Nursing Care of Survivors of Abuse and Violence

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Nursing Care of Survivors of Abuse and Violence

• Mary Vercoutere,RN,MSN,CNS
• Instructor

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Introduction

• Violence as a public health issue.
• Effects of violence can lead to problems of
  anxiety, depression, suicide and other health
  problems.
• Experience of violence is devastating and
  survivors are often seen in psychiatric care.
• The true prevalence is unknown due to
  underreporting. Of those reported, 95 of the
  victims of family violence are women. Domestic
  violence is the leading cause of injury to women
  between the ages of 15-44.

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Topics of Discussion

• Predisposing factors Biological theories,
  psychological theories, sociocultural theories
• Characteristics of Family Violence Types of
  mistreatment
• Nursing Attitudes towards survivors of violence
• Nursing Assessment/ Interventions

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Predisposing Factors

• Biological Theories
• Neurological systems in humans and animals effect
  the expression and inhibition of aggression.
  This includes the temporal lobe, limbic system
  and the amygdaloid nucleus.
• There are neurotransmitters that help in the
  expression and inhibition of aggression
  norepinephrine,dopamine, serotonin.
• Head injury, brain damage

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Genetic

• Genetic components have been linked to aggressive
  and violent behavior.
• Disorders of the brain can lead to violent
  behavior such as brain tumors in the limbic
  system and temporal lobe.
• Diseases encephalitis, epilepsy, mood
  disorders, dementias, Schizophrenia, Borderline
  personality DO, Antisocial Personality DO, and
  psychosis.

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Psychological Theories

• This theory looks at a cause for violence from
  unmet needs for security and satisfaction in
  life. This leads to undeveloped ego strength.
• When frustration is felt, it is aggression and
  violence that give the individual control and
  power in the situation.
• Underdeveloped ego means the individual doesnt
  feel guilt or self responsible.

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Psycho/social Theories

• Children learn from role-models
• ExampleParents, TV, external models.
• 1950s-60s Heroes didnt kill anybody
• Gene Autry, Roy Rogers, Hop Along Cassity
• Cultural- Current general acceptance of violence
  in America has profound effect on the violence in
  society.
• Example a husbands use of violence be accepted
  if his wife is having an affair.

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Characteristics of Family Violence

• Family violence includes a broad range of
  behavior including physical and emotional abuse
  of children, neglect of children, spouse
  battering and elder abuse.
• Regardless of the abuse, all members of the
  family, extended family are affected.
• This may be a family secret, think this is
  private.
• Common characteristics are multigenerational,
  isolation, problems with authority figures, abuse
  of power, effect of ETOH, drugs.

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Children of Abuse

• Psychotherapy to Process Grief and to bring out
  good so they dont focus on the trauma.
• Play Therapy a natural way for children to
  communicate.
• Reading stories used to pull out childs inner
  turmoil.
• Children Post Traumatic Stress Syndrome

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Types of Mistreatment

• Physical, sexual, psychological, emotional, and
  economic.
• Assault an intentional threat that makes the
  victim apprehensive and fear harm.
• Battering coercive control with the use of
  violence. Examples are hitting, biting, rape,
  choking, stabbing, burning,shooting.
• Cycle of battering Tension building, triggering
  event, acute battering, honeymoon stage.

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Profile of the Victim

• Battered women/men represent all ages,
  educational, cultures, socioeconomic groups.
• Low self esteem.
• Accept the blame, dont want to press charges
• Common are feelings of fear, guilt, anger, and
  shame.
• Poor support system.

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Profile of the Perpetrator

• Gender most risk is male, under 35yo,
• Low self esteem, blames others.
• Limited coping ability, views world as hostile
  and threatening.
• Strives to keep the victim isolated, and
  dependent, puts their needs first.
• Frequently has a history of violence was abused
  as a child or a witness to abuse.

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Physical Signs of Injury

• Bruises, especially of different colors and in
  places the victim couldnt have caused
  themselves, shapes of an object.
• Bite marks,skin welts, perforated ear drums.
• Burns, especially in the shape of an object.
• Fractures and old fractures in various stages of
  healing.
• Injuries that arent supported by a believable
  history.
• Miscarriages

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Behavioral Signs

• Behaviors alone do not indicate abuse.
• Very aggressive or demanding behavior.
• Fear of caretaker or partner.
• Extreme rage, passivity, withdrawal.
• Verbal report of abuse.
• Wearing clothing that covers the body and is
  inappropriate for the weather.
• Hyperactivity, disorganized thinking,
  self-injurious behavior, suicidal.
• Regressive behavior.

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Treatment

• Nursing assessment, identify signs indicating
  stress ie restlessness, assess support systems.
• Diagnosis Risk for Injury, Risk for Violence,
  Anxiety, Fear, Disabled Family Coping,
  Powerlessness, Caregiver Role Strain, others.
• Give validationWhat is the matter? You look
  upset.
• OutcomeCessation of abuse reported by victim
• Emotional abuse has stopped.
• Neglect has stopped. Financial
  exploitation has stopped.
  

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Nursing Intervention

• Legal responsibility to report.
• Oral, immediate, written 24 or 48 hours.
• Communication simple, clear.
• Give support and explain the procedures
• Offer alternatives as goal for individuals is
  empowerment and picking self-healthy options for
  life, developing strong sense of self.
• Discuss whom to call for personal support.
• Prevention give referrals.
• Family Therapy

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Nurses Attitudes

• Difficulty when giving care to survivors of
  violence, frustrating, difficult.
• The attitude brought into the situation by the
  nurse can focus the response. Stay calm.
• Studies of health-care providers have shown that
  myths about battered women are believed. Also
  that sympathy for the victim of an attack or rape
  decreases due to situation. Nurses show a lack
  of understanding on why abused children want to
  return to their parents and why battered wives
  stay with their husbands.

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Negative Responses

• Health care workers reflect societys norms. ER
  charts were reviewed to evaluate found was a
  lack of details, negative reporting of the
  events, and a lack of intervention.
• Society norms that people get what they deserve
  is underlying influence for negative feelings
  towards survivors.
• Important for nurses to explore their own
  feelings,gain education on full spectrum of
  victims experience, changing feelings, gaining
  education about violence.

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Conclusions

• What is my gut feeling?
• What if this was my sister, aunt, mother, or
  father?
• Check your view.
• Look at the bigger picture of this persons life,
  not just the situation.