Flashcards in 1229 Exam 6 Family Violence Deck (66):
What is Anger?
an emotional response to the perception of frustration of desires, threat to one's neds, or challenges.
What is aggression?
is harsh physical or verbal action that reflects rage, hostility, and potential for physical or verbal destructiveness.
Anger and Aggression:
are the last two stages of a response that begins with feelings of vulnerability followed by uneasiness.
-identify anxiety before it escalates to anger and aggression
-expressions of anxiety and anger look quite similar--- increased rate and volume of speech, increased demands, irritability, frowning, redness of face, pacing twisting hands, or clenching and unclenching of fist.
should include taking an accurate history of -the patient's background, usual coping skills, and perception of the issue.
how we intervene safely depends on our own self-awareness.
-nursing responses to angry patients can escalate along a continuum similar to that of patients.
-the more a nursing intervention is prompted by emotion, the less likely it is to be therapeutic.
-nurses' responses reflect norms from their families or origin, personal issues, and situational events.
What techniques beside self-assessment could be used?
empathetic interpretation of patient' distress
review of intervention strategies can be helpful
family members keep to self
no invitations to the home
no sharing of information or friends
abusers may threaten if they tell
tell them that parent, siblings, or pets will die.
child will keep secret due to fear.
Abuse of Power and COntrol
abusive family member in position of power over the victim.
economic and social as well as physical power
onl one who can make decisions about money or time spent outside the home.
any indication, real, or imagined, of the victim having been disobedient or trying to be independent leads to violence.
Alcohol is frequently associated with family violence.
patterns of violence from one generation to another --role modeling--social learning
*learned patten of behavior
-children who see violence between their parents learn violence is a way to solve conflicts
immigrant women are more at risk to be in abusive home.
The abusive person is more likely to what?
use drugs or alcohol.
Alcohol lowers their inhibitation--make the violent behavior more intense and frequent
major factor in rape cases and sexual assault.
Family structure for conditions for Violence:
lacks role models and did not learn problem solving skills
-cares only about their own needs
-dissatisfied with life
witnessed family violence/experienced it
poor social skills/no support from outside marriage
-poor impulse control
emotionally immature--- needy, irrational, jealous, possessive
the one in the family that is abused--age or situation make vulnerable (children, women, elderly, mentally ill or physically challenged person or child
stressful event--something that taxes their coping skills.
job stress (no job)
marital problems (soldier's families, away from home, increased stress on remaining parent.
Risk factors for violence:
types of abuse:
Coping mechanisms of the abusers:
the world is unfair
blame someone else for their difficulties
"My boyfriend made me drink."
Discharge our feelings o a less threatening object
Transferred to someone other than who they are angry at.
deny they are angry but deep down they really are
afraid of rejection or punishment
an alcoholic who says he can control his drinking--doesnt want to see or face the problem.
battering and physical endangerment
any sexual approach or act, explicit or implicit, toward a child.
the sexual abuse of adults is usually catergorized as sexual assault or rape
infliction of mental anguish
physical, developmental, or educational
using another's recources without permission for one's own personal gain
tension building stage:
minor incidents (pushing or verbal abuse)
acute battering stage:
perpetrator releases built up tension by beating a vulnerable person
perpetrator feels remorse and acts in kindly, loving ways by apologizing or bringing gifts
tension building state:
abuse recurs and cycle begins again.
grow up learning that violence is normal
-works out bad feelings with violence
-abuses alcohol and drugs
traditional ideas about what a man/woman should be
-jealous of other relationships
-access to guns, knives, and other lethal instruments
-expects the wife to follow orders/advice
-extreme highs and lows
-has bad temper
-treats the wife roughly.
What are secondary effects of violence?
*can last a life time.
what are the four stages of abuse?
tension building stage
acute battering stage
honey moon stage
tension building stage
* the intentional injury of a child*
all socioeconomical levels
mandated to report
most common form "neglect"
failure to provide food, clothes, shelter, supervision
history of abuse as a child, lacking self esteem, lack of parenting skills, poor impusle control
handicapped, chronically ill, hyperactive, or have special meaning attached to the child
parental stress or crisis situation frequently precipitates battering. social isolation and fewer supportive type relationships
warning signs of abuse:
physical evidence- injuries including prior ones
conflicting stories from parents/others
blaming of siblings
injury inconsistent with history
inappropriate parental concern for the degree of injury--exaggerated or unemotional or mad at the child for getting hurt.
refusal to sign in for additional/necessary treatment
repeated emergency department visits
delay in seeking treatment--coming to the emergency department a long time after incident
inappropriate response of child
fear of being touched
acting out in class
Shaken baby syndrome
Munchausen's Syndrome by Proxy
caused by parent or fabricated illness
not easily explained phsiologically
occurs while alone with parent
often medicaly sophisticated
* The mother seeks attention by making the child sick or appear to be sick.
Munchausen's Syndrome looks like:
chronic poisoning of the child
suffocating the child
put blood feces in the child's urine to look like an infection
contaminaton of food requirng IV fluids
give emetics to cause vomiting
give cathartics to cause diarrhea
claim sexual abuse against the other parent--"child's protector"
symptoms improve in the hspital and worsen at home.
-blood in lab specimens do not match the patients
-parent is too enthusiastic; too helpful
-pay careful attention to the history of the illness and how the parent and child interact
can aslo be nurses..
When working with abusive situations with children;
be non confronting and non threatening as possible
ask how the parents discipline
try to find out as much as you can
Misdiagnosis: Don't confuse or misdiagnose other conditions with abuse.
What conditions are easily misdiagnosed?
symptoms of sexual abuse:
pain, itching of genitals
STIs and or recurrent UTI
unwillingness to change clothes or participate in gym activites
bruises, bleeding in genital or rectal area
poor peer relations
exvessive interest in sexual matters-masturbation
more advanced knowledge than would be expected for thier age
sexual abuse in children
avoidance of family/peers
poor school performance
most people abused know the abuser.
it is often a parent or family member.
failure to provide for the basic needs as physical emotional and educational needs.
location, size, shape, and color of injury
distinguish characteristics. (shape of hand, fingers, objects)
body outline/body map--draw it
What is the most important criteria upon which to base the decision to report suspected abuse?
look for incompatibility between the history and the injury
What is battering?
coercive behavior used to gain power and control over another.
Stages of Battering*******
phase 1: tension building
phase 2: event/acute battering/violent behavior
pase 3: calm/honeymoon/remorse/contrition
The acronym "SAFE:
a--are you afraid; is anyone abusing you?
f--family friends siblings parents aware? could you tell them and get support?
e-- emergency plan
Check list for leaving an abuser:
3 basic catergories for elder abuse:
Forms of elder abuse:
rape is not sexually motivated. the desire is to have power, control, and humiliate th victim. It has NOTHING to do with sex.
race--most are within the race
sex-- most are female, but males are usually younger victimized by older males
occupation--most are students or women who work alone.
classifcations of rapist:
compensates for feelings of inadequacy and incompetence with no intent to do harm other than the rape.
physically brutal with intended rage and retaliation against women
sees sexual abuse of the vicitm as gratifying and exciting. may use bizarre ritualistic behavior or torture in extreme cases murder