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Behavioral Health Chapter 28: Child, Elder & Intimate Partner Violence
Terms in this set (34)
Child, Partner, and Elder Violence
- family violence is prevalent among all social strata: ethnic, religious, age, and social and SES
- besides family abuse, trusted authority figures are part of the picture of violence in our society
- often underdiagnosed as people don't report
What are the 4 categories of abuse?
Social Learning Theory
- learning theory or intergenerational violence theory of family violence relies on role modeling, identification, and human interaction
- child learns violence as a behavioral norm
Societal and Cultural Factors
- poverty or unemployment
- communities with inadequate resources
- social isolation of families
Personality traits "cause" abusiveness.
Legal or illegal drugs and alcohol may co-exist with family violence.
Some abusers argue a "loss of control," but this is not supported by behavior as evidenced by:
Perpetrators of violence most likely choose not to hit bosses or policemen, no matter how angry.
Abusers often plan where (in the home), when (no one is around), and how (leave no visible marks) they inflict violence.
(Child Abuse) Physical abuse and deaths
80% were younger than 4 years of age.
Majority of these were infants of 1 year of age or younger.
Parents are usually the perpetrators, but siblings can be also.
(Child Abuse) Neglect
59% of all cases
(Child Abuse) What does overindulgence result in?
- lack of empathy
- social/emotional impairment
(Child Abuse) Sexual Abuse
- 1/4 girls
- 1/6 boys
(Child Abuse) Assessment
- reassure children that they did not do anything wrong
- children should not feel pressured to talk
- experience should be nonthreatening and supportive
- use open-ended questions
- interview should not resemble trial or inquisition
- children may express experiences through playing out the incident with dolls or drawings
- do not suggest answers
- do not promise that everything is confidential (abuse must be reported)
- do not react with shock to anything; do not force a child to undress or be examined
(Child Abuse) Characteristics of Abusive Parents
- history of violence, neglect, or emotional deprivation as a child
- low self-esteem
- poor coping skills
- involved in a crisis situation (unemployment, divorce, financial difficulties)
- unrealistic expectations of a child
- frequently use harsh punishment
- history of severe mental illness
- violent temper outbursts
- history of drug or alcohol abuse
- feels little or no control over life
- low tolerance for frustration
- poor impulse control
(Child Abuse) Parent/Caregiver Interview Assessment Guidelines
- conduct a private interview
- be direct, honest, and professional
- be attentive and understanding
- inform the person if you must make a referral to Child Protective Services, and explain the process
- try to "prove" accusations or demands
- display horror, anger, or disapproval of parents or situation
- place blame on or make judgements about the parent(s) or child
(Child Abuse) What is the primary goal?
(Child Abuse) Nursing Diagnoses
- disabled family coping
- posttrauma syndrome
- impaired parenting
- acute pain
- delayed growth and development
- imbalanced nutrition: less than body requirements
(Child Abuse) Short-Term Goals
- receive medical care for injuries within an hour
- notify proper state authorities to ensure continued safety for the child after abuse is suspected
- provide safety until adequate home or family assessment is made
(Child Abuse) Interventions
- adopt a nonthreatening, nonjudgemental relationship with the parents
- understand that children do not want to betray their parents
- provide (or have a physician provide) a complete physical assessment of the child
- using dolls might help the child tell how the "accident" happened
- early diagnosis results in a better outcome
- forensic examination of the sexually assaulted child should be conducted according to specific protocols
(IPV) Intimate Partner Violence
Is the number one cause of ED visits by women.
Is drastically underreported
Between 22% and 39% of all US women experience battering.
Worldwide rate: 69% (2015)
Prevalence of DV by women against men has increased.
Also occurs in LGBT communities.
Is the leading cause of homelessness among women.
IVP is the leading cause of injury-related deaths during pregnancy.
(IPV) Teen Dating Violence
Between 25-33% of adolescents report verbal, physical, emotional, or sexual abuse from a dating partner each year.
In teen relationships, girls and boys abuse each other about equally.
Violence is from both past and present partners.
About 25% of all high school and college women have been physically or sexually abused by a dating partner.
(IPV) Characteristics of Battered Partner
- does not ask to be beaten and does not enjoy it
- lives in terror
- does not usually initiate the violence, but when aggressive toward a violent mate, it is usually in self-defense
- has feelings of powerlessness and low self-esteem
- loses his or her sense of self
- violence and pain remain secret
- approximately 93% of women who kill their mates have been battered by them
(IPV) Characteristics of Batterer
- denies that the abuse occurs
- shifts the responsibility to the partner
- belittles, criticizes, insults, uses name calling, and undermines
- use threats
- control through isolation
- limit the family or friends
- controls activities and social events
- tracks the time or mileage on the car
- monitors activities
- stalks the partner at work
- takes the partner to and from work or school
- may demand permission to leave house
- control money and resources
- use power - make partner subservient
(IPV) Cycle of Violence
1.) tension-building phase
- abuser: edgy; minor explosion; may become verbally abusive; minor incidents begin
- victim: feels tense and afraid; helpless; becomes compliant; accepts blame
2.) serious battering phase
3.) honeymoon phase
- abuser: loving behavior; contrite; makes promises to change
- victim: trusting; hoping for change; wants to believe partner's promises
- be non-judgemental
- be matter of fact when asking questions
- avoiding asking why they have stayed
- document signs and symptoms
- ask permission to treat
- watch body language and facial expressions
If injury does not match the explanation or if the patient minimizes the abuse, then suspect IPV.
If IPV is suspected, then complete a physical history, including an x-ray study and a neurologic examination.
Rape may be part of the abuse - evaluate, especially if the woman is pregnant, exposed to sexually transmitted diseases (STDs), or has signs of infection or trauma.
Signs of abuse may include burns, bruises, scars, and other wounds in various stages of healing, particularly around the head and neck.
Physical examination includes assessing:
Internal injuries (concussions, perforated eardrums, abdominal injuries, eye injuries, and strangulation marks on the neck)
Broken (fractured) bones - arms, pelvis, ribs, clavicle, legs, or jaw
Examination might reveal burns from cigarettes, acids, scalding liquids, or appliances.
(IPV) 3 Questions
1.) Have you been hit, kicked, punched, or otherwise hurt by someone within the past year? If so, by whom?
2.) Do you feel safe in your current relationship?
3.) Is there a partner from a previous relationship who is making you feel unsafe now?
(IPV) Safety Plan
Tell the neighbors about the abuse, and ask them to call the police when they hear a disturbance.
Have a code word to use with the kids, family, and friends.
Have a safe place selected in case you have to leave.
Pack a bag beforehand with:
Essential clothes and valuables
Prepaid phone card, cell phone, address book, and a 1-month supply of medications
Keep this packed bag hidden but easy to grab quickly.
Include legal documents:
Social security card
Chloe is now being seen by the ED physician. Her husband, Chad, is quietly demanding to see his wife. As the triage nurse, what are your best actions? (Select all that apply.)
A. Have a staff member regularly touch base with Chad in the waiting room to reassure him that Chloe is "fine" but no room for visitors is provided.
B. Immediately call hospital security.
C. Move Chloe to secluded area in the ED so that you can interview her in private and advise her of safe shelters and offer brochures.
D. Insist that Chloe admit she is being abused by Chad and immediately report the abuse to the police department.
(IPV) Nursing Diagnosis
- risk for violence
- risk for injury
- acute or chronic pain
- risk for trauma
- risk for self-directed or other-directed violence
(Elder Violence) Prevalence
Elder abuse is serious and rapidly growing.
Wave of baby boomers - an overwhelming number of older adults, 65 years +, will affect the next decade and beyond.
Health care system is unprepared.
Population is growing rapidly.
6% of older adults are mistreated annually.
Between 70-80% of incidents of elder abuse are never reported.
Numbers of elder abuse will increase.
(Elder Violence) 5 Types
(Elder Violence) Characteristics
- seniors are vulnerable to abuse and other crimes
- age-related syndromes often result in frailty, making older adults more at risk for abuse and neglect
- frailty places older adults at a greater risk for sexual abuse
- when reported, it is often disbelieved
- elder abuse is most often diagnosed in patients with depression, alcohol or drug abuse, dementia, or psychiatric illness, which compounds the person's vulnerability and draws attention to their vulnerable situation
(Elder Violence) Assessment
- signs of abuse are similar to IPV
- fear of being alone with caregiver
- obvious malnutrition
- bedsores or skin lesions
- begging for food
- needs medical and/or dental care
- left unattended for long periods
- reports of abuse and neglect
- passive, withdrawn, and emotionless
- concern over finances and missing valuables
(Elder Violence) Interventions and Outcomes
- check the individual state for laws regarding elder abuse
- involve APS if abuse is suspected
- suggest family members meet on a regular basis to identify stressors
(Elder Violence) Notify community agencies
Support group for elder and abuser
Meals on Wheels
Daycare for seniors and respite services
Visiting nurse services
Encourage abuser's use of counseling
Which is most true about elder abuse?
A. Abusive caretakers are mentally ill.
B. Most abused older adults were abusive themselves as parents.
C. Often an abusive caretaker is financially dependent on the older adult in their care.
D. It is against the law for a caretaker to have any access to an older adult's bank account.
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