Chapter 26Substance AbuseCopyright © 2015, 2011, 2007, 200.docx

Chapter 26
Substance Abuse
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders,
an imprint of Elsevier Inc.
More deaths, illnesses, and disabilities are attributed to
substance abuse than to any other preventable health conditions
in the United States.
– Substance Abuse and Mental Health
Services Administration (SAMSHA)
2
Social Consequences of Substance Abuse
Crimes while under the influence of drugs, alcohol, or both
Need for money to buy substances
Specific theft of drugs
Almost 75% of inmates report prior drug use
All aggregates in society are potentially affected by substance
abuse problems regardless of age or economic level
3
Etiology of Substance Abuse
Numerous theories try to explain it

Combination of many factors
Genetics within families
Individual (impulsivity and ease of disinhibition)
Environmental factors
Medical models
Biopsychosocial models
4
Historical Overview of Alcohol and Illicit Drug Use
Alcohol use has gained more social acceptance than other drug
use.
Public attitudes and governmental policies have also influenced
the history of illicit drug use.
5
Historical Overview of Alcohol and Illicit Drug Use (Cont.)
Consumption and laws affected by:
Alcohol-related deaths after lowered drinking age
Less tolerant national attitudes toward drinking
Increased societal and legal pressures and actions against
drinking and driving
Increased health concerns among Americans
Knowledge of addictive properties
Counterculture acceptance of hallucinogens, cannabis, and
heroin
The “War on Drugs”
Renewed interest in prevention/treatment efforts

6
Laws Impacting Substance Abuse
Anti–Drug Abuse Acts of 1986 and 1988
Increased funding for treatment and rehabilitation
Created the Office of National Drug Control Policy (“drug
czar”)
Worked on a public health approach to drug control
National Institute on Drug Abuse (NIDA)
Science on drug abuse and addiction
Prevention
Treatment
Decreasing the spread of HIV/AIDS
Other priority areas
7
Laws Impacting Substance Abuse (Cont.)
Substance Abuse and Mental Health Services Administration
(SAMHSA)
Builds and sustains programs, policies, information and data,
contracts, and grants toward helping the nation act on the
knowledge that promotes behavioral health treatment through
all levels of prevention
8

Prevalence, Incidence, and Trends
Alcohol use by persons aged 12 or older:
Slightly more than half (52.8%) drink alcohol
Binge drinking at least once in prior 30 days— (22.6%)
Heavy drinking—6.2%
Young adults ages 18-25 had highest prevalence of binge and
heavy drinking—39.8%
Drove under the influence of alcohol at least once in past year—
11.1%
– SAMHSA (2011)
9
Prevalence, Incidence, and Trends (Cont.)
Illicit drug use by persons aged 12 or older:
About 8.7% were current drug users, used an illicit drug during
the past month
Illicit drugs used
Marijuana was the most commonly used drug
Others included cocaine (including crack), heroin,
hallucinogens, inhalants, or prescription-type
psychotherapeutics (pain relievers, tranquilizers, stimulants,
and sedatives) used nonmedically
– SAMHSA (2011)
10

Nonmedical use of prescription-type psychotherapeutics
There is a significant increase in the lifetime nonmedical use of
pain relievers—specifically Percocet®, Percodan®, Vicodin®,
Lortab®, Darvocet®, Darvon®, Tylenol® with Codeine,
Propoxyphene, or Codeine Products, Oxycodone, and
Hydrocodone
– NIDA (2010)
11
Hallucinogen, inhalant, and heroin use
LSD (d-lysergic acid diethylamide)
Peyote cactus
Psilocybin
PCP (phencyclidine)
Inhalants of choice are amyl nitrite, “poppers,” followed by
glue, shoe polish, or toluene; correction fluid, degreaser, or
cleaning fluid; gasoline or lighter fluid; and spray paints and
other aerosols.
12
Gender difference
Males more likely to be current illicit drug users

Female illicit drug use (12 and older) increasing
Geographic trends
Highest in West > Midwest > Northeast > South
Racial/ethnic groups
Highest among American Indians or Alaska natives > African
Americans> whites > Hispanics > Asians
– SAMHSA (2010)
13
Trends in Substance Abuse
May or may not relate to classically or clinically defined
dependence or addiction.
Many are turning to recovery before they have developed
physiological dependence.
Need to differentiate between use and misuse/abuse.
Use of harmful substances is indirectly and directly related to
all of the leading health indicators targeted in Healthy People
2020.
14
Methamphetamine (MA)
Most widely produced controlled substance in the United States.
Illegal street names of the drug (crank, crystal, meth, ice, or
glass).
Can be injected, inhaled, taken orally, or smoked.
Used predominantly by white young persons, with an

overrepresentation of females.
15
Methamphetamine (MA) (Cont.)
Pleasurable effects are caused by the release of high levels of
dopamine in the brain, leading to increased energy, a sense of
euphoria, and increased productivity.
Short-term effects: increased heart rate, insomnia, excessive
talking, excitation, and aggressive behavior
Prolonged use results in tolerance and physiological dependence
Negative consequences range from anxiety, convulsions, and
paranoia, to brain damage.
16
Methamphetamine (MA) (Cont.)
The impact of MA abuse on communities, families, and social
networks is considerable.
Young children of users are at risk for abuse and neglect.
Prenatal use puts children at risk for developmental problems,
aggression, and attention disorders.
Exposure to combustible second-hand fumes.
Associated with increased incidence of violence (e.g., domestic
abuse, homicide, and suicide)
17

Steroids
Anabolic steroids are synthetic variants of male sex hormone
testosterone
Build muscle and said to be androgenic
Most commonly used in athletes and other individuals willing
to risk potential and irreversible health consequences to build
muscle
Potentially fatal risks
Blood clots, liver damage, premature cardiovascular changes,
increased cholesterol
Increased potential for suicide and aggressive and risky
behaviors
18
Inhalants
Contain volatile components with psychoactive properties
Many products found in home or workplace (e.g., spray paints,
markers, glues, and cleaning fluids)
Produce a rapid high that may resemble alcohol intoxications;
may progress to loss of sensation and even unconsciousness
Irreversible effects:
Hearing loss, limb spasms, CNS or brain damage, or bone
marrow damage; may result in death from heart failure or
suffocation

19
Adolescent Substance Abuse
Highest prevalence of illicit drug use during lifetime between
18 and 25 years
Teen use of cigarettes and smokeless tobacco has declined
Nearly half of teens try marijuana before they graduate—
skepticism about drug’s danger
As harmful, illicit substances come in and out of vogue, CHN
needs a good understanding of drug culture, terminology, and
differing signs and symptoms
20
Conceptualizations of Substance Abuse
Conceptualizations have changed over the years, often for
political and social reasons rather than for scientific reasons.
“Dependence” or “abuse”
What substances can be abused?
APA focuses on alcohol, amphetamines, caffeine, cannabis,
cocaine, hallucinogens, inhalants, nicotine, opioids,
phencyclidine, sedatives, and hypnotics or anxiolytics
21

Defining Substance Abuse
Substance abuse: a maladaptive pattern of substance use that is
manifested by recurrent and significant adverse consequences
related to repeated use of a substance.
Failure to fulfill major role obligations
Repeated use in physically hazardous situations
Multiple legal problems
Recurrent social and interpersonal problems
22
Defining Substance Abuse (Cont.)
Dependence: a cluster of cognitive, behavioral, and
physiological symptoms that indicate continued use of the
substance despite significant substance-related problems
Pattern of repeated, self-administered use
Tolerance, withdrawal, and compulsive drug-taking behaviors
A craving or strong desire for the substance
Preoccupation with supply, money to purchase, and getting
through time between periods of use
23
Sociocultural and Political Aspects of Substance Abuse
Determined largely by economic, cultural, and political
conditions of potential users
Cultural conditions create ambiguity in clearly determining

when a problem exists.
Competing value systems lead to cultural disintegration and a
sense of powerlessness and hopelessness.
24
Course of Substance-Related Problems
Path from initiation to dependency is multidimensional.
Person + substance + context/environment
Progression varies—from initiation to continuation, transition to
abuse, and finally, addiction and dependency
Critical point is transition from use to abuse
Addiction/dependency marked by changes in both behavior and
cognition
Once addiction is established, withdrawal symptoms are strong
motivators to continue use
25
Legal and Ethical Concerns
U.S. policy based on prohibition and criminal sanctions against
use and sale of illicit drugs
Criminal activities (violence and drug trafficking)
Drinking and driving, working while intoxicated
Impact on fetus (FAS)
Modes of intervention
Limit access

Media campaigns
Educational programs
National organizations that promote community education,
research, and support
26
Prevention Strategies
Primary prevention
Needs assessment to identify high-risk situations and potential
problems
Decriminalization and legalization of drugs(?)
Community-based programs
Training of health professionals
Faith-based initiatives
Volunteer consumer groups
Organized sports programs
Employer programs
Often overshadowed by “War on Drugs”
27
Prevention Strategies (Cont.)
Secondary prevention
Screening and finding resources
CAGE: an alcoholism screening test

Clinical Institute Withdrawal Assessment (CIWA)
Use evidence-based programs
Efforts should be specific to aggregates, rather than directed at
the “general public”
Incorporate culturally sensitive and appropriate interventions
and strategies
Work toward improving individuals’ general competencies,
communication skills, and self-esteem
28
Treatment
For individuals, consider:
Cultural and educational background
Resources of the person
Attitudes of significant others
Degree of invasiveness of the effects of the substance use The
existence of alternatives
Relapse prevention
29
Treatment (Cont.)
Inpatient and outpatient treatment programs
May or may not include detoxification component
Voluntary vs. compulsory
Pharmacologically based vs. drug free

Treatment approaches and models vary
Assessment process is of primary importance.
Therapeutic relationship based on trust is essential.
Physical examination is a valuable tool.
Nonjudgmental attitude minimizes defensiveness.
30
Treatment (Cont.)
Programs usually include:
Group and individual therapy and counseling
Motivational interviewing
Family counseling
Education
Socialization into 12-step mutual self-help groups
Integrate psychotherapy with pharmacotherapy
May include other strategies:
Hypnosis, occupational therapy, confrontation, assertiveness
training, blood alcohol level discrimination training, behavior
modification approaches
31
Treatment (Cont.)
Pharmacotherapies
Used in detoxification, stabilization, maintenance, as
antagonists, and as treatment for coexisting disorders
Mutual help groups

Operate through face-to-face supportive interaction focusing on
a mutual goal; AA was first
Harm reduction
Elimination of the more harmful effects of substance use
through behavior and policy modifications
32
Social Network Involvement
Therapy that involves the family has proved to be most
effective in aiding recovery.
Family and friends
Highly influential or aid and abet
Codependency and enabling
Effects on the family
Functional or dysfunctional families
Psychological and financial burdens
Professional enablers
Treatment of symptoms by medication
Reluctant to bring up this taboo subject
33
Vulnerable Aggregates: Preadolescents and Adolescents
Times of experimentation, searching, confusion, rebellion, poor
self-image, alienation, and insecurity
Use of legal substances (e.g., tobacco, alcohol) almost always

precedes use of illegal drugs.
Poor school performance and drug use among peers are
strongest predictors of subsequent drug involvement, followed
by lack of strong family bond.
The younger the initiation, the greater the probability of
prolonged and accelerated use.
Feeling of powerlessness; selling drugs seen as a viable
economic solution to poverty.
34
Vulnerable Aggregates: Preadolescents and Adolescents (Cont.)
Primary prevention focuses on:
Advocating for these vulnerable children
Educating teachers on the vital importance of maintaining a
validating, nonjudgmental attitude toward these students
Supporting strong families in the community
Improving knowledge through education and media
Early detection of predisposing factors
Providing structured clubs and organizations
Facilitating school success, career skills, family communication
skills, and conflict resolution
35
Vulnerable Aggregates: Elderly
Elderly experience
Diminished physiological tolerance

Increased use/misuse of medically
prescribed drugs
Cultural and social isolation
Misuse of prescription drugs may be the most common form of
drug abuse among the elderly
Use prescription medications approximately three times as
frequently as general population
36
Vulnerable Aggregates: Women
Alcohol use and abuse affects women much differently than
men.
Women absorb and metabolize alcohol differently.
Body composition differences and production of less gastric
alcohol dehydrogenase
Metabolize alcohol at a different rate
37
Vulnerable Aggregates: Women (Cont.)
Increased risk stems from economic, social, and cultural factors.
Marginalization of certain groups
History of child abuse
Physical and medical problems related to reproductive systems
Use during pregnancy has long-term developmental

consequences for the newborn
38
Vulnerable Aggregates: Ethnocultural Considerations
African Americans, Hispanics, and Native Americans—
increased risk for substance abuse.
Economically disenfranchised groups
Discrimination and racism
Socioeconomic, political, and historical realities
Myths and stereotypes
Social support—positive effect on treatment/outcome
Environmental cues and conditioned reinforcement
Treatment poses special challenges.
39
Vulnerable Aggregates: Other Aggregates
Substance abuse is most common psychopathological problem in
the general population.
Dual-diagnosis individuals
Psychiatric disorder + substance abuse disorder
Risk for multiple vulnerabilities in one individual
Impact of substance abuse on STDs
Substance abuse among health care professionals

40
Nursing Interventions in the Community
Understand own experiences and prejudices.
Routinely assess substance use patterns when performing client
histories.
Be alert to environmental cues in the home that indicate
substance abuse.
Increase the individual’s and family’s awareness of the
problem.
Involve the social network in getting the client into treatment.
Develop a caring nursing relationship.
41
Other Traditional Nursing Roles and Interventions
Health teaching regarding addictive illness and addictive effects
of different substances
Advocating that EBP treatment works in special populations
through problem-solving courts (drug courts), specialized
adolescent treatment, and other community case management
programs.
Providing direct care for abuse- and dependence-related medical
problems
Educating clients and families about problems related to
substance abuse
Collaborating with other disciplines to ensure continuity of care

42
Other Traditional Nursing Roles and Interventions (Cont.)
Coordinating health care services for the client to prevent
prescription drug abuse and avoid fragmentation of care
Providing consultation to nonmedical professionals and lay
personnel
Facilitating care through appropriate referrals and follow-up
Knowing how to use community resources for working with
substance abuse, mental health, and other issues
43
Chapter 27
Violence
Overview of Violence
Violence is a national public health problem.
WHO (2013) defines violence as “the intentional use of physical
force or power, threatened or actual, against oneself, another
person, or against a group or community which either results in
or has a high likelihood of resulting in injury, death,

psychological harm, maldevelopment, or deprivation.”
Injuries from violence are referred to as intentional injuries.
2
Factors That Contribute to Violence
Poverty, unemployment, economic dependency
Substance abuse
Dysfunctional family and/or social environment and lack of
emotional support
Mental Illness
Media influence (e.g., violent video games, television shows,
and movies)
Access to firearms
Political and/or religious ideology
Intolerance and ignorance
3
History of Violence
Long history of human violence.
In the Bible, Cain killed his brother Abel out of jealousy and
anger
Audience pleasure (e.g., gladiators in Rome)
Infanticide—if child was female, a twin, sickly, or deformed
Children, especially firstborn, sacrificed for religious reasons

4
History of Violence (Cont.)
Corporal punishment used to control children
“Spare the rod and spoil the child” (Proverbs, 13:24)
“Beating some sense into him”
First legal protection in the United States in 1874
Spousal abuse/marital rape
“Rule of thumb”
“Wives be subject to your husband” (Ephesians, 5:22)
Assault against women not explored until 1960s
Elder abuse
Often undetected because of lack of awareness of HCP
Lack of mandatory reporting
5
Interpersonal Violence
Crosses all ethnic, racial, socioeconomic, and educational lines
Interpersonal Violence (IPV) is about control, not anger.
Includes:
Homicide and suicide
Intimate partner violence
Child maltreatment
6

Interpersonal Violence: Homicide
Homicide
One of the leading causes of death in the United States.
For black males aged 15 to 34, homicide is the leading cause of
death.
Young people, women, and African American and Hispanic
males at higher risk than the general population.
African Americans were more likely to commit homicide than
whites and were more likely to be victims of homicide than
whites (2010 data)
7
Interpersonal Violence: Suicide
Suicide is 10th leading cause of death for all Americans in all
age groups (2010)
More people die from suicide than homicide.
Men often use firearms.
Women use poisoning.
In Native Americans and Alaska Natives, suicide is the
second leading cause of death in persons 15 to 34 years of age.
8
Interpersonal Violence: Suicide (Cont.)

Risk factors for suicide
Psychiatric disorders such as major depression, bipolar disorder,
and/or schizophrenia
Substance abuse
Posttraumatic stress disorder (PTSD)
Bulimia or anorexia nervosa
Past history of attempted suicide
Genetic disposition to suicide
Age, such as elderly, and white males (highest rate)
9
Interpersonal Violence: Partner
Intimate partner violence (IPV)
A pattern of coercive behaviors perpetrated by someone who is
or was in an intimate relationship with the victim
May include battering, resulting in physical injury,
psychological abuse, and sexual assault to progressive social
isolation and intimidation of the victim
Typically repetitive and often escalates in frequency and
severity
10
Interpersonal Violence: Partner (Cont.)
Risk factors for IPV
Low self-esteem
Poverty
Risky sexual behavior

Eating disorders and/or depression
Substance abuse
Trust and relationship issues
Victims often suffer in silence and accept abuse as a
transgenerational pattern of normal behavior
11
Interpersonal Violence: Partner (Cont.)
Pregnancy
May increase stress within the family
All pregnant women should be routinely screened for abuse for
commons sign of IPV
Delay in seeking prenatal care
Unexplained bruising or damage to breasts or abdomen
Use of harmful substances (cigarettes, alcohol, drugs)
Recurring psychosomatic illnesses
Lack of participation in prenatal education
12
Interpersonal Violence: Dating
Abusive, controlling, or aggressive behavior in an intimate
relationship that takes the form of emotional, verbal, physical,
or sexual abuse
May involve the use of date rape drugs

Studies have linked alcohol with dating violence
Stalking—a pattern of repeated and unwanted attention, contact,
harassment, or any type of conduct directed at a person that
instills fear
Bullying—a repeated oppression, psychological or physical, of
a less powerful person by a more powerful person or group of
persons
13
Wheel of Power and Control
14
Figure 27-1
Developed by the Domestic Abuse Intervention Project. 206
West Fourth Street, Duluth, MN 55806. Used with permission.
Impact of Interpersonal Violence
Victims often experience…
Chronic fatigue and tension
Disturbed sleeping and eating patterns
Vague gastrointestinal and genitourinary complaints
Misdiagnosis often occurs because of the obscurity of symptoms
and/or failure to adequately assess
Victims stay in abusive relationships because of cultural,
religious, and economic factors

15
Impact of Interpersonal Violence (Cont.)
Victims who are most likely to leave a battering situation:
Have resources and power
No children
No personal history of abuse (themselves or their mother)
Most dangerous time for victim is when he or she leaves or
attempts to leave the relationship
More likely to be killed at this time than any other time in the
relationship
16
Interpersonal Violence: Child
Child maltreatment
Most child maltreatment occurs within the family.
More often abused by parents than other relatives or caregivers.
More commonly seen in families in poverty, families in
disorganization, or with parents who are younger and who are
substance abusers.
17

Interpersonal Violence: Child (Cont.)
Child maltreatment
Risk factors include but are not limited to
Special needs children
Children less than 4 years of age
Family history of violence
Substance abuse
Poverty
Social isolation
18
Interpersonal Violence: Child (Cont.)
Child maltreatment
Four types of child abuse:
Neglect
Physical abuse
Includes beating, burning, biting, and bruising
Abusive head trauma/shaken baby syndrome is leading cause of
death in the United States from abuse
Emotional abuse
Sexual abuse
19

Interpersonal Violence: Elderly
Elder abuse
Society fails to recognize the cruelty many older adults
experience.
Elders are an “invisible” segment of the population.
Reasons for underreporting of elder abuse
Shame on part of victim
Social and physical isolation from resources
Failure of health care provider to routinely assess during points
of contact
No uniform reporting system
20
Interpersonal Violence: Elderly (Cont.)
Elder abuse
Types of abuse and neglect
Physical abuse
Psychological-emotional abuse
Sexual abuse
Neglect
Financial exploitation
Health care fraud and abuse
21

Community Violence
Community violence usually occurs suddenly and without
warning and can potentially destroy entire segments of the
population
Community violence includes
Workplace violence
Youth violence
Gang-related violence
Hate crimes
Terrorism
22
Community Violence: Workplace
Risk factors include:
Increasing number of acute and chronically mentally ill patients
Working alone
Availability of drugs at worksite
Low staffing levels
Poorly lit parking areas and corridors
Long waits for service
Inadequate security
Increasing number of substance abusers
Access to firearms
23
Workplace violence includes physical assaults, muggings, and
verbal and written threats

Community Violence: Youth
Youth-Related Violence
Concentrated in minority communities and inner cities, causing
a disproportionate burden on these communities
Adolescents and youth increasingly use violence to settle
disputes.
Even when taught peaceful ways of resolving differences, learn
by what they observe at home, on television, and in movies.
Schools have become common sites for violence.
24
Risk Factors for Youth Violence
(from Textbook, Table 27-3)
25Individual Risk FactorsCommunity Risk FactorsInvolvement
with drugs, alcohol, or tobaccoDiminished economic
opportunitiesAntisocial beliefs and attitudesHigh concentration
of poor residentsLow IQHigh level of family disruptionHistory
of violent victimizationLow levels of community
participationHistory of early aggressive behaviorSocially
disorganized neighborhoods

(from Textbook, Table 27-3—Cont.)
26Individual Risk FactorsCommunity Risk FactorsAttention
deficits, hyperactivity, or learning disordersHigh level of
transiencyPoor behavioral controlDeficits in social, cognitive or
information-processing abilitiesExposure to violence and
conflict in the familyHigh emotional distressHistory of
treatment of emotional problems
(from Textbook, Table 27-3—Cont.)
27Family Risk FactorsPeer/Social Risk FactorsPoor family
functioningAssociation with delinquent peersLow emotional
attachment to parents of caregiversInvolvement in gangsLow
parental education and incomeSocial rejection by peersParental
substance abuse or criminalityLack of involvement in
conventional activitiesPoor monitoring and supervision of
childrenPoor academic performanceHarsh, lax, or inconsistent
disciplinary practicesLow commitment to school and school
failureAuthoritarian childrearing practices
Community Violence: Gangs
Reasons that young people join gangs:
Believe that gangs will protect them
Peer pressure
The need for respect

A sense of belonging
Increasingly responsible for crimes and violence throughout the
United States
Crimes include illegal alien smuggling, armed robbery, assault,
auto theft, drug and weapon trafficking, identity theft, and
murder.
28
Community Violence: Prison
Prison violence
The United States has one of the world’s
highest rates of incarceration
Inmates are both victims and perpetrators of violence.
Includes allegations of physical abuse and reports of rape by
corrections officers and inmates
Little sympathy for this population for a variety of reasons,
including indifference, disbelief, and denial
29
Community Violence: Trafficking
Human trafficking is a global problem and a public health issue.
Involves:
Prostitution
Sexual exploitation

Forced labor
Slavery
Removal of organs
30
Community Violence: Hate Crimes
Crimes in which offender is motivated by
An individual’s race*1
Sexual orientation*3
Religious beliefs*2
Ethnic background
National origin
*Rank—most commonly reported
Hate crimes may include
Murder
Rape
Sexual or physical assault
Harassment
Attacks on homes or on places of worship
Vandalism
31
Community Violence: Terrorism
“The calculated use of unlawful violence or threat of unlawful
violence to inculcate fear; intended to coerce or to intimidate
governments or societies in the pursuit of goals that are
generally political, religious, or ideological.”

(Department of Defense)
All terrorist acts include at least three key elements—violence,
fear, and intimidation.
32
Factors Influencing Violence
Firearms
A gun in the home…
…triples the risk for homicide in the home
…increases the risk for suicide 3 to 5 times
…increases risk for accidental deaths by 4
Firearms are the number one weapon of choice in homicides in
the United States.
Direct and indirect costs are staggering.
“Right to bear arms” arguments persist.
33
Factors Influencing Violence (Cont.)
Media violence includes exposure to and participation in …
…violent video games
…music and music videos that depict date rape or violence
…virtual violence that allows subscribers to harm or kill
victims

Repeated exposure to media violence leads to emotional
desensitization to real-life violence
34
Factors Influencing Violence (Cont.)
Mental illness is considered by many to be a major factor in
violence.
Studies are inconclusive that all violence is committed by
mentally unstable persons.
Increasing push for legislation to fund public health strategies
that identify and treat mental illness across the country
Funding issues have forced states to eliminate or reduce
availability of mental health services
35
Violence Is a Public Health Epidemic
The public health system is challenged to go beyond its
traditional programs to include prevention and management of
violence.
Efforts being made with
Public health strategies
Community approaches
Local, state, and federal governments

Addressed by Healthy People 2020
36
Prevention of Violence: Primary Prevention
Goal: to stop violence, abuse, or neglect before it occurs
Education may include life skills training:
Parenting and family wellness
Anger management
Conflict resolution
Nurses should:
Increase awareness of violence
Identify cases
Work with the community
37
Prevention of Violence: Primary Prevention (Cont.)
Must begin at community level to change attitudes
Focuses on stopping transgenerational aspect of abuse
Start with young children
Continue across the lifespan
Mentoring and peer programs to promote healthy relationships
and decrease conflict
Work with high-risk individuals

38
Prevention of Violence: Secondary Prevention
Goal: assess, diagnose, and treat victims and perpetrators of
violence.
Consideration of safety of potential victim is critical
Begins with assessment
Once identified, victims must be offered…
Resources to increase their safety
Legal options and how to access them
39
Prevention of Violence: Secondary Prevention (Cont.)
Nurses must screen for abuse. Ask questions
Within the last year, have you been hit, slapped, kicked, or
otherwise physically hurt by someone?
Since you’ve been pregnant, have you been hit, slapped, kicked,
or otherwise physically hurt by someone?
Within the last year, has anyone forced you to have sexual
activities?
Intervene when essential
Interdisciplinary approach leads to optimal outcomes.
40

Prevention of Violence: Tertiary Prevention
Goal: Aimed at rehabilitation of individuals, families, groups,
or communities and includes both victims and perpetrators of
violence
May take months or even years
Nurses must work in conjunction with a variety of mental health
professionals and social service agencies to provide coordinated
care
Self-care and recognition of own limitations and needs
41

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