1 CARE OF SURVIVORS OF ABUSE AND VIOLENCE PREPARED BY: MOHAMMED F. EL-BURAI SUPERVISED BY: Dr. ASHRAF EL-JEDI RN DrPH Faculty of Nursing Community Mental Health Nursing9/19/2015

CONTENTS 2 DIMENSION OF FAMILY VIOLENCE Characteristics of Violent Family Nursing attitudes toward survivors of violence • Responses of survivors • Preventive nursing Intervention

PREFACE The words used to describe people who have experienced violence are important, Traditionally the word ( victim) has been used along with discussions of syndromes. The words used to describe people who have experienced violence are important, Traditionally the word ( victim) has been used along with discussions of syndromes. In this chapter the word ( survivor) is used to emphasize that the person who has experienced abuse has many strengths and coping strategies that can be incorporated into the plan of care. In this chapter the word ( survivor) is used to emphasize that the person who has experienced abuse has many strengths and coping strategies that can be incorporated into the plan of care. 3 Community Mental Health Nursing9/19/2015

Dimensions of family violence Family violence is a range of harmful behaviors that occur among family and other household members. It includes physical and emotional abuse of children, child neglect, abuse b/w adult intimate partners, marital rape & elder abuse. Family violence is a range of harmful behaviors that occur among family and other household members. It includes physical and emotional abuse of children, child neglect, abuse b/w adult intimate partners, marital rape & elder abuse. Family violence although often unnoted,is at the core of many family disturbance. Family violence although often unnoted,is at the core of many family disturbance. Violence may be a family secret and often continues through generation. Violence may be a family secret and often continues through generation. 4 Community Mental Health Nursing9/19/2015

Cont. Violence and abuse are caused by an interaction of personality demographic, biological, situational, & sociocultural factors, many of the unique ch.ch. of the family as asocial group - time spent together emotional involvement privacy and in depth knowledge of each other - can lead to both intimacy and violence, thus a given family can be loving and supportive as well as violent. Violence and abuse are caused by an interaction of personality demographic, biological, situational, & sociocultural factors, many of the unique ch.ch. of the family as asocial group - time spent together emotional involvement privacy and in depth knowledge of each other - can lead to both intimacy and violence, thus a given family can be loving and supportive as well as violent. 5 Community Mental Health Nursing9/19/2015

Characteristics of violent family Factors common to violent families include multigenerational transmission social isolation, the use and abuse of power and effect of alcohol and drug abuse. 6 Community Mental Health Nursing9/19/2015

Multigenerational Transmission Multigenerational transmission means that family violence is often perpetuated through generations by a cycle of violence ( Ehrensaft) Multigenerational transmission means that family violence is often perpetuated through generations by a cycle of violence ( Ehrensaft) Violence & victimization are behavior learned through childhood experience. The child learns both the means and approval of violence. Violence & victimization are behavior learned through childhood experience. The child learns both the means and approval of violence. Experiencing abuse as a child does not totally determine an adults later behaviors many people who were abused as children are able to avoid violence with their own children, A key factor may be the age at which the child was abused or which parent was abusive. Experiences from a father at age 4- year may be totally different from experiencing abuse from a mother as an adolescent. Experiencing abuse as a child does not totally determine an adults later behaviors many people who were abused as children are able to avoid violence with their own children, A key factor may be the age at which the child was abused or which parent was abusive. Experiences from a father at age 4- year may be totally different from experiencing abuse from a mother as an adolescent. 7 Community Mental Health Nursing9/19/2015

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Social Isolation Violent families are also socially isolated one reason may be that some types of violence are considered abnormal or illegitimate & become a family secret, Violent families are also socially isolated one reason may be that some types of violence are considered abnormal or illegitimate & become a family secret, Social isolation is a factor in elder abuse, intimate partner violence and child abuse Social isolation is a factor in elder abuse, intimate partner violence and child abuse 9 Community Mental Health Nursing9/19/2015

Use and Abuse of power In almost all forms of family violence the abuser has some form of power or control over those whom they abuse power issues appear to be a central factor in intimate partner abuse and violence ( Tilly & Brackly 2005) In almost all forms of family violence the abuser has some form of power or control over those whom they abuse power issues appear to be a central factor in intimate partner abuse and violence ( Tilly & Brackly 2005) In marriage abuser may justify the use of violence for trivial events such as not having a meal ready. In marriage abuser may justify the use of violence for trivial events such as not having a meal ready. (Box 38-1) describes five forms of abuse within families that reflect domestic struggles for power and control: (Box 38-1) describes five forms of abuse within families that reflect domestic struggles for power and control: 10 Community Mental Health Nursing9/19/2015

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Alcohol and Drug Abuse Survivors of violence often report substance abuse by the abuser. How ever.one behavior is not necessary for the other to occur. that is people who abuse alcohol are not consistently violent and people who are violent are not always intoxicated Survivors of violence often report substance abuse by the abuser. How ever.one behavior is not necessary for the other to occur. that is people who abuse alcohol are not consistently violent and people who are violent are not always intoxicated The person uses alcohol as a socially acceptable explanation for the behavior. The person uses alcohol as a socially acceptable explanation for the behavior. 12 Community Mental Health Nursing9/19/2015

Nursing Attitude toward Survivors of Violence Studies of heath care professionals attitudes indicate that myths about battered women are accepted even through there is sympathy toward the survivor. Studies of heath care professionals attitudes indicate that myths about battered women are accepted even through there is sympathy toward the survivor. (Table 38-1 ) describes common myths about survivors of abuse. (Table 38-1 ) describes common myths about survivors of abuse. Studies describe how survivors find the health care system to be unhelpful and even traumatizing when they go for help. Nurses often use a paternalistic and individualistic model of helping battered women the paternalistic model may be contrasted with the empowerment model (Table 38-2) compares the Ch. Ch. Studies describe how survivors find the health care system to be unhelpful and even traumatizing when they go for help. Nurses often use a paternalistic and individualistic model of helping battered women the paternalistic model may be contrasted with the empowerment model (Table 38-2) compares the Ch. Ch. The empowerment model is not only more helpful to the survivor but also more professionally satisfying for the nurse. The empowerment model is not only more helpful to the survivor but also more professionally satisfying for the nurse. 13 Community Mental Health Nursing9/19/2015

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Origins of Negative Attitudes The just world hypothesis proposes that people believe that others generally get what they deserve Good things happen to good people & Bad things happen to bad people.. The just world hypothesis proposes that people believe that others generally get what they deserve Good things happen to good people & Bad things happen to bad people.. According to the just world hypothesis when a person victimized by violence people feel a need to make rational sense of this horrible circumstance, If bad things happen to bad people the victimized person must have done something wrong or unwise therefore we ( blame the victim), Because the nursing profession remains a predominantly female group, more nurses have been victimized by violence than other groups which might explain nurses negative attitudes toward other survivors. According to the just world hypothesis when a person victimized by violence people feel a need to make rational sense of this horrible circumstance, If bad things happen to bad people the victimized person must have done something wrong or unwise therefore we ( blame the victim), Because the nursing profession remains a predominantly female group, more nurses have been victimized by violence than other groups which might explain nurses negative attitudes toward other survivors. 16 Community Mental Health Nursing9/19/2015

Overcoming Negative Attitude The 1 st step in providing effective nursing care is exploring one own attitudes toward survivors of family violence understanding the mechanisms that help create such attitudes is also helpful. Nurses who have had clinical experience with survivors may be less blaming than nurses who have not, therefore it is important to gain this experience through educational program. Nurses who have had clinical experience with survivors may be less blaming than nurses who have not, therefore it is important to gain this experience through educational program. Nurses also can increase their own understanding and appreciation of the experience of survivors by reading book and watching media program about these issues. Nurses also can increase their own understanding and appreciation of the experience of survivors by reading book and watching media program about these issues. 17 Community Mental Health Nursing9/19/2015

Responses of Survivors A growing body of knowledge describes how people respond to violence from other family members for example women in dangerous initiate partner relationship have been shown to have significant mental health symptoms and health behaviors, including anxiety, depression, difficulty concentrating memory loss, suicide attempts, wt gain, past history of smoking. A growing body of knowledge describes how people respond to violence from other family members for example women in dangerous initiate partner relationship have been shown to have significant mental health symptoms and health behaviors, including anxiety, depression, difficulty concentrating memory loss, suicide attempts, wt gain, past history of smoking. 18 Community Mental Health Nursing9/19/2015

Physical Responses to family violence A ch.ch pattern of injuries, especially to the head, neck, face, threat, trunk and sexual organs, has been seen in all forms of family violence. For all groups experience physical abuse, this has been best documented in battered women. Several studies have found that approximately 40% were also sexually assaulted by their partners. A ch.ch pattern of injuries, especially to the head, neck, face, threat, trunk and sexual organs, has been seen in all forms of family violence. For all groups experience physical abuse, this has been best documented in battered women. Several studies have found that approximately 40% were also sexually assaulted by their partners. 19 Community Mental Health Nursing9/19/2015

Physical Responses to family violence All survivors of family violence tend to have injuries at multiple sites in various stage of healing. All survivors of family violence tend to have injuries at multiple sites in various stage of healing. Although the physical manifestations of family violence have often been diagnosed as evidence of somatization they may be more accurately identified as part of a physical stress reaction that is common to those who have experienced various types of emotional trauma. Although the physical manifestations of family violence have often been diagnosed as evidence of somatization they may be more accurately identified as part of a physical stress reaction that is common to those who have experienced various types of emotional trauma. 20 Community Mental Health Nursing9/19/2015

Behavioral Response of family violence Many attempts have been made to understand the behavior of survivors of family violence, especially their continued involvement with an abuser, this has been especially damaging in literature addressing. In actuality, when a battered woman leaves, she is in the most danger of being stalked and killed by a partner with power and control Many attempts have been made to understand the behavior of survivors of family violence, especially their continued involvement with an abuser, this has been especially damaging in literature addressing. In actuality, when a battered woman leaves, she is in the most danger of being stalked and killed by a partner with power and control 21 Community Mental Health Nursing9/19/2015

Behavioral Response of family violence At the other end of the continuum, some battered women are able to end the violence but maintain their relationship using a variety of strategies. At the other end of the continuum, some battered women are able to end the violence but maintain their relationship using a variety of strategies. Most women eventually leave a relationship that is continuously violent, but there is often a pattern of leaving and returning many times before making a final break. Most women eventually leave a relationship that is continuously violent, but there is often a pattern of leaving and returning many times before making a final break. 22 Community Mental Health Nursing9/19/2015

Psychological Responses of family violence Nurses often are involved in the recovery process of adults who, years after the traumatic event are dealing with the effects of childhood sexual abuse. The question of "false memories" ahs complicated the diagnosis and treatment process. Nurses often are involved in the recovery process of adults who, years after the traumatic event are dealing with the effects of childhood sexual abuse. The question of "false memories" ahs complicated the diagnosis and treatment process. Psychological Responses studied most often include the cognitive response of attribution and problem solving and emotional responses of depression, anxiety, and lowered self-esteem. Psychological Responses studied most often include the cognitive response of attribution and problem solving and emotional responses of depression, anxiety, and lowered self-esteem. 23 Community Mental Health Nursing9/19/2015

Problem-solving techniques Problem with academic performance and school behavior have been reported in abused children in addition some studies have found that women in abusive relationship have trouble with problem solving, so however recent research has revealed that women use a variety of approaches to achieve and maintain safety for themselves and their children. Problem with academic performance and school behavior have been reported in abused children in addition some studies have found that women in abusive relationship have trouble with problem solving, so however recent research has revealed that women use a variety of approaches to achieve and maintain safety for themselves and their children. 24 Community Mental Health Nursing9/19/2015

Preventive Nursing Interventions All nurses have important roles to play in the primary prevention of family violence. They do this through education the public, detecting risk factors for or actual experience of family violence early on to facilitate timely intervention and preventing complication and recurrence of abuse or violence for survivors. All nurses have important roles to play in the primary prevention of family violence. They do this through education the public, detecting risk factors for or actual experience of family violence early on to facilitate timely intervention and preventing complication and recurrence of abuse or violence for survivors. 25 Community Mental Health Nursing9/19/2015

Primary Prevention Primary Prevention is an activity that stops a problem before it occurs. Changing society's acceptance of violence and abuse in an important first step in prevention. Primary Prevention is an activity that stops a problem before it occurs. Changing society's acceptance of violence and abuse in an important first step in prevention. 26 Community Mental Health Nursing9/19/2015

Secondary Prevention Secondary Prevention efforts involve identification of families at risk for abuse, neglect, or exploitation of family members, as well as early detection of those who are beginning to use violence. Secondary Prevention efforts involve identification of families at risk for abuse, neglect, or exploitation of family members, as well as early detection of those who are beginning to use violence. Assessing the health and well-being of women during their pregnancies affords and ideal opportunity to identify women at risk for becoming battered or those who may be involved in the early stages of an abusive relationship. (Libbuset al. 2006) Assessing the health and well-being of women during their pregnancies affords and ideal opportunity to identify women at risk for becoming battered or those who may be involved in the early stages of an abusive relationship. (Libbuset al. 2006) 27 Community Mental Health Nursing9/19/2015

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Secondary Prevention Early indication of families at risk include violence in the family of origin of either partner, communication problem & excessive family stress. Such as an unplanned pregnancy, inadequate family resources. Early indication of families at risk include violence in the family of origin of either partner, communication problem & excessive family stress. Such as an unplanned pregnancy, inadequate family resources. When the nurse becomes aware of risk factors immediate nursing intervention is required, taking the time to explore a safety planning checklist with the pt. is time well spent.(Box38-3) When the nurse becomes aware of risk factors immediate nursing intervention is required, taking the time to explore a safety planning checklist with the pt. is time well spent.(Box38-3) 30 Community Mental Health Nursing9/19/2015

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Tertiary Prevention Tertiary Prevention efforts refer to those nursing activity that address the immediate and long-term needs of survivors as they recover from their experiences in order to ameliorate negative effects. Tertiary Prevention also in focused on stopping the current abuse preventing the recurrence of abuse Tertiary Prevention efforts refer to those nursing activity that address the immediate and long-term needs of survivors as they recover from their experiences in order to ameliorate negative effects. Tertiary Prevention also in focused on stopping the current abuse preventing the recurrence of abuse 32 Community Mental Health Nursing9/19/2015

33 THANKS FOR YOUR ATTENTION Faculty of Nursing Community Mental Health Nursing9/19/2015