41. Violence and Abuse

Question 1

effects of violence

Answer 1

• permanent changes in survivor’s reality and meaning of life
• deep wounds
• endangerment of core beliefs about self, others, and the world
• damage or destruction of survivor’s self-esteem

Question 2

theories of violence

Answer 2

• biochemical (increased dopamine, serotonin, and NE)
• substance abuse
• social learning theory
• economic disadvantage
• community disorganization
• attitudes supportive of violence
• imbalances in relationship power (subordination of women)
• factors influencing leaving vs staying in violent relationships (fear, lack social networks, or lack of resources)

Question 3

what does the social learning theory say

Answer 3

• children witnessing violence in homes often perpetrate violent behaviors in families as adults
• learn to accept violence and expect it

Question 4

most common type of violence and abuse

Answer 4

domestic (family violence)

Question 5

types of domestic abuse

Answer 5

• intimate partner violence (IPV): physical, psychological, or sexual
• stalking
• rape/sexual assault
• child abuse: neglect, physical, psychological, sexual
• elder abuse: physical, sexual, emotional, neglect, abandonment, financial

Question 6

repeated unwanted contact, attention, and harassment

Answer 6

stalking

Question 7

characteristics of stalking

Answer 7

• crime of intimidation
• cyberstalking
• women 18-24 have highest risk of being stalked

Question 8

characteristics of rape/sexual assault

Answer 8

• act of aggression no passion
• can occur at any age
• highest risk group: 16-24
• most victim single women and occurs near own neighborhood

Question 9

nursing interventions for rape victim

Answer 9

• you’re safe
• I’m sorry this happened to you
• this is not your fault
• I’m glad you survived
• you did the best you could
• explain every assessment procedure ahead of time
• provide privacy
• encourage victim to give account of incident
• provide information about referrals

Question 10

rape survivor is openly emotional

Answer 10

express-response pattern

Question 11

rape survivor will mask emotions and will appear to be calm w/ blunted affect; may feel numb

Answer 11

control-response pattern

Question 12

rape survivor will have variety of sxs (muscle tension, headache, sleep disturbances, or ABD pain)

Answer 12

somatic reaction

Question 13

when the rape survivor suppresses feelings and doesn’t tell anyone; may regress to childhood and experience night terrors

Answer 13

silent rape reaction

Question 14

reaction to intimate partner violence

Answer 14

• women: afraid or reluctant to identify abusers due to retaliation; attribute injuries to other causes
• men: hesitant to report victimization or fail to consider behaviors as abuse

Question 15

describe psychological IPV

Answer 15

• criticize, insult, humiliate, or ridicule
• destroy another person’s property
• threaten or harm pets
• control or monitor spending and activities
• isolate person from friends or family
• more constant than physical violence (episodic)
• varieties of abuse to exert power and control

Question 16

secondary victims of IPV

Answer 16

children of IPV victims

Question 17

T/F: victims of IPV are also victimized by family courts

Answer 17

True

Question 18

phase 1 of cycle of battery

Answer 18

tension build up phase (abuser is moody and victim is being careful to not trigger them)

Question 19

phase 2 of cycle of battery

Answer 19

acute battering incident (when abuse takes place)

Question 20

phase 3 of cycle of battery

Answer 20

honeymoon phase (abuse is calm and loving; trying to regain control and power over victim; using undoing defense mechanism)

Question 21

when the abuse tries to make the victim feel like they’re crazy and everything is their fault

Answer 21

gaslighting

Question 22

survivors psychological response to trauma from violence

Answer 22

• fear
• low self-esteem
• guilt and shame
• problems w/ intimacy
• revictimization (end up in another abuse relationship)

Question 23

survivors biological response to trauma from violence

Answer 23

• physical injury
• negative health consequences
• somatic complaints
• GYN problems (STDs)

Question 24

mental health consequences from violence trauma

Answer 24

• depression
• PTSD
• alcohol and other drug disorders
• suicidal
• co-occurring disorders

Question 25

profile of the victim

Answer 25

- all socioeconomic groups - married or unmarried - all employment types - low self-esteem - accept blame for abuse - grew up in violence house - accept relationship as male dominated - can't see possible options - learned helplessness

Question 26

profile of victimizer

Answer 26

- low self esteem - dual personality - under great deal of stress - poor coping skills - become threatened if woman shows any signs of interest in other people - ignore young children - threaten to take children

Question 27

reasons why someone stays in abuse relationship

Answer 27

- fear of retaliation - for the children - for financial reasons - lack of support network - religious reasons - hopefullness

Question 28

most common form of child abuse

Answer 28

neglect

Question 29

consequences of emotional abuse in children

Answer 29

results in impairment of social, emotional, intellectual functioning

Question 30

indicators of child sexual abuse

Answer 30

- difficulty walking or sitting - suddenly refuses to change for gym or to participate in physical activities - reports nightmares or bedwetting - experience sudden change in appetite - demonstrates bizarre, sophisticated, or unusual sexual knowledge or behavior

Question 31

characteristics of incestuous relationship

Answer 31

- father domineering and mother passive (she knows about it but uses denial or keeps quiet out of fear of being abused by husband) - poor communication between parents - usually starts when child is 8-10 years old - usually oldest child - child becomes bewildered

Question 32

characteristics of adults who survive incest

Answer 32

- lack trust - low self esteem - poor sense of identity - does not trust own feelings - are not comfortable sexually as adults - poor relationships w/ peers - often find relationship where they are abused again - often poor relationships w/ family (not believed)

Question 33

characteristics of child abuser

Answer 33

- were likely abuse as children themselves - stressful life situation - lack of support systems - lack of understanding of child development - maladaptive coping strategies - unrealistic expectations of child

Question 34

assessment of victims of abuse

Answer 34

- establish nurse-pt relationship - conduct lethality assessment (danger assessment screen) -> checks for danger of harm when returned home - screen for violence and abuse (abuse assessment screen and Burgess-Partner Abuse Scale for Teens) - obtain Hx and PE

Question 35

evaluation and treatment for victims of abuse

Answer 35

- manage pt's immediate safety - ending abusive relationships - recognizing that one is not to blame - demonstrate strengths and coping skills - re-establish social network - follow-up efforts important (monitor living environment and sxs)

Question 36

treatment for abuser

Answer 36

- usually court mandated - extensive outpatient programs includes: cognitive behavioral techniques, psychoeducational topics, anger management, and couple counseling

Question 37

goals of care for victims of abuse

Answer 37

- prevent injury - stop violence - ensure safety

Question 38

nursing assessment for psychological domain

Answer 38

- MSE - observation for sxs (anhedonia, difficulty concentrating, feelings of worthlessness/guilt) - suicidal or homicidal intent - problems w/ intimacy

Question 39

nursing assessment for social domain

Answer 39

- social networks and support - restrictions on freedom - degree of dependency in relationship - revictimization

Question 40

teaching for abusive families

Answer 40

- child management skills - parenting skills - leisure skills - household organization - anger control and stress management