Problems related to abuse or neglect

SEMINAR
ON
ABUSE OR NEGLECT
PRESENTED BY:
PRIYANKA KUAMRI
M.Sc. NURSING

INTRODUCTION
Abuse is on the rise in the society. Books, newspapers, movies &
television inundate their readers & viewers with stories of “man’s
inhumanity to man” (no gender bias intended).
Nearly 5.3 million intimate partner victimizations occur each year
among United States women aged 18 & older.
More injuries are attributed to intimate partner violence than to all
rapes, muggings & automobile accidents combined.

VULNERABLE GROUPS:
Vulnerable populations include the economically
disadvantaged, racial and ethnic minorities, the uninsured,
low-income children, the elderly, the homeless, those with
human immunodeficiency virus (HIV), and those with other
chronic health conditions, including severe mental illness.
ABUSE: The maltreatment of one person by another.

EPIDEMIOLOGICAL STATISTICS OFABUSE OR
NEGLECT IN INDIA
Related to child abuse:
 In child labour cases, boys were abused as frequently as girls
according to the 2007 study conducted along with the Ministry of
Women and Child Development. 488 cases saw the victim raped
by grandfathers, brothers, fathers. At 55% and 49% respectively,
Tamil Nadu and Gujarat reported the highest number of child
workplace sexual abuse cases.
 The number of cases registered for child abuse raised from 8,904
in the year 2014 to 14,913 in the year 2015, under. Sexual
offences and kidnapping account for 81% of the crimes against
minors.

 State wise cases - Uttar Pradesh led the highest number of
child abuse cases (3,078) followed by Madhya Pradesh
(1,687 cases), Tamil Nadu (1,544 cases), Karnataka (1,480
cases) and Gujarat (1,416 cases).
 94.8% of rape cases saw children being raped by someone
they knew, not strangers.
 These acquaintances include neighbors (3,149 cases) who
were the biggest abusers (35.8%).
 10% of cases saw children being raped by their own direct
family members and relatives.
 About 1,545 children died from causes related to abuse or
neglect in 2011.

Related to Women Abuse:
In a Thomson Reuters survey, India was ranked FIRST
and named the world’s most dangerous country for women
in 2018. four years ago, in the same survey, India was
ranked fourth.
In India, 30% of women aged 15-49 have experienced
physical violence since the age of 15.
In 2016, 19,223 women became victims of human
trafficking in India.
In 2015 alone total of 3,27,394 crimes were registered
against women.

92% of women reported their husband as perpetrators of
sexual violence.
In India, one third of all married women have experienced
physical, sexual, or emotional violence by their husband.
In 2017 alone, 148 cases of acid attack on women were
reported across India.
Between 2015 to 2018, over 300 cases of honor killing
were registered. And 4% of pregnant women have
experienced physical violence during pregnancy.

In 2017, 1147 cases of cybercrimes against women and
children were reported in Maharashtra alone.
In 2018, 5 women were raped and 8 were molested
everyday, on average, in Delhi alone.
And yet, such crimes have become so common that it
appears we have become “Numb” as a nation. Because for
‘India’s daughters’, safety is a far-fetched dream and a
‘Twitter trend’ is the extent of a whole nation concern.
And if things don’t change any time soon, then the
“VISION-2020” that India is looking at seems dark and
devoid of humanity.

Related to Elderly Abuse:
 Elder abuse was reported maximum in Mangalore,
Ahmedabad, Bhopal, Amritsar, Delhi and Kanpur. It was
least in Jammu, Mumbai, Vizag, Kochi, Guwahati.
 The most common form of abuse they experienced was
Disrespect (56%), Verbal Abuse (49%) and Neglect (33%).
They had been facing this since the past 5 years.
 The main abusers were Son (52%) and Daughter-in-law
(34%).

Abuse in terms of showing disrespect was reported in
Chennai (71%), and Kolkata (54%).
Verbal abuse was reported more in Mumbai (79%),
Ahmedabad (57%) and Kolkata (54%).
Physical abuse was reported more in Kolkata (23%),
Hyderabad (22%), Mumbai (21%) and Ahmedabad (20%).
Emotional Abuse was reported more in Delhi (62%) and
Kolkata (54%).

PREDISPOSING FACTORS
Biological theories
Psychological theories
Sociological theories

BIOLOGICAL THEORIES
Neurophysiological Influences: -
 Various components of the neurological system in both
humans & animals have been implicated in both the
facilitation & inhibition of aggressive impulses.
 Areas of the brain that may be involved include the
temporal lobe, the limbic system & the amygdaloidal
nucleus.

Biochemical Influences: -
 Studies show that various neurotransmitters- in particular
nor-epinephrine, dopamine & serotonin – may play a role
in the facilitation & inhibition of aggressive impulses.

Disorders of Brain: -
 Organic brain syndromes associated with various cerebral
disorders have been implicated in the predisposition to
aggressive & violent behaviour.

PSYCHOLOGICAL THEORIES
Psychodynamic Theory: -
 The psychodynamic theorists imply that unmet needs
for satisfaction & security results in an underdeveloped
ego & a weak superego.
 It is thought that when frustration occurs, aggression &
violence supply this individual with a dose of power &
prestige that boosts the self-image & validates
significance to his or her life that is lacking.

Learning Theory: -
 Children may have an idealistic perception of their parents
during the very early developmental stages but, as they
mature, may begin to imitate the behavior patterns of their
teachers, friends & others.
 Individuals who were abused as children or whose parents
disciplined with physical punishment are more likely to
behave in an abusive manner as adults.

SOCIOCULTURAL THEORIES
Societal Influences: -
 Although they agree that perhaps some biological &
psychological aspects are influential, social scientists believe
that aggressive behaviour is primarily a product of one’s
culture & social structure.
 American Society essentially was founded on a general
acceptance of violence as a means of solving problems.
 The concept of relative deprivation has been shown to have
a profound effect on collective violence within a society.

 “Studies have shown that poverty & income are powerful
predictors of homicide & violent crime.
 The effect of the growing gap between the rich & poor is
mediated through an undermining of social cohesion, or
social capital, & decreased social capital is in turn
associated with increased firearm homicide & violent
crime”.
 The lack of opportunity & subsequent delinquency may
even contribute to a subculture of violence within a
society.

CHARACTERISTICS OF ABUSE OR
NEGLECT
INTIMATE PARTNER ABUSE:
 Core concept of Battering: - A pattern of coercive control
founded on & supported by physical &/or sexual violence
or threat of violence of an intimate partner.
 The National Coalition Against Domestic Violence: -
“Battering is a pattern of behaviour used to establish
power & control over another person through fear &
intimidation, often including the threat or use of violence.
Battering happens when one person believes they are entitled
to control another”.

The American Medical Association (2005) defines domestic
violence as:
 “An ongoing, debilitating experience of physical, psychological,
&/or sexual abuse in the home, associated with increased isolation
from the outside world & limited personal freedom & accessibility
to resources.”
 Physical abuse between domestic partners may be known as spouse
abuse, domestic or family violence, wife or husband battering, or
intimate partner or relationship abuse.
 United States bureau of Justice (2003) statistics for 2001 reflected
the following: Approximately 85% of victim of intimate violence
were women, women ages 16 to 24 experienced the highest per
capita rates of intimate violence. Intimate partners committed 3% of
the nonfatal violence against men.

Profile of the Victim: -
 Battered women represent all age, racial, religious, cultural,
educational & socioeconomic group.
 They may be married or single, housewives or business
executives. Many women who are battered have low self-
esteem, commonly adhere to feminine sex-role stereotypes, &
often accept the blame for the batterer’s actions.
 Feelings of guilt, anger, fear & shame are common. They may
be isolated from family & support systems.

Profile of the Victimizer: -
 Men who batter usually are characterized as persons with
low self-esteem.
 Pathologically jealous, they present a “dual personality”,
one to the partner& one to the rest of the world.
 They are often under a great deal of stress, but have limited
ability to cope with the stress.
 The typical abuser is very possessive & perceives his
spouse as a possession.
 He becomes threatened when she shows any sign of
independence or attempts to share herself & her time with
others.

THE CYCLE OF BATTERING
 In her classic studies of battered women & their
relationships, Walker (1979) identified a cycle of
predictable behaviours that are repeated over time.
 The behaviours can be divided into three distinct phases
that vary in time & intensity both within the same
relationship & among different couples.

Phase I (The Tension-Building Phase):
 During this phase, the women sense that the man’s tolerance
for frustration is declining.
 He becomes angry.
 The woman may become very nurturing & compliant, in an
effort to prevent his anger from escalating. She may just try to
stay out of his way.

 Minor battering incidents may occur during this phase, & in
a desperate effort to avoid more serious confrontations, the
woman accepts the abuse as legitimately directed toward her.
 She denies her anger & rationalizes his behavior.
 She assumes the guilt for the abuse, even reasoning that
perhaps she did deserve the abuse.
 The minor battering incidents continue & the tension mounts,
as the woman waits for the impending explosion.

 The abuser begins to fear that his partner will leave him. His
jealousy & possessiveness increase, & he uses threats &
brutality to keep her in his captivity.
 Battering incidents become more intense, after which the
woman becomes less & less psychologically capable of
restoring equilibrium. She withdraws from him, which he
misinterprets as rejection, further escalating his anger toward
her.
 Phase I may last from few weeks to many months or even
years.

Phase II (The Acute Battering Incident):
 This phase is the most violent & the shortest, usually lasting up
to 24 hours.
 It most often begins with the batterer justifying his behaviour
to himself.
 By the end of the incident, however, he cannot understand what
has happened, only that in his rage he has lost control over his
behaviour.
 This incident may begin with the batterer wanting to “just teach
her a lesson”.

 In some instances, the woman may intentionally provoke the
behaviour. Having come to a point in phase I in which the tension is
unbearable, long-term battered women know that once the acute
phase is behind them, things will be better.
 During phase II, women feel their only option is to find a safe place
to hide from the batterer.
 The beating is severe, & many women can describe the violence in
great detail, almost as if dissociation from their bodies had occurred.
The batterer generally minimizes the severity of the abuse.
 Help is usually sought only in the event of severe injury or if the
woman fears for her life or those of her children.

Phase III. Calm, Loving, Respite (“Honeymoon”) Phase:
 In this phase, the batterer becomes extremely loving, kind &
contrite. He promises that the abuse will never recur & begs
her forgiveness. He is afraid she will leave him & uses every
bit of charm he can muster to ensure this does not happen.
 He believes he now can control his behaviour & because now
he has “taught her a lesson,” he believes she will not “act up”
again.
 He plays on her feelings of guilt, & she desperately wants to
believe him. During this phase the woman relieves her
original dream of ideal love & chooses to believe that this is
what her partner is really like.

 This loving phase becomes the focus of the woman’s
perception of the relationship.
 She bases her reason for remaining in the relationship on
this “magical” ideal phase & hopes against hope that the
previous phases will not be repeated.
 This hope is evident even in those women who have lived
through a number of horrendous cycles.
 Although phase III usually lasts somewhere between the
lengths of time associated with phases I & II, it can be so
short as to almost pass undetected.

 In most instances, the cycle soon begins again with renewed
tension & minor battering incidents.
 In an effort to “steal” a few precious moments of the phase III
kind of loving, the battered woman becomes a collaborator in
her own abusive lifestyle.
 Victim & batterer become locked together in an intense,
symbiotic relationship.

 Why Does She Stay?
They fear for their life or the lives of their children. As
the battering progresses, the man gains power & control
through intimidation & instilling fear with threats such as,
“I’ll kill you & the kids if you try to leave”. Challenged
by these threats & compounded by her low self-esteem &
sense of powerlessness, the woman sees no way out.

Women have been known to stay in an abusive relationship for
many reasons, some of which include the following:
 For the children: She may fear losing custody of the children if
she leaves.
 For financial reasons: She may have no financial resources,
access to the resources, or job skills.
 Fear of retaliation: Her partner may have told her that if she
leaves he will find her & kill her & the children.
 Lack of a support network: She may be under pressure from
family members to stay in the marriage & try to work things out.
 Hopefulness: She remembers good times & love in the
relationship & has hope that her partner will change his
behaviour & they can have good times again.

ABUSE OR NEGLECT
CHILD ABUSE: -
 Erik Erikson (1963) stated, “The worst sin is the
mutilation of a child’s spirit.” Children are vulnerable &
relatively powerless, & effects of maltreatment are
infinitely deep & long lasting.
 Child maltreatment typically includes physically or
emotional injury, physical or emotional neglect or sexual
acts inflicted upon a child by a caregiver.
 The Child Abuse Prevention & Treatment Act (CAPTA),
as amended & reauthorized in October 1996, identifies a
minimum set of acts or behaviours that characterize
maltreatment.

PHYSICAL ABUSE: -
 “Any physical injury as a result of punching, beating, kicking,
biting, burning, shaking, throwing, stabbing, choking, hitting
(with a hand, stick, strap or other object), burning or
otherwise harming a child”.
 Maltreatment is considered whether or not the caretaker
intended to cause harm, or even if the injury resulted from
over-discipline or physical punishment.
 The most obvious way to detect it is by outward physical
signs. However, behavioral indicators also may be evident.

Signs of physical Abuse:
The child:
 Has unexplained burns, bites, bruises, broken bones or
black eyes.
 Has fading bruises or other marks noticeable after an
absence from school.
 Seems frightened of the parents & protests or cries
when it is time to go home.
 Shrinks at the approach of adults.

 Report injury by a parent or another adult caregiver.
 Physical abuse may be suspected when the parent or
other adult caregiver Offers conflicting, unconvincing,
or no explanation for the child’s injury.
 Describes the child as “evil,” or in some other very
negative way.
 Uses harsh physical discipline with the child.
 Has a history of abuse as child.

EMOTIONALABUSE: -
 Emotional abuse involves a pattern of behaviour on the
part of the parent or caretaker that results in serious
impairment of the child’s social, emotional or intellectual
functioning.
 Examples of emotional injury include belittling or
rejecting the child, ignoring the child, blaming the child
for things over which he or she has no control, isolating
the child from normal social experiences, & using harsh &
inconsistent discipline.

Behavioral indicators of emotional injury may include:
 Shows extremes in behaviour, such as overly compliant or
demanding behaviour, extreme passivity or aggression.
 Is either inappropriately adult (e.g., parenting other
children) or inappropriately infantile (e.g., frequently
rocking or head-banging).
 Is delayed in physical or emotional development.
 Has attempted suicide.
 Report a lack of attachment to the parent.

Emotional abuse may be suspected when the parent or
other adult caregiver:
 Constantly blames, belittles or berates the child.
 Is unconcerned about the child & refuse to considered
offers of help for the child’s problems.
 Overtly rejects the child.

PHYSICAL AND EMOTIONAL NEGLECT: -
Core Concept of Neglect: -
 Physical neglect of a child includes refusal of or delay in
seeking health care, abandonment, expulsion from the home
or refusal to allow a runway to return home, & inadequate
supervision.
 Emotional neglect refers to a chronic failure by the parent
or caretaker to provide the child with the hope, love &
support necessary for the development of a sound, healthy
personality.

Indication of Neglect: -
The possibility of neglect may be considered when the
child:
 Is frequently absent from school.
 Begs or steals food or money.
 Lacks needed medical or dental care, immunizations, or
glasses.
 Is consistently dirty & has severe body odor.
 Lacks sufficient clothing for the weather.
 Abuses alcohol or other drugs.
 States that there is no one at home to provide care.

The possibility of neglect may be considered when the
parent or other adult caregiver:
 Appears to be indifferent to the child.
 Seems apathetic or depressed.
 Behaves irrationally or in a bizarre manner.
 Is abusing alcohol or other drugs.

SEXUALABUSE OF A CHILD
“Employment, use, persuasion, inducement, enticement, or
coercion of any child to engage in, or assist any other person
to engage in, any sexually explicit conduct or any simulation
of such conduct for the purpose of producing any visual
depiction of such conduct; or the rape, & in cases of
caretaker or inter-familial relationships, statutory rape,
molestation, prostitution, or other form of sexual
exploitation of children, or incent with children (NCCAN,
2004).”

Core Concept of Incest: -
 Incest is the occurrence of sexual contacts or interaction
between or sexual exploitation of, close relatives, or
between participants who are related to each other by a
kinship bond that is regarded as a prohibition to sexual
relations (e.g., caretakers, stepparents, stepsiblings).
Indication of Sexual Abuse: -
 Child abuse may be considered a possibility when the
child:
 Has difficulty walking or sitting.
 Suddenly refuses to change for gym or to participate in
physical activities.

 Report nightmares or bedwetting.
 Experiences a sudden change in appetite.
 Demonstrates bizarre, sophisticated or unusual sexual
knowledge or behaviour.
 Becomes pregnant or contracts a venereal disease,
particularly if under age 14.
 Run away.
 Report sexual abuse by a parent or another adult caregiver

Sexual abuse may be considered a possibility when the
parent or other adult caregiver:
 Is unduly protective of the child or severely limits the
child’s contact with other children, especially of the
opposite sex.
 Is secretive & isolated.
 Is jealous or controlling with family members.

Characteristics of the Abuser: -
 A number of factors have been associated with adults who
abuse or neglect their children. 90% of parents who abuse their
children were severely physically abused by their own mothers
or fathers. Murray & Zentner (2001) identify the following as
additional characteristics that may be associated with abusive
parents:
 Experiencing a stressful life situation (e.g., unemployment;
poverty)
 Lacking understanding of child development or care needs.
 Lacking adaptive coping strategies; angers easily; has
difficulty trusting others
 Expecting the child to be perfect may exaggerate any mild
difference the child manifests from the “usual”

The Incestuous Relationship: -
 Onset of the incestuous relationship typically occurs when
the daughter is 8 to 10 years of age & commonly begins
with genital touching & fondling. In the beginning, the
child may accept the sexual advances from her father as
signs of affection.
 As the incestuous behaviour continues & progresses, the
daughter usually becomes more bewildered, confused, &
frightened, never knowledge whether her father will be
paternal or sexual in his interactions with her.

 The relationship may become a love-hate situation on the
part of the daughter.
 She continues to strive for the ideal father-daughter
relationship but is fearful & hateful of the sexual demands
he places on her.
 The mother may be alternately caring & competitive as
she witnesses her husband’s possessiveness & affections
directed toward her daughter.
 Out of fear that his daughter may expose their
relationship, the father may attempt to interfere with her
normal peer relationships.

 It has been suggested that some fathers who participate
in incestuous relationship may have unconscious
homosexual tendencies & have difficulty achieving a
stable heterosexual orientation.
 On the other hand, some men have frequent sex with
their wives & several of their own children but are
unwilling to seek sexual partners outside the nuclear
family because of a need to maintain the public facade
of a stable & competent patriarch.
 Although the oldest daughter in a family is most
vulnerable to becoming a participant in father-daughter
incest, some fathers from sequential relationship with
several daughters.

WOMAN ABUSE:
Woman abuse is not just physical or sexual abuse.
Rather, it is a chronic syndrome characterized by emotional
abuse, degradation, restrictions on freedom, destruction of
property, threatened or actual child abuse, threat against
one’s family, stalking, and isolation from family and
friends.
 Mainly it includes Battering and Rape and sexual assault.
Core Concept of Rape: -
Rape is the expression of power & dominance by means
of sexual violence, most commonly by men over women,
although men may also be rape victims.

Sexual Assault: -
Sexual assault is viewed as many type of sexual act in
which an individual is threatened or coerced, or forced to
submit against his or her will.
Rape, a type of sexual assault, occurs over a broad spectrum
of experiences ranging from the surprise attack by a stranger
to insistence on sexual intercourse by an acquaintance or
spouse.
Regardless of the defining source, one common theme
always emerges:
 Rape is an act of aggression, not one of passion.

Date rape: -
Date rape is a term applied to situations in which the
rapist is known to the victim.
 They may be out on a first date, may have been dating
for a number of months, or merely may be
acquaintances or schoolmates.
 College campuses are the location for a staggering
number of these types of rapes, a great many of which
go unreported.
 An increasing number of colleges & universities are
establishing programs for rape prevention & counseling
for victims of rape.

Marital rape: -
It has been recognized only in recent years as a legal
category, is the case in which a spouse may be held liable for
sexual abuse directed at a marital partner against that
person’s will.
 Historically, with societal acceptance of the concept of
women as marital property, the legal definition of rape
held an exemption within the marriage relationship.

Statutory rape: -
It is defined as unlawful intercourse between a man older
than 16 years of age & a woman under the age of consent.
 The age of consent varies from state to state, ranging from
age 14 to 21.
 A man who has intercourse with a woman under the age of
consent can be arrested for statutory rape, although the
interaction may have occurred between consenting
individuals.
 The charges, when they occur, usually are brought by the
young woman’s parents.

Profile of the Victimizer: -
 Many rapists report growing up in abusive homes. Even
when the parental brutality is discharged by the father, the
anger may be directed toward the mother who did not
protect her child from physical assault.
 More recent feminist theories suggest that the rapist
displaces this anger on the rape victim because he cannot
directly express it toward other man.
 Statistics show that the greatest numbers of rapists are
between the ages of 25 & 44. Many are either married or
cohabiting at the time of their offenses.. Most rapists do not
have histories of mental illness.

The Victim: -
Rape can occur at any age. Although victims have been
reported as young as 15 months old & as old as 82 years, the
high-risk age group appears to be 16 to 24 years.
 Of rape victims, 70 to 75% are single women, & the attack
frequently occurs in or close to the victim’s own
neighborhood.
 Scully (1994), in a study of a prison sample of rapists,
found that in “stranger rapes,” victims were not chosen for
any reason having to do with appearance or behaviour, but
simply because the individual happened to be in a certain
place at a certain time.

ELDER ABUSE:
It is generally agreed that abuse of older people is either an act
of commission or of omission (in which case it is usually described
as ‘‘neglect’’), and that it may be either intentional or
unintentional.
 The abuse may be of a physical nature, it may be psychological,
or financial or other material maltreatment. Regardless of the
type of abuse, it will certainly result in unnecessary suffering,
injury or pain, the loss or violation of human rights, and a
decreased quality of life for the older person.
 Whether the behaviour is termed abusive, neglectful or
exploitative will probably depend on how frequently the
mistreatment occurs, its duration, severity and consequences,
and above all, the cultural context.

 ‘‘Elder abuse is a single or repeated act, or lack of
appropriate action, occurring within any relationship
where there is an expectation of trust which causes harm
or distress to an older person.’’
 Such abuse is generally divided into the following
categories:
 Physical abuse – the infliction of pain or injury, physical
coercion, or physical or drug induced restraint.

 Psychological or emotional abuse – the infliction of mental
anguish.
 Financial or material abuse – the illegal or improper
exploitation or use of funds or resources of the older person.
 Sexual abuse – non-consensual sexual contact of any kind
with the older person.
 Neglect – the refusal or failure to fulfil a caregiving
obligation. This may or may not involve a conscious and
intentional attempt to inflict physical or emotional distress on
the older person.

NURSING MANAGEMENT OF ABUSE OR
NEGLECT
NURSING DIAGNOSIS/ OUTCOME IDENTIFICATION: -
Some common nursing diagnoses for victims of abuse include:
 Rape-trauma syndrome r/t sexual assault evidence by
verbalizations of the attack; bruises & lacerations over area of
body; severe anxiety.
 Powerlessness r/t cycle of battering evidence by verbalizations
of abuse; bruises & lacerations over areas of body; fear for her
safety & that of her children; verbalizations of no way to get out
the relationship.

 Delayed growth & development r/t abusive family
situation evidence by sudden onset of enuresis, thumb
sucking, nightmares, and inability to perform self-care
activities appropriate for age.
 The following criteria may be used to measure outcomes
in the care of abuse victims:
The client who has been sexually assaulted:
 Is no longer experiencing panic anxiety.
 Demonstrates a degree of trust in the primary nurse.
 Has received immediate attention to physical injuries.
 Has initiated behaviour consistent with the grief response.

The client who has been physically battered:
 Verbalizes assurance of his or her immediate safety.
 Discusses life situation with primary nurse.
 Can verbalize choices from which he or she may receive
assistance.
The child who has been abused:
 Demonstrate trust in primary nurse by discussing abuse
through the use of play therapy.
 Is demonstrating a decrease in regressive behaviour.

PLANNING/IMPLEMENTATION: -
Nursing Diagnosis: Rape-Trauma Syndrome
Nursing Implementation:
It is important to communicate the following to the
victim of sexual assault:
 You are safe here.
 I’m sorry that it happened.
 I’m glad you survived.
 It’s not your fault. No one deserves to be treated this way.
 You did the best that you could.

 Explain every assessment procedure that will be conducted
& why it is being conducted. Ensure that data collection is
conducted in a caring, nonjudgmental manner.
 Encourage that the client has adequate privacy for all
immediate post-crisis interventions. Try to have as few
people as possible providing the immediate care or
collecting immediate evidence.
 Encourage the client to give an account of the assault.
Listen, but do not probe.
 Discuss with the client whom to call for support or
assistance. Provide information about referrals for
aftercare.

Nursing Diagnosis: Powerlessness
 In collaboration with physician, ensure that all physical
wounds, fractures & burns receive immediate attention. Take
photographs if the victim will permit.
 Take the woman to a private area to do the interview.
 If she has come alone or with her children, assure her of her
safety. Encourage her to discuss the battering incident. Ask
questions about whether this has happened before, whether
the abuser takes drugs, whether the woman has a safe place to
go, & whether she is interested in pressing charges.
 Ensure that “rescue” efforts are not attempted by the nurse.
Offer support but remember that the final decision must be
made by the client.

 Stress to victim the importance of safety. She must be
made aware of the variety of resources that are available
to her.
 These may include crisis hotlines, community groups for
women who have been abused, shelters, counseling
services, & information regarding the victim’s right in the
civil & criminal justice system.
 Following a discussion of these available resources, the
woman may choose for herself.
 If her decision is to return to the marriage & home, this
choice also must be respected.

Nursing Diagnosis: Delayed Growth & Development.
 Perform complete physical assessment of the child. Take
particular note of bruises (in various stages of healing),
lacerations, & client complaints of pain in specific areas.
 Do not overlook or discount the possibility of sexual
abuse.
 Assess for nonverbal signs of abuse: aggressive conduct,
excessive fears, extreme hyperactivity, apathy,
withdrawal, age-inappropriate behaviours.

 Conduct an in-depth interview with the parent or adult
who accompanies the child. Considered: If the injury is
being reported as an incident, is the explanation
reasonable? Is the injury consistent with the explanation?
Is the injury consistent with the child’s developmental
capabilities?
 Use games or play therapy to gain child’s trust. Use these
techniques to assist in describing his or her side of the
story.
 Determine whether the nature of the injuries warrants
reporting to authorities. Specific state statutes must enter
into the decision of whether to report suspected child
abuse. Individual state statutes regarding what constitutes
child abuse & neglect may be found.

TREATMENT MODALITIES
CRISIS INTERVENTION:
 The focus of the initial interview & follow-up with the
client who has been sexually assaulted is on the rape
incident alone.
 The goal of crisis intervention is to help victims return to
their previous lifestyle as quickly as possible.
 The client should be involved in the intervention from
the beginning. This promotes a sense of competency,
control & decision-making. Because an overwhelming
sense of powerlessness accompanies the rape experience,
active involvement by the victim is both a validation of
personal worth & the beginning of the recovery process.

 Crisis intervention is time limited – usually 6 to 8 weeks. If problems
resurface beyond this time, the victim is referred for assistance from
other agencies.
 During the crisis period, attention is given to coping strategies for
dealing with the symptoms common to the post trauma client.
 Initially the individual undergoes a period of disorganization during
which there is difficulty making decisions, extreme or irrational fears,
& general mistrust. Over able manifestations may range from stark
hysteria to expression of anger & rage to silence & withdrawal.
 Guilt & feelings of responsibility for the rape, as well as numerous
physical manifestations are common. The crisis counselor will attempt
to help the victim draw upon previous successful coping strategies to
regain control over his or her life.

THE SAFE HOUSE OR SHELTER:
 Most major cities in the Country now have safe houses
or shelters where women can go to be assured of
protection for them & their children.
 These shelters provide a variety of services, & the
women receive emotional support from staff & each
other.
 Most shelters provide individual & group counseling;
help with bureaucratic institutions such as the police,
legal representation, & social services; child care &
children’s programming; & aid for the woman in
making future plans, such as employment counseling &
linkages with housing authorities.

 The shelters are usually run by a combination of professional
& volunteer staff, including nurses, psychologists, lawyers &
others.
 Women who themselves have been previously abused are
often among the volunteer staff members.
 Group work is an important part of the services of shelters.
Women in residence range from those in the immediate crisis
phase to those who have progressed through a variety of
phases of the grief process.
 Those newer members can learn a great deal from the women
who have successfully resolved similar problems. Length of
stay varies a great deal from individual to individual,
depending on a number of factors, such as outside support
network, financial situation & personal resources.

FAMILY THERAPY:
 The focus of therapy with families who use violence is
to help them develop democratic ways of solving
problems.
 Studies show that the more a family uses the democratic
means of conflict resolution, the less likely they are to
engage in physical violence.
 Families need to learn to deal with problems in ways
that can produce mutual benefits for all concerned,
rather than engaging in power struggles among family
members.

 Parents also need to learn more effective methods of
disciplining children, aside from physical punishment.
Methods that emphasize the importance of positive
reinforcement for acceptable behaviour can be very
effective.
 Family members must be committed to consistent use of this
behaviour modification technique for it to be successful.
 Teaching parents about expectations for various
developmental levels may alleviate some of the stress that
accompanies these changes.
 Knowing what to expect from individuals at various stages
of development may provide needed anticipatory guidance to
deal with the crises commonly associated with these stages.

SUMMARY
Today we had discussed vulnerable groups, predisposing
factors of abuse or neglect, child abuse, women abuse,
elderly abuse or neglect, their clinical features, nursing
management and treatment modalities.

CONCLUSION
 Abuse of women & children began early in the
development of this country when these individuals
were considered the property of their husbands &
fathers; this physical abuse was considered acceptable.
Many women came to believe that they deserved any
physical or sexual abuse they encountered.
 Problems related to abuse & neglect are becoming a
national crisis in the India.
 Nurses are in a unique position to intervene at the
primary, secondary, & tertiary levels of prevention
with the victims of these problematic behaviors.

RESEARCH ARTICLE:
 Child Abuse and Neglect in India
 Article in The Indian Journal of Pediatrics 82(8) · December
2014. Source: PubMed , By Rajeev Seth
Abstract
India is home to the largest child population in the world, with
almost 41 % of the total population under 18 yrs of age. The
health and security of the country's children is integral to any
vision for its progress and development. Doctors and health care
professionals are often the first point of contact for abused and
neglected children. They play a key role in detecting child abuse
and neglect, provide immediate and longer term care and support
to children.

Despite being important stakeholders, often physicians have
a limited understanding on how to protect these vulnerable
groups. There is an urgent need for systematic training for
physicians to prevent, detect and respond to cases of child
abuse and neglect in the clinical setting. The purpose of the
present article is to provide an overview of child abuse and
neglect from a medical assessment to a socio-legal
perspective in India, in order to ensure a prompt and
comprehensive multidisciplinary response to victims of
child abuse and neglect.

During their busy clinical practice, medical professionals
can also use the telephone help line (CHILDLINE
telephone 1098) to refer cases of child abuse, thus
connecting them to socio-legal services. The physicians
should be aware of the new legislation, Protection of
Children from Sexual Offences (POCSO) Act, 2012, which
requires mandatory reporting of cases of child sexual abuse,
failing which they can be penalized. Moreover, doctors and
allied medical professionals can help prevent child sexual
abuse by delivering the message of personal space and
privacy to their young patients and parents.

BIBLIOGRAPHY
 Mary Ann Boyd. Psychiatric nursing Contemporary Practice. Ed. 2nd, Lippincott; 2002, page No. 975-1000.
 Sreevani R. Mental health & psychiatric nursing. Ed.2nd, Jaypee brothers medical publishers; 2007, Page no.
245-252.
 Stuart Gail W. Principals & practice of psychiatric nursing. Ed. 8th, Elsevier; 2007, Page no. 798-813.
 Townsend Marry C. Psychiatric mental health nursing. Ed. 5th, Jaypee brothers medical publishers; 2007,
Page no. 778-794.
 http://www.childhelp.org/child-abuse/
 https://www.helpguide.org/articles/abuse/child-abuse-and-neglect.htm
 https://www.cry.org/statistics-on-children
 https://www.who.int/ageing/projects/elder_abuse/en/
 https://www.helpguide.org/articles/abuse/elder-abuse-and-neglect.htm
 https://en.wikipedia.org/wiki/Violence_against_women_in_India
 https://www.researchgate.net/publication/269185305_Child_Abuse_and_Neglect_in_India

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