1. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Chapter 33Clients Experiencing Abuse and Violence

2. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Please, Mom and Dad My hands are small—I don’t mean to spill my milk. My legs are short—please slow down so I can keep up with you. Don’t slap my hands when I touch something bright and pretty—I don’t understand. Please look at me when I talk to you—it lets me know you are really listening. My feelings are tender—don’t nag me all day—let me make mistakes without feeling stupid.

3. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Don’t expect the bed I make or the picture I draw to be perfect—just love me for trying. Remember I am a child not a small adult— sometimes I don’t understand what you are saying. I love you so much. Please love me just for being me—not just for the things I can do. — J. Richardson and J. Richardson (Poster Funded by Health and Rehabilitative Services, State of Florida)

4. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Learning Objectives After studying this chapter, you should be able to Identify risk factors that create an environment for child abuse Differentiate between child abuse and child neglect, and cite an example of each Recognize at least five common physical findings indicating physical abuse of a child Differentiate among the terms sexual harassment, sexual assault, rape, and statutory rape Articulate the dynamics of rape trauma syndrome Illustrate how elderly persons are abused

5. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Learning Objectives (cont.) Explain at least four causative factors related to domestic violence Discuss the dynamics of intimate partner or spousal abuse Construct a profile of an individual who may become violent in the work setting Describe the emotional and behavioral reactions of the following victims of physical abuse or domestic violence: children, women, men, and the elderly Develop an assessment tool for the following clients: a victim of child abuse, an elderly victim of domestic violence, and a teenaged victim of rape

6. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Elements of Abuse The abuser –Individuals who grew up in an abusive family –Low self-concept, immature, fear authority, lack skills to meet emotional needs, believe in harsh physical discipline, poor impulse control, lack of parenting or relationship skills, often use alcohol or other substances to cope with stress The abused –Pattern of learned helplessness, low self-esteem, and shame and feelings of dependence, isolation, guilt, and entrapment A crisis –The precipitating event that sets an abusive person into action

7. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Child Abuse Etiology of child abuse Characteristics of potentially abusive parents Characteristics of an abused child Classifications of child abuse –Physical abuse of a child Physical indicators Munchausen’s syndrome by proxy Shaken baby syndrome Behavioral and environmental indicators

8. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Examples of Child Abuse

9. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Child Abuse (cont.) –Child neglect Physical indicators Behavioral and environmental indicators –Emotional abuse or neglect Behavioral and environmental indicators –Child sexual abuse Classifications of child sexual abuse Terminology of child sexual abuse –Child abduction

10. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Domestic or Intimate Partner Violence Groups at risk Epidemiology Factors contributing to domestic violence Profiles of the abuser and the abused Forms of domestic violence

11. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Domestic or Intimate Partner Violence (cont.) Dynamics of domestic violence –Tension-building phase –Acute battering phase –Loving phase Barriers to leaving a violent relationship –Lack of resources –Lack of institutional responses –Traditional ideology

12. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Adult Sexual Abuse Sexual harassment, stalking, and sexual coercion Rape –Essential elements of rape –Rape victim profile –Motives for rape –Subclassifications of rape –Emotional reactions to rape Long-term reactions to rape Adult survivors of childhood sexual abuse

13. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Elder Abuse Major types of elder abuse –Physical abuse –Sexual abuse –Emotional or psychological abuse –Abandonment –Financial or material exploitation –Self-neglect Etiology Emotional responses to elder abuse

14. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Violence Youth violence –Etiology –Emotional responses of youth violence victims Workplace violence –Predictors of workplace violence –Classification of workplace violence incidents –Emotional responses of workplace violence victims Hate crimes

15. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins The Nursing Process Assessment Nursing diagnoses Outcome identification Planning interventions Implementation Evaluation

16. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Assessment Assessment of abuse in children and adolescents – Biopsychosocial data – Documentation of the assessment Assessment of adult victims of physical abuse or violence – Biopsychosocial data – Assessment tools – Documentation of data

17. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Assessment (cont.) Assessment of victims of sexual abuse or rape – Guidelines for data collection – Medical data – Behavioral and emotional responses – Collection and documentation of physical evidence Transcultural considerations

18. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Nursing Diagnoses Anxiety Impaired verbal communication Ineffective denial Disabled family coping Interrupted family processes Fear Rape trauma syndrome Risk for violence

19. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Outcome Identification Outcomes focus on the following: Reducing anxiety, fear, pain, and the potential for injury or violence Improving communication, coping, self-esteem, or self- concept Identifying members of support system(s) and the appropriate use of them Assisting the victim in returning to a precrisis level of functioning

20. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Planning Interventions Immediate care should focus on the following: Meeting the client’s physical and emotional needs Promoting homeostasis and comfort Reducing fear

21. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Implementation Interventions for child abuse: –Multidisciplinary approach –Behavioral interventions –Continuum of care –Prevention of child abuse and neglect

22. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Implementation (cont.) Interventions for victims of physical abuse and violence: –Safe environment –Supportive therapies –Continuum of care

23. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Implementation (cont.) Interventions for victims of sexual abuse: –Crisis intervention –Continuum of care –Care of elderly survivors of sexual abuse

24. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Implementation (cont.) Interventions for victims of youth or workplace violence and hate crimes: –Developing awareness –Trauma/crisis counseling or critical-incident stress debriefing –Providing assistance

25. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Evaluation Evaluation should focus on the following: The client’s emotional and physical well-being Efficacy of the medication Effectiveness of interventions Client progress

26. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Key Terms Abduction Abuse Attempted rape Child abuse Discipline Domestic violence Emotional abuse Emotional neglect Family violence Hate crime Incest Intimate partner violence Munchausen’s syndrome by proxy

27. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Key Terms (cont.) Neglect Rape Rape trauma syndrome Sexual abuse Sexual coercion Sexual harassment Sexual misuse of a child Shaken baby syndrome Silent rape syndrome Sodomy Stalking Statutory rape Violence Workplace violence

28. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Reflection Reflect on the chapter-opening quote by Richardson and Richardson. In your own words, interpret the message that the authors are relating. ? In what situations would it be appropriate to use this poster? Explain the rationale for your answer.