LEC 11: Interpersonal Violence & Nursing Practice

Question 1

What is abuse (what forms does abuse take)?

Answer 1

• Emotional or psychological abuse
  
  • Mind games
• Social abuse (social abuse involving children)
  
  • Using the children as pawns in their game
• Economic/fanancial abuse
  
  • Using monies to control the partner
• Ritual abuse
  
  • Satanic
• Physical abuse
• Sexual abuse
• Religious abuse

Question 2

What is family violence?

Answer 2

• It is a complex problem
• Ranges across the lifespan
• It involves an abuse of power and the violation of position of trust
• Any behaviour by one person against another person in an intimate relationship which may endanger that person’s survival, security, or well-being
• Must look beyond the family and consider the values and attitudes of the community and the larger society

Question 3

Statistics Canada’s Measuring Violence Against Women:

Answer 3

• The rate of violence against women in Saskatchewan is almost double the national average
• Saskatchewant lead all provinces and territories in rates of intimate partner violence and sexual offence, and in rates of violence against girls and female teenagers

Question 4

Saskatchewan is #1

Answer 4

• In police-reported violent crime rates in Canada since 1997 (x2 the National Rate)
• In provincial family violence rate
• Provincial intimate partner violence rate
• Dating violence
• Provincial child and youth violent victimization rate
• Family-related violence against seniros
• 2nd highest violent crime severity index and homicide rate

Question 5

Family Violence Prevalence of Abuse in Canada

Answer 5

• Most often, victims of family violenc were in a spousal relationship with the accused, with about half of victims (49%) being currently or previously married to the accused. Another 18% of family violence victims were victimized by their parent, 13% by an exteneded family memebr, 11% by a sibling and 9% by a child, most often a grown child.
• Victims of family violence were predominantly femal (69%). This disproportionate representation was most pronounced for spousal violence, as 80% of victimes were female, but was also evident when the accused was a child (63%), extended family memebr (58%), parent (57%), and sibling (57%)

Question 6

Family Violence During Pregnancy

Answer 6

• Incidence of violence during pregnancy ranges from 4% to 17%. however domestic violence during pregancy is underreported
• Women who are abused during pregancy are 4 times as likely to experience serious physical violence

Question 7

Ways they May Assert Power Over the Prenatal Women

Answer 7

• forcing her to have an abortion or injure her with the intent of causing her to lose the baby
• forcing her to continue an unwanted pregnancy
• directing physical assaults at the woman’s breasts, abdomen and/or genital area
• controlling, limiting, delaying or denying her access to prenatal care
• refusing to support her during pregnancy, labour and delivery and/or recovery
• restricting her access to food or resources
• making negative comments about her appearance, the baby, or her parenting abilities
• denying her access to her newborn child
• blaming her for the baby and any changes that have to be made in the household because of it
• threatening the woman’s or child’s safety or custody

Question 8

Family Violence in Children/Youth

Answer 8

• Male family members were identified as the accused in a sizable majority of family-related sexual (96%) and physical assaults (71%) against children and youth.
• Infants (<1yr) experience higher rates of family-related homicide, than older children
• Young parents are disproportionally represented among those accused (60%)

Question 9

Family Violence: Abuse of the Elderly

Answer 9

• Most often, frustration, anger or despair was the apparent motive for family-perpetrated homicides against seniors. In contrast, financial gain was the most commonly identified reason behind senior homicides committed by non-family members.
• Between 4% - 10% of seniors (in Canada) experience some type of abuse
• Victims who are elderly are most likely to be victimized by an adult child or current/former spouse
• The issue of low numbers of 4-10% may be because seniros don’t normally report abuse

Question 10

Older Adults May Experience Different Types of Abuse Including:

Answer 10

• Physical or sexual abuse
• Psychological or emotional abuse
• Financial abuse
• Neglect, unintentional neglect, self neglect

Question 11

Adults who experience abuse are:

Answer 11

• 103% more likely to become smokers
• 95% more likely to become obese
• 103% more likely to become alcoholics
• 192% more likely to develop dru addicitons
• 43% more likely to become suicidal

Question 12

Consequences of Abuse of Women

Answer 12

• Health consequences
• Economic consequences
• Impact of abuse on children
• Physical
• Sexual and reproductive
• Psychological and behavioral
• Faal health consequences

Question 13

Impact on Children

Answer 13

• Physical effects
• Psychological and behavioral effects
  
  • physical effects: not able to sleep
  • Psychological: nightmares, fears to be alone
  • Children exposed to violence
    
    • Are the silent witness in this situation

Question 14

Three Stages of the Cycle of Violence

Answer 14

1. Tension builds and escalates
2. Violent incident-blow up
3. Absence of violence- remorse/romance phase

Question 15

Cycle of Violence: Phase 1: Tension Building

Answer 15

¨Tension Building Phase

• Duration: days, weeks, months, years
• Initial infatuation of the relationship fades
• Abuser - starts exhibiting aggressive/abusive tendencies
• Victim - attempts to stop aggression by pleasing, placating, or staying out of the way, thinking those actions can control the abusive behavior
• When these actions do not control or stop the abuse, the victim withdraws
• Abuser feels rejected and tries harder to control the victim’s activities
• At this point, an abusive incident will inevitably happen

Question 16

Traits of the abuser in Phase 1 (tension building)

Answer 16

• Jelousy
• Actions that isolate the victim
• Rule changing
• Name calling
• Dominating

Question 17

Traits of the victim in Phase 1 (tension building)

Answer 17

• Use of calming techniques
• Minimizing abusers behaviours
• Anger suppression
• Fatigue
• Confusion
• Self-doubt
• Withdrawal
• Fear

Question 18

The Cylce of Abuse: Phase 2: Violent Incident Phase

Answer 18

• Physcial, emotional, mental, spiritual or sexual abuse
• The violent incident relieves the stress/tension of the abuser
  
  • While the perpetrator feels instant relief, the victim experiences shock/denial
• Police are usually involved at this stage, victim may seek safe shelter

Question 19

Traits of the abuser in Phase 2 (violent incident)

Answer 19

• ANger
• Assault on the victim
• Uncontrolled tension
• Exahustion

Question 20

Traits of the victim in phase 2 (violent incident)

Answer 20

• Fear
• Anger
• May call the police
• May seek safety

Question 21

Cycle of Abuse: Phase 3: Remorse/Romance Phase

Answer 21

• Abuser becomes tender, apologetic, gift giving, proclaims love, one time event etc.
• Abuser may take actions and demonstrate willingness/desire to change (i.e. rehab, stop drinking etc)
• High number of women return to the abuser during this phase, believing the abuser and their actions to be sincere

Question 22

Traits of the abuser in phase 3 (remors/romance)

Answer 22

• Apologies and promises
• Shows insecurites
• Loving
• Demosntrates dependency on the victim

Question 23

Traits of the victim in phase 3 (remorse/romance)

Answer 23

• Guilt
• Hope
• Lonliness
• Low-self esteem
• Dependency

Question 24

Challenges Facing Women: Why do they stay?

Answer 24

• Fear of injury (or death)
• Finances
• Family
• Faith
• Father
• Fatigue
• Fantasy and forgivness
• Familiar
• Foresight

Question 25

What is the goal of nursing interventions in relation to family violence?

Answer 25

* To empower the client to take control * To provide supprot * To maximize safety

Question 26

Screening: Role of the Nurse

Answer 26

* Ask the question * Acknowledge the abuse * Validate the woman's experience * Access immediate safety * Explore options * Refer to services at the woman's request * Document the interaction

Question 27

Guiding Principles for Screening ABCD-ER

Answer 27

* **Attitude** and **Approachability** of the healthcare provider * **Belief** in the women's account of her experience * **Confidentiality** is essential for disclosure * **Documentation** that is consistent and legible * **Education** about the serious effects of violence and abuse * **Recignition** that dealing with violence and abuse has to be her pace, directed by her decisions

Question 28

Documentation

Answer 28

* Document quotes, observed behaviour, physical assessment and interventions (facts not opinions) * Accuracy is important (specifics – who/what/where/when) * Document as soon as possible – document physical and psychological symptoms – be objective, quote the client) when possible * Use tools such as body maps to document locations and patterns of physical injuries * With a clients permission photograph injuries

Question 29

What types of nursing actions might jeopardize your relationship with patients experiencing abuse?

Answer 29

* Telling people what to do * Blaming the victim * Violating confidentiality * Confronting the abuser about the abuse

Question 30

Challenges of a rural setting related to family violence include:

Answer 30

* Lack of access to public transportation/phone service * Decreased anonymity and condifentiality * Lack of services/ ineffective services * Increased number of weapons in the home * Fwer resources

Question 31

What need to be considered when a disclosure of abuse is made?

Answer 31

* Reporting of violence and abuse against females * Young women and disclosure of abuse * Age of consent for sexual activity is 16 years in Canada * Children who witness violence and abuse

Question 32

Child Maltreatment

Answer 32

* Professionals must report cases in which they suspect that a child is or may be suffering or may have suffered abuse * Child protection overrides obligation to confidentiality

Question 33

Reporting Child Abuse/Neglect

Answer 33

* Anyone who suspects that a child is being abused or neglected has a legal duty to report it * You are not expected to determine if a child is being abused or neglected * Members of the public are obligated by the law to report suspected abuse or neglect * There are legal consequences for failing to report a suspicion of abuse or neglect (in Saskatchewan)

Question 34

Abuse Against Older Adults

Answer 34

* Reassurance * Unlike child abuse, reporting is not mandatory * Abuse help lines in SK tel phonebooks * Review available services