1. Elsevier items and derived items © 2010, 2006 by Saunders, an imprint of Elsevier Inc. Chapter 26 Child, Older Adult, and Intimate Partner Abuse

2. Elsevier items and derived items © 2010, 2006 by Saunders, an imprint of Elsevier Inc. 2 Types of Abuse Physical abusePhysical abuse Sexual abuseSexual abuse Emotional abuseEmotional abuse NeglectNeglect Economic abuseEconomic abuse

3. Elsevier items and derived items © 2010, 2006 by Saunders, an imprint of Elsevier Inc. 3 Cycle of Violence Process of escalation/de-escalationProcess of escalation/de-escalation –Tension-building stage –Attempts to reduce tension by both partners –Acute battering stage –Honeymoon stage –Tension builds and cycle continues

4. Elsevier items and derived items © 2010, 2006 by Saunders, an imprint of Elsevier Inc. 4 Epidemiology and Comorbidity Epidemiology and Comorbidity PrevalencePrevalence –Half of all Americans have experienced violence in their families ComorbidityComorbidity –Secondary effects of violence AnxietyAnxiety DepressionDepression Suicidal ideationSuicidal ideation

5. Elsevier items and derived items © 2010, 2006 by Saunders, an imprint of Elsevier Inc. 5 Actual Occurrence of Violence Requires: 1.Perpetrator 2.Vulnerable person 3.Crisis situation

6. Elsevier items and derived items © 2010, 2006 by Saunders, an imprint of Elsevier Inc. 6 Characteristics of Perpetrators Consider their own needs more important than needs of othersConsider their own needs more important than needs of others Poor social skillsPoor social skills Extreme pathological jealousyExtreme pathological jealousy May control family financesMay control family finances Likely to abuse alcohol or drugsLikely to abuse alcohol or drugs

7. Elsevier items and derived items © 2010, 2006 by Saunders, an imprint of Elsevier Inc. 7 Characteristics of Vulnerable Persons: Women Pregnancy may trigger or increase violencePregnancy may trigger or increase violence Violence may escalate when wife makes move toward independenceViolence may escalate when wife makes move toward independence Greatest risk for violence when attempts to leave relationshipGreatest risk for violence when attempts to leave relationship

8. Elsevier items and derived items © 2010, 2006 by Saunders, an imprint of Elsevier Inc. 8 Characteristics of Vulnerable Persons: Children Younger than 3 yearsYounger than 3 years Perceived as differentPerceived as different Remind parents of someone they do not likeRemind parents of someone they do not like Product of an unwanted pregnancyProduct of an unwanted pregnancy Interference with emotional bonding between parent and childInterference with emotional bonding between parent and child

9. Elsevier items and derived items © 2010, 2006 by Saunders, an imprint of Elsevier Inc. 9 Characteristics of Vulnerable Persons: Older Adults Poor mental or physical healthPoor mental or physical health Dependent on perpetratorDependent on perpetrator Female, older than 75 years, white, living with a relativeFemale, older than 75 years, white, living with a relative Elderly father cared for by a daughter he abused as a childElderly father cared for by a daughter he abused as a child Elderly woman cared for by a husband who has abused her in the pastElderly woman cared for by a husband who has abused her in the past

10. Elsevier items and derived items © 2010, 2006 by Saunders, an imprint of Elsevier Inc. 10 Assessment: Interview Guidelines Verbal approachesVerbal approaches –Tell me about what happened to you. –Who takes care of you? (for children and dependent elders) –What happens if you do something wrong? –How do you and your partner resolve disagreements? –What do you do for fun? –Who helps you with your children/parent? –What time do you have for yourself?

11. Elsevier items and derived items © 2010, 2006 by Saunders, an imprint of Elsevier Inc. 11 Assessment: Interview Guidelines Continued Open-ended questions for parentsOpen-ended questions for parents –What arrangements do you make when you have to leave your child alone? –How do you discipline your child? –When your infant cries for a long time, how do you get him/her to stop? –What about your child’s behavior bothers you the most?

12. Elsevier items and derived items © 2010, 2006 by Saunders, an imprint of Elsevier Inc. 12 Assessment Should include:Should include: –Violence indicators –Level of anxiety –Coping responses –Family coping patterns –Support systems –Suicide and/or homicide potential –Drug and alcohol use

13. Elsevier items and derived items © 2010, 2006 by Saunders, an imprint of Elsevier Inc. 13 Nursing Diagnoses Risk for injuryRisk for injury Risk for violence (self- or other- directed)Risk for violence (self- or other- directed) AnxietyAnxiety FearFear Disabled family copingDisabled family coping PowerlessnessPowerlessness Caregiver role strainCaregiver role strain

14. Elsevier items and derived items © 2010, 2006 by Saunders, an imprint of Elsevier Inc. 14 Outcomes Identification Evidence that the victim is no longer hurt or exploitedEvidence that the victim is no longer hurt or exploited –Physical abuse has ceased –Emotional abuse has ceased –Sexual abuse has ceased –Financial exploitation has ceased

15. Elsevier items and derived items © 2010, 2006 by Saunders, an imprint of Elsevier Inc. 15 Planning Guidelines developed byGuidelines developed by –The Joint Commission on Accreditation of Healthcare Organizations –The Nursing Network on Violence Against Women The general tolerance of violence in America must be addressed if long- lasting changes are to be made.The general tolerance of violence in America must be addressed if long- lasting changes are to be made.

16. Elsevier items and derived items © 2010, 2006 by Saunders, an imprint of Elsevier Inc. 16 Implementation Reporting abuseReporting abuse Counseling – safety planCounseling – safety plan Case managementCase management Milieu managementMilieu management Promotion of self-care activitiesPromotion of self-care activities Health teaching and health promotionHealth teaching and health promotion

17. Elsevier items and derived items © 2010, 2006 by Saunders, an imprint of Elsevier Inc. 17 Prevention of Abuse Primary preventionPrimary prevention –Measures taken to prevent the occurrence of abuse Secondary preventionSecondary prevention –Early intervention in abusive situations to minimize their disabling or long-term effects Tertiary preventionTertiary prevention –Facilitating healing and rehabilitative process –Providing support –Assisting survivors of violence to achieve their optimal level of safety, health, and well-being

18. Elsevier items and derived items © 2010, 2006 by Saunders, an imprint of Elsevier Inc. 18 Advanced Practice Interventions Individual psychotherapyIndividual psychotherapy Family psychotherapyFamily psychotherapy Group psychotherapyGroup psychotherapy

19. Elsevier items and derived items © 2010, 2006 by Saunders, an imprint of Elsevier Inc. 19 A 12-year-old child is admitted to the ED with a broken wrist, swollen eye, and fractured jaw. The child agrees to tell what actually happened if the nurse promises not to tell anyone. What would be the most appropriate nursing action?

20. Elsevier items and derived items © 2010, 2006 by Saunders, an imprint of Elsevier Inc. 20 a.Agree to keep the child’s secret to build trust. b.Ask the child’s parents to explain what happened. c.Report the suspected abuse to child care services. d.Have the child talk to another victim of child abuse.