Nur 448 Persons at Risk for Abuse and Violence
Rape <ul><li>Non-consensual vaginal, anal, or oral penetration </li></ul><ul><ul><li>Force, threat, underaged, impaired </...
Rape theories <ul><li>Intrapersonal </li></ul><ul><ul><li>Rapist powerlessness and high stress </li></ul></ul><ul><ul><li>...
<ul><li>Social Learning </li></ul><ul><ul><li>Intimidation and force to achieve goals </li></ul></ul><ul><ul><li>Violence ...
Rape Trauma Syndrome <ul><li>Factors contributing to victim ’ s response </li></ul><ul><ul><li>Age of victim </li></ul></u...
<ul><li>Response factors related to the rape </li></ul><ul><ul><li>Severity </li></ul></ul><ul><ul><li>Duration </li></ul>...
Rape Trauma Syndrome <ul><li>Acute phase </li></ul><ul><ul><li>Up to two weeks </li></ul></ul><ul><ul><li>Two types of res...
Somatic Reaction-Acute phase <ul><li>Bruises, soreness </li></ul><ul><li>Headaches, sleep disturbances </li></ul><ul><li>N...
Emotional Reaction-Acute Phase <ul><li>Fear </li></ul><ul><li>Denial </li></ul><ul><li>Anxiety </li></ul><ul><li>Shock </l...
Long-term Re-organization phase of Rape Trauma Syndrome <ul><li>Occurs two weeks or more post rape </li></ul><ul><ul><li>I...
Nursing Intervention for Rape  <ul><li>Before assessment </li></ul><ul><ul><li>Inform of rights </li></ul></ul><ul><ul><li...
<ul><li>Outcome identification </li></ul><ul><ul><li>Control over remembering </li></ul></ul><ul><ul><li>Decreased flashba...
<ul><li>Planning and implementation </li></ul><ul><ul><li>Support defense mechanisms </li></ul></ul><ul><ul><li>Give time ...
<ul><li>Where is Rape treatment center in Miami? </li></ul><ul><li>Where is Rape treatment center in small town? </li></ul>
Intrafamily violence <ul><li>Domestic violence </li></ul><ul><li>Battering </li></ul><ul><li>Sibling abuse </li></ul><ul><...
<ul><li>Partner abuse </li></ul><ul><ul><li>Heterosexual </li></ul></ul><ul><ul><li>homosexual </li></ul></ul><ul><li>Elde...
<ul><li>Stalking </li></ul><ul><ul><li>Following, viewing, communication </li></ul></ul><ul><li>Cycle of violence </li></u...
Cycle of Violence <ul><li>Phase 1- Perpetrator is hostile, critical </li></ul><ul><li>Phase 2- Abuse occurs-up to 24 hours...
Child victim <ul><li>Singled out child-difficult becomes victim </li></ul><ul><li>Self blame for family conflict </li></ul...
Partner as victim <ul><li>Blames self </li></ul><ul><li>Low self-esteem </li></ul><ul><li>Sense of helplessness </li></ul>...
Theories <ul><li>Neurobiological </li></ul><ul><ul><li>Genetic </li></ul></ul><ul><ul><li>Decreased serotonin </li></ul></...
<ul><li>Social learning theory </li></ul><ul><ul><li>Violence is learned </li></ul></ul><ul><ul><li>Opportunity to abuse <...
Trauma responses <ul><li>Hyperarousal </li></ul><ul><li>Hypervigilence </li></ul><ul><li>Anxiety </li></ul><ul><li>Emotion...
Symptoms of Child Abuse <ul><li>Aggression </li></ul><ul><li>Oppositional behavior </li></ul><ul><li>Clinging </li></ul><u...
Nursing intervention <ul><li>Non-judgmental attitude </li></ul><ul><li>Multiprofessional approach </li></ul><ul><li>Assure...
Intra-family violence-sexual abuse <ul><li>Incest </li></ul><ul><ul><li>Child is often  “ special ”  child </li></ul></ul>...
Symptoms of incest <ul><li>Age inappropriate sexual behavior </li></ul><ul><li>Excessive masturbation </li></ul><ul><li>Es...
Intervention for victims <ul><li>Women </li></ul><ul><ul><li>Safety plan first </li></ul></ul><ul><ul><li>Hotline number <...
Reporting is mandated <ul><li>Florida coalition afainst domestic violence </li></ul><ul><li>24 hour hotline 800 500 1119 <...
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Unit11 persons at risk for abuse and violence

  1. 1. Nur 448 Persons at Risk for Abuse and Violence
  2. 2. Rape <ul><li>Non-consensual vaginal, anal, or oral penetration </li></ul><ul><ul><li>Force, threat, underaged, impaired </li></ul></ul><ul><li>Crime </li></ul><ul><li>Force, domination, and humiliation </li></ul><ul><li>Any forced sexual activity </li></ul><ul><li>Rape statistics are trending down </li></ul><ul><ul><li>2002 216,000 victims </li></ul></ul><ul><ul><ul><ul><ul><li>13 % males </li></ul></ul></ul></ul></ul><ul><ul><ul><ul><ul><li>70 % known to individual </li></ul></ul></ul></ul></ul>
  3. 3. Rape theories <ul><li>Intrapersonal </li></ul><ul><ul><li>Rapist powerlessness and high stress </li></ul></ul><ul><ul><li>5 types of rape </li></ul></ul><ul><ul><ul><li>Stranger </li></ul></ul></ul><ul><ul><ul><li>Acquaintance </li></ul></ul></ul><ul><ul><ul><li>Spousal </li></ul></ul></ul><ul><ul><ul><li>Statutory </li></ul></ul></ul><ul><ul><ul><li>Confidence </li></ul></ul></ul><ul><li>Interpersonal </li></ul><ul><ul><li>Rapist preoccupied with control </li></ul></ul>
  4. 4. <ul><li>Social Learning </li></ul><ul><ul><li>Intimidation and force to achieve goals </li></ul></ul><ul><ul><li>Violence is expression of power </li></ul></ul><ul><li>Feminist </li></ul><ul><ul><li>Result of socioeconomic traditions </li></ul></ul>
  5. 5. Rape Trauma Syndrome <ul><li>Factors contributing to victim ’ s response </li></ul><ul><ul><li>Age of victim </li></ul></ul><ul><ul><li>History of prior victimization </li></ul></ul><ul><ul><li>Relationship to perpetrator </li></ul></ul><ul><ul><li>Precrisis coping skills </li></ul></ul><ul><ul><li>Ability to use support resources </li></ul></ul>
  6. 6. <ul><li>Response factors related to the rape </li></ul><ul><ul><li>Severity </li></ul></ul><ul><ul><li>Duration </li></ul></ul><ul><ul><li>Frequency </li></ul></ul><ul><ul><li>Number of offenders </li></ul></ul><ul><ul><li>Degree of violence </li></ul></ul>
  7. 7. Rape Trauma Syndrome <ul><li>Acute phase </li></ul><ul><ul><li>Up to two weeks </li></ul></ul><ul><ul><li>Two types of responses </li></ul></ul><ul><ul><ul><li>Expressed </li></ul></ul></ul><ul><ul><ul><ul><li>Crying, restless, confused, tense, laughing </li></ul></ul></ul></ul><ul><ul><ul><li>Controlled </li></ul></ul></ul><ul><ul><ul><ul><li>Confusion, disorientation, calm, shocked </li></ul></ul></ul></ul>
  8. 8. Somatic Reaction-Acute phase <ul><li>Bruises, soreness </li></ul><ul><li>Headaches, sleep disturbances </li></ul><ul><li>N,V, & D </li></ul><ul><li>Poor appetite </li></ul><ul><li>Vaginal itching, discharge, or pain </li></ul>
  9. 9. Emotional Reaction-Acute Phase <ul><li>Fear </li></ul><ul><li>Denial </li></ul><ul><li>Anxiety </li></ul><ul><li>Shock </li></ul><ul><li>Humiliation </li></ul><ul><li>Self-blame </li></ul><ul><li>Anger </li></ul><ul><li>Guilt-shame </li></ul>
  10. 10. Long-term Re-organization phase of Rape Trauma Syndrome <ul><li>Occurs two weeks or more post rape </li></ul><ul><ul><li>Intrusive thoughts </li></ul></ul><ul><ul><li>Increased motor activity </li></ul></ul><ul><ul><li>Increased emotional lability </li></ul></ul><ul><ul><li>Fears and phobias </li></ul></ul>
  11. 11. Nursing Intervention for Rape <ul><li>Before assessment </li></ul><ul><ul><li>Inform of rights </li></ul></ul><ul><ul><li>Do not disturb clothing </li></ul></ul><ul><li>Assessment </li></ul><ul><ul><li>Physical-STDs, HIV- Pregnancy </li></ul></ul><ul><ul><li>Photographs </li></ul></ul><ul><li>Nursing Diagnosis </li></ul><ul><ul><li>Rape trauma syndrome </li></ul></ul>
  12. 12. <ul><li>Outcome identification </li></ul><ul><ul><li>Control over remembering </li></ul></ul><ul><ul><li>Decreased flashbacks and nightmares </li></ul></ul><ul><ul><li>Affect tolerance </li></ul></ul><ul><ul><li>Symptom mastery </li></ul></ul><ul><ul><li>Reconnecting </li></ul></ul>
  13. 13. <ul><li>Planning and implementation </li></ul><ul><ul><li>Support defense mechanisms </li></ul></ul><ul><ul><li>Give time to respond to questions </li></ul></ul><ul><ul><li>Communicate knowledge and understanding of responses to rape </li></ul></ul><ul><ul><li>Community resources </li></ul></ul><ul><ul><li>Group therapy </li></ul></ul>
  14. 14. <ul><li>Where is Rape treatment center in Miami? </li></ul><ul><li>Where is Rape treatment center in small town? </li></ul>
  15. 15. Intrafamily violence <ul><li>Domestic violence </li></ul><ul><li>Battering </li></ul><ul><li>Sibling abuse </li></ul><ul><li>Child abuse </li></ul><ul><ul><li>Physical </li></ul></ul><ul><ul><li>Shaken baby </li></ul></ul><ul><ul><li>Neglect </li></ul></ul>
  16. 16. <ul><li>Partner abuse </li></ul><ul><ul><li>Heterosexual </li></ul></ul><ul><ul><li>homosexual </li></ul></ul><ul><li>Elder abuse </li></ul><ul><ul><li>Psychological abuse </li></ul></ul><ul><li>Emotional abuse </li></ul><ul><li>Abuse of pregnant women </li></ul>
  17. 17. <ul><li>Stalking </li></ul><ul><ul><li>Following, viewing, communication </li></ul></ul><ul><li>Cycle of violence </li></ul><ul><ul><li>Conflict escalates to violent episode </li></ul></ul><ul><ul><li>Beg for forgiveness </li></ul></ul><ul><ul><li>Promises of reforrm </li></ul></ul><ul><ul><li>Perpetrators—jealous, possessive </li></ul></ul><ul><ul><li>Victims—anxious, fearful, depressed </li></ul></ul>
  18. 18. Cycle of Violence <ul><li>Phase 1- Perpetrator is hostile, critical </li></ul><ul><li>Phase 2- Abuse occurs-up to 24 hours </li></ul><ul><li>Phase 3- Honey moon phase-guilt, shame, remorse, promises, caring behavior </li></ul><ul><ul><li>Direct victimization </li></ul></ul><ul><ul><li>Indirect victimization </li></ul></ul>
  19. 19. Child victim <ul><li>Singled out child-difficult becomes victim </li></ul><ul><li>Self blame for family conflict </li></ul><ul><li>Fear of perpetrator </li></ul><ul><li>Cheating, lying, underachievement </li></ul><ul><li>Depression, helplessness </li></ul>
  20. 20. Partner as victim <ul><li>Blames self </li></ul><ul><li>Low self-esteem </li></ul><ul><li>Sense of helplessness </li></ul><ul><li>Isolation from family and friends </li></ul><ul><li>Views self as subserivent </li></ul><ul><li>Dependence on partner </li></ul>
  21. 21. Theories <ul><li>Neurobiological </li></ul><ul><ul><li>Genetic </li></ul></ul><ul><ul><li>Decreased serotonin </li></ul></ul><ul><ul><li>Increased norepinephrine </li></ul></ul><ul><li>Intrapersonal </li></ul><ul><ul><li>Violence associated with personality </li></ul></ul><ul><ul><li>80% of abusers raised in abusive environment </li></ul></ul>
  22. 22. <ul><li>Social learning theory </li></ul><ul><ul><li>Violence is learned </li></ul></ul><ul><ul><li>Opportunity to abuse </li></ul></ul><ul><ul><li>Conscious choice </li></ul></ul><ul><li>Feminist theory </li></ul><ul><ul><li>Cultural influence </li></ul></ul><ul><ul><li>Domestic violence is gender issue </li></ul></ul>
  23. 23. Trauma responses <ul><li>Hyperarousal </li></ul><ul><li>Hypervigilence </li></ul><ul><li>Anxiety </li></ul><ul><li>Emotional constriction </li></ul><ul><li>Numbing </li></ul><ul><li>Low self-esteem </li></ul><ul><li>Low sense of security </li></ul><ul><li>Decreased trust </li></ul>
  24. 24. Symptoms of Child Abuse <ul><li>Aggression </li></ul><ul><li>Oppositional behavior </li></ul><ul><li>Clinging </li></ul><ul><li>Huyperactive </li></ul><ul><li>Nightmares </li></ul><ul><li>Eneuresis or encoproesis </li></ul><ul><li>School problems </li></ul><ul><li>Regressed behavior </li></ul>
  25. 25. Nursing intervention <ul><li>Non-judgmental attitude </li></ul><ul><li>Multiprofessional approach </li></ul><ul><li>Assure physical safety </li></ul><ul><li>Improvement of communication </li></ul><ul><li>Identify family dynamics </li></ul><ul><li>Parenting skills </li></ul><ul><li>Survivor center approach </li></ul>
  26. 26. Intra-family violence-sexual abuse <ul><li>Incest </li></ul><ul><ul><li>Child is often “ special ” child </li></ul></ul><ul><ul><li>Not necessarily to have physical violence </li></ul></ul><ul><ul><li>Father is primary </li></ul></ul><ul><ul><li>Sibling </li></ul></ul><ul><ul><li>Step-father </li></ul></ul><ul><ul><li>Uncle </li></ul></ul>
  27. 27. Symptoms of incest <ul><li>Age inappropriate sexual behavior </li></ul><ul><li>Excessive masturbation </li></ul><ul><li>Escalation of negative behavior </li></ul><ul><li>Risk taking behavior </li></ul><ul><li>Sexual acting out </li></ul><ul><li>Substance </li></ul><ul><li>Precursor to morbid obesity </li></ul><ul><li>Precursor to Diffuse Identity Disorder </li></ul>
  28. 28. Intervention for victims <ul><li>Women </li></ul><ul><ul><li>Safety plan first </li></ul></ul><ul><ul><li>Hotline number </li></ul></ul><ul><ul><li>Domestic violence shelter </li></ul></ul><ul><li>Children </li></ul><ul><ul><li>Will be removed from home immediately </li></ul></ul>
  29. 29. Reporting is mandated <ul><li>Florida coalition afainst domestic violence </li></ul><ul><li>24 hour hotline 800 500 1119 </li></ul><ul><li>Call 911 </li></ul>
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