Family violence rf order 12


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Mental Health Fall '12

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Family violence rf order 12

  1. 1. Renee Franquiz MSN, RN
  2. 2. Family Violence: Prevalence Prevalence  Half of all Americans have experienced violence in their families Types of Violence/Abuse  Domestic – Intimate Partner  Child Abuse  Sexual Assault
  3. 3. Intimate Partner Violence One in every four women will experience domestic violence 1.3 million women are victims of physical assault each year. 85% of domestic violence victims are women. Females have been most often victimized by someone they knew. Females 20-24 years of age are at the greatest risk Most cases of domestic violence are never reported to the police  Source: National Coalition Against Domestic Violence
  4. 4. Effects of Family Violence Effect on Children Development adversely affected Energy needed to accomplish developmental tasks successfully goes to coping with family violence Effect on Adolescents Poorer coping and social skills Higher incidence of Dissociative ID d/o Poorer impulse control
  5. 5. Intimate Partner Violence Establishes power and control Intimidates – Looks, gestures, brandish weapons Threaten – To Hurt, leave, report to authorities Isolates – Prevents from having outside involvements Economic enslavement – Control finances, gives an allowance, prevents from working Minimizes – Makes light of the abuse, denying Pawning the Children – use them as a weapon, threaten to take them Emotional abuse – putting down, name calling, humiliation
  6. 6. Profile of the Victim Represent all demographics Demonstrate low self-esteem, helplessness, hopelessness, powerlessness, guilt, shame Attempts to protect perpetrator Takes Responsibility Denies severity of the situation
  7. 7. Profile of the Perpetrator Low self esteem/Easily threatened Jealous/Possessive – See partner as a possession Degrading and Humiliating Uses threats and intimidation Poor Coping Mechanisms High incidence of substance abuse Experienced violence as a childEscalates and greatest risk of violence is when partner attempts to leave relationship
  8. 8. Cycle of Violence Phase I Tension Building (weeks to years) Minor Anger, Verbal Abuse, Minor Physicality Victim is tense and accepts blame; Attempts nurturing Prolonged tension makes the victim withdraw, abuser becomes more threatened and angry Phase II Acute Battering (Hours) Physical Violence, battery and injury Phase III Honeymoon (hours to years) Remorse, contrite, loving, kind, apologetic Abuser feels in control now of self Victim visualizes this as the image of the relationship
  9. 9. Child Abuse  Approx 5 children die every day as a result of child abuse  80% of children that die from abuse are under the age of 4  90% of juvenile sexual abuse victims know their perpetrator  Child abuse occurs across all demographics  About 30% of abused and neglected children will later abuse their own children  Source: US Dept Health and Human Services
  10. 10. Child Physical Abuse Physical Injury regardless of intent Suspect When: Unexplained injuries Healing Injuries Child resists going with parents Child cowers Caretaker “harsh” Injury does not match story Caretaker w/Hx of Abuse
  11. 11. Child Emotional Abuse Behavior that results in impairment of social, emotional, intellectual function Victim Characteristics Overly compliant Inappropriately adult Developmental delays Lack of Attachment Suspect When Parent Belittles, rejects, ignores, isolates
  12. 12. Child Neglect Failure to provide that which is needed for health, welfare, growth and development Victim Characteristics  High absenteeism from school  Unkempt – Poor hygiene, lack of appropriate clothing  Steals – for food or “essentials”  Lack of medical care – immunizations Suspect When Caretaker  Indifferent, apathetic  Bizarre Behavior
  13. 13. Self-Assessment of the Nurse Work with a partner and discuss your honest feelings about: ○ Intimate Partner Violence ○ Child Neglect ○ Child Abuse ○ Child Sexual Abuse ○ Sexual Assault -Rape
  14. 14. Nursing Process - Assesment History  Physical  Privacy  Use experts – Child  Direct Abuse Teams, SANE  Therapeutic Comm Nurses  Inspect for physical  Separate Providers injuries - trauma,  “Tell me what bruises, welts, happened” fractures, bites, burns  Explore for qualities  Match to the story of a perpetrator and victim ○ Inform client/family if a referral is being made
  15. 15. Nursing Process Nursing Dx Rape-Trauma Syndrome Powerlessness Delayed Growth and Development Risk for other directed violence Anxiety Fear Disabled family coping Caregiver role strain
  16. 16. Outcome Criteria Physically and Psychologically safe from harm Reduction of Stress-Related Symptoms (Anxiety, Panic, Fear, Sleep Disturbance) Demonstration of Trust Initiation of Grief Response Develops a safety plan
  17. 17. Nursing Process -Intervention ABCs – Treat any physical injuries, attend to stress response, photograph Ensure a safe environment Listen, empathize, comfort, reassure Call or direct to authorities Critical Incident Debriefing – psychological care After care  CPS for child abuse  Safety Plan Domestic Violence  Support Groups Sexual Assault  See page 740 in Townsend for good overview
  18. 18. Developing a Safety Plan A plan for a fast escape when violence occurs Identified sign of escalation of violence and designate this as a time to leave Include in plan a destination and a way to get there Have the hotline referral telephone number of a shelter or a safe house