1. Nursing 204 West Coast University

2. Types of Abuse Physical abuse Sexual abuse Emotional abuse Neglect Economic abuse

3. People at Risk for Violence Sexual abuse 90+% of rape victims are women Not age related 18-20% of rape victims are teens 50% of victims raped by spouse, partner, relative, or friend 50% of rapes on college campuses are date rapes 80+% of sexual assault involves alcohol

4. Cycle of Violence Process of escalation/de-escalation Tension-building stage Attempts to reduce tension by both partners Acute battering stage Honeymoon stage Tension builds and cycle continues

5. Epidemiology and Comorbidity Prevalence Half of all Americans have experienced violence in their families Comorbidity Secondary effects of violence Anxiety Depression Suicidal ideation

6. Actual Occurrence of Violence Requires: 1. Perpetrator 2. Vulnerable person 3. Crisis situation

7. Characteristics of Perpetrators Consider their own needs more important than needs of others Poor social skills Extreme pathological jealousy May control family finances Likely to abuse alcohol or drugs

8. Characteristics of Vulnerable Persons: Women Pregnancy may trigger or increase violence Violence may escalate when wife makes move toward independence Greatest risk for violence when attempts to leave relationship

9. Characteristics of Vulnerable Persons: Children Younger than 3 years Perceived as different Remind parents of someone they do not like Product of an unwanted pregnancy Interference with emotional bonding between parent and child

10. Characteristics of Vulnerable Persons: Older Adults Poor mental or physical health Dependent on perpetrator Female, older than 75 years, white, living with a relative Elderly father cared for by a daughter he abused as a child Elderly woman cared for by a husband who has abused her in the past

11. Theories of Domestic Violence Neurobiologic theory Role of serotonin (5-HT), corticotropin-releasing factor (CRF) Intrapersonal theory Experience of previous abuse a strong predictor for violence Social learning theory Family models, media models Gender bias theory Socioeconomic factors

12. Assessment: Interview Guidelines Verbal 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?

13. Assessment: Interview Guidelines Continued Open-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?

14. Assessment Should include: Violence indicators Level of anxiety Coping responses Family coping patterns Support systems Suicide and/or homicide potential Drug and alcohol use

15. Nursing Diagnoses Risk for injury Risk for violence (self- or other- directed) Anxiety Fear Disabled family coping Powerlessness Caregiver role strain

16. Outcomes Identification Evidence 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

17. Planning Guidelines 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.

18. Implementation Reporting abuse Counseling – safety plan Case management Milieu management Promotion of self-care activities Health teaching and health promotion

19. Prevention of Abuse Primary prevention Measures taken to prevent the occurrence of abuse Secondary prevention Early intervention in abusive situations to minimize their disabling or long-term effects Tertiary prevention Facilitating healing and rehabilitative process Providing support Assisting survivors of violence to achieve their optimal level of safety, health, and well-being

20. Chapter 27

21. Sexual Assault Any type of sexual activity the victim does not want or agree to From inappropriate touching to penetration Verbal sexual assault can occur by phone or electronically online Forced activities Prostitution or posing for pornographic pictures or videos Children, older adults, women, or men can be victims

22. Rape Type of sexual assault Nonconsensual vaginal, anal, or oral penetration, obtained by force or by threat of bodily harm or when a person is incapable of giving consent Second most violent crime (FBI, 2008)

23. Epidemiology People of lower socioeconomic classes more often victims 80% of victims are white 1/3 of all assaults occur inside home Most of time, no weapon involved Young females (12–19) at particular risk 9% to 10% of all rapes are male victim

24. Profile of Sexual Perpetrators Young 30% under 21 23% under 30 Under the influence of alcohol or drugs at time of offense 61% acquainted with victim

25. Psychological Effects of Sexual Assault Depression Suicide Anxiety Fear Difficulties with daily functioning Low self-esteem Sexual dysfunction Somatic complaints

26. Responses to Rape A variety of factors contribute to the response. Depersonalization, denial are common defense mechanisms Anxiety, agitation, nonpurposeful behaviors, shock, disbelief, fear are common emotional responses The victim usually experiences extensive physical injuries.

27. Long-term Consequences Post-trauma depression which may develop into a major depressive disorder Disruption in daily functioning Flashbacks, violent dreams, preoccupation with thoughts of future danger Social withdrawal, concerns about safety Sexual problems

28. History of Sexual Abuse in Psychiatric Patients Associated with a Characteristic Pattern Depression Anxiety disorders Chemical dependency Suicide attempts Self-mutilation Compulsive sexual behavior Psychosis-like symptoms

29. Rape-Trauma Syndrome: Acute Phase Occurs immediately after the assault May last for a few weeks Lifestyle disorganized Somatic symptoms are common Reaction to crisis includes disruptions in cognitive, affective, and behavioral functions

30. Rape-Trauma Syndrome: Long-Term Reorganization Phase Reactions likely to be experienced include: Intrusive thoughts Increased motor activity Increased emotional lability Fears and phobias

31. Theories of Sexual Abuse Intrapersonal Theory Guidelines for perpetrator assessment: Low self-esteem Emotionally deprived as children Lack impulse control Rigid, overcontrolling, aggressive Family Systems Theory Family system may be enmeshed, chaotic, with poor communication patterns

32. Nursing Process Physical Assessment Behavioral Assessment Affective Assessment Cognitive Assessment Sociocultural Assessment

33. Assessment Follow protocols of hospital regarding rape victims. Assess: Level of anxiety Coping mechanisms Available support systems Signs and symptoms of: Emotional trauma Physical trauma

34. Nursing Diagnosis Rape-trauma syndrome Ineffective coping

35. Outcomes Identification Abuse protection Abuse recovery: emotional Abuse recovery: sexual Coping Personal resiliency Sexual functioning Stress level

36. Interventions Individual-Based: Assure safety, develop rapport, clarify presenting problems, identify victim’s strengths, abilities, coping skills, identify available support systems, suggest group therapy, experience anger, work through their terrifying fears Community-Based: Identify risk factors, implement crisis interventions

37. Interventions Counseling 24-hour telephone hotline Emergency department Nonjudgmental care Emotional support Confidentiality Listen and let survivor talk

38. Interventions Continued Promotion of self-care activities Provide detailed written information concerning referral and follow-up options Case management After initial evaluation: Provide follow-up assessment within 24 to 48 hours Provide follow-up visits at 2, 4, and 6 weeks

39. Treatment of Families Experiencing Violence Multidisciplinary Approach Assess physical safety first for both victim and abuser Psychoeducation Focus on communication, anger management Empowering the Victim Address self-esteem, anxiety, depression Treating the Abuser Violence is a choice

40. Treatment Evaluation Short-term: Identification of domestic violence Family’s ability to recognize the problem Family’s willingness to accept assistance Removal of the victim from the situation Long-term: Primary prevention Secondary prevention

41. Spirituality Questions and struggles Connectedness Trusting relationships Self-forgiveness Healing

42. Roles of the Nurse Nurses are involved in: Individual interventions for the victim Family assessment, and family therapy Community awareness and education Prevention and public policy changes

43. Self-Awareness Be aware of personal beliefs and feelings about rape. Prepare to give empathetic and effective care. Examine personal feelings about abortion.