is required
- rewards may be slow coming
- it is our duty to identify, report and assist victims of abuse
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