1. Violence Against Women
Chapter 5
Violence Against Women
Copyright © 2016 by Elsevier Inc. All rights reserved.

2. Learning Objectives
Describe the beliefs and practices that historically have perpetuated violence against women.
Examine the prevalence and effects of intimate partner violence.
Contrast the theoretic premises underlying the victimization of women.
Discuss theories of violence and how they can be used in assessment and intervention for women who are abused.

3. Learning Objectives (Cont.)
Develop a plan of care for a woman who is experiencing intimate partner violence.
Review the dynamics of sexual assault.
Describe the rape-trauma syndrome.
Develop a nursing plan of care for a woman in the acute phase of rape-trauma syndrome.
Evaluate resources available to women experiencing abuse.
Describe human sex trafficking and implications for health care providers.

4. Violence Against Women
Definition of violence against women (VAW):
“Any act of gender-based violence that results in or is likely to result in physical, sexual or mental harm or suffering to women including threats of such acts, coercion, or arbitrary deprivation of liberty whether occurring in public or private” (Blanchfield, 2008; United Nations, 1993).

5. Violence Against Women (Cont.)
Intimate partner violence (IPV) is the most common form of violence against women.
IPV: actual or threatened physical, sexual, or psychologic or emotional abuse by a spouse, ex- spouse, boyfriend, ex-boyfriend, girlfriend, ex- girlfriend, date, or cohabiting partner
Other terms: partner abuse, domestic or family violence

6. Violence Against Women (Cont.)
In the United States the prevalence of some form of IPV (rape, physical violence, and/or stalking) during a woman’s lifetime is estimated to be 35.6% (Black et al., 2011).
Throughout the world more than one third of female homicides occur at the hands of an intimate partner (Stockl et al., 2013).
Reducing the rates of intimate partner violence and sexual violence are Healthy People 2020 sub-objectives under the main objective of violence prevention.

7. Historical Perspective
Women have been treated inhumanely throughout history.
In the 1700s under British common law, “rule of thumb” gave a man permission to beat his wife as long as the implement used was no wider than his thumb.
In the 1800s men gradually lost the right to beat their wives.
The first shelter for women opened in London in 1971.
Books and articles on domestic violence began to appear in the 1970s.

8. Conceptual and Theoretic Perspectives
Battered woman syndrome was described by Lenore Walker in 1979.
She proposed the model to be referred to as the Cycle of Violence
Tension building
Acute battering
Honeymoon phase

9. Conceptual and Theoretic Perspectives (Cont.)
Biologic factors
Neurochemical factors
Testosterone: abnormally high levels
Psychologic perspective
Sociologic perspective
Multigenerational transmission of violence
Feminist perspective
Ecologic model

10. Women Experiencing IPV
Characteristics of women in abusive relationships
Every segment of society is represented among people experiencing abuse.
Race, religion, social background, age, and educational level do not differentiate women at risk.
Myths about battered women

12. Women Experiencing IPV (Cont.)
Cultural considerations
Reporting rates may not reflect the magnitude of the problem due to fear or embarrassment
Caucasian women
African-American culture
Hispanic and Latino culture
Native-American culture
Asian culture
Implications for nursing

13. Women Experiencing IPV (Cont.)
IPV during pregnancy
IPV has serious consequences for the health of the mother and fetus
Abuse may begin or escalate with pregnancy, but abuse may actually decrease during pregnancy in some couples (Taylor & Nabors, 2009).
Pregnant adolescents are abused at higher rates than are adult women.
Homicide is the leading cause of trauma death in pregnancy and postpartum.

14. Care Management Mandatory reporting of domestic violence
IPV is considered a crime in all states, but varies between being a felony and a misdemeanor.
Majority of states categorize it as a misdemeanor.
Mandatory reporting remains controversial because it takes away a woman’s right to make an informed decision … and may put her in danger.

16. Care Management (Cont.)
Plan of care and interventions
ABCDES of caring for abused women
Alone
Belief
Confidentiality
Documentation
Education
Safety

17. Care Management (Cont.)
Plan of care and interventions
Recognize that most dangerous period for a battered woman is when she is in the process of leaving.
Prevention
Educate women that abuse is a violation, and facilitate access to protective and legal services as a first step.
Evaluation
Based on expected outcomes and must be in harmony with the choices the woman has made

19. Sexual Violence
Broad term that encompasses a wide range of sexual victimization, including:
Sexual harassment
Sexual assault
Rape
Molestation
Statutory rape

20. Sexual Violence (Cont.)
The National Intimate Partner and Sexual Violence Survey reported that almost 1 in 5 women experienced rape at some time in their lives, and about 1 in 20 women experienced sexual assault other than rape (Black et al., 2011).

21. Sexual Violence (Cont.)
Why do some men rape?
History of sexual abuse
Violent pornography
Acquaintance rape
Stranger rape: least common type
Alcohol and drug use
Date rape drugs

22. Sexual Violence (Cont.)
Mental health consequences of sexual assault
Rape-trauma; PTSD
3 Phases of rape-trauma syndrome:
Acute phase: disorganization
Outward adjustment phase
Long-term process: reorganization phase

23. Care Management of Sexual Violence Victims
Collaborative care
Psychologic first aid
Sexual assault examination
Sexual assault nurse examiners (SANEs)
Follows specific protocols
Preservation of dignity during the examination
History
Collection of evidence
Documentation
Physical examination and laboratory tests
Immediate care

24. Care Management of Sexual Violence Victims (Cont.)
Collaborative care (Cont.)
Discharge
After discharge
Telephone contact
Prevention education
Rape awareness groups

25. Sex Trafficking
It is estimated that 14,000 to 50,000 individuals are trafficked each year (ACOG, 2011; National Human Trafficking Resource Center [NHTRC], 2012).
Sex trafficking is a serious and under-studied phenomenon.
Although victims of sex trafficking can be male or female, the vast majority are women and girls.
The three primary sex trafficking U.S. networks are Asian, Latino, and domestic (U.S. citizen) networks.
Health care professionals may interact with victims who are in captivity.
Nurses play a critical role in identifying perpetrators and victims of this crime

26. Key Points
Violence against women is a major social and health care problem in the United States, costing thousands of lives and billions of dollars in direct and indirect health care costs.
IPV includes physical, sexual, emotional, psychologic, and economic abuse.
To provide effective care, nurses must increase awareness of their own beliefs and values regarding victimization of women.

27. Key Points (Cont.)
Theoretic frameworks—psychologic, sociologic, biologic, and feminist perspectives—provide the foundation for understanding the complexity of the victimization of women.
Cultural influences regarding violent behaviors and relationships sensitize the nurse to the special needs of women from various ethnic groups.
IPV affects young, middle-aged, and older women of all races; all socioeconomic, educational, and religious groups; and pregnant women.

28. Key Points (Cont.)
All states have mandatory reporting of the abuse of children and older adults; some states have initiated mandatory reporting of wife abuse. Mandatory reporting is controversial and takes away the right for women to choose.
Rape is a legal term defined by each state differently but usually refers to penetration of an orifice against someone’s will.
Nurses in all professional areas should respond with sensitivity and caring to women who experience abuse and victimization.

29. Key Points (Cont.)
Follow-up and collaborative care are important in all instances of abuse.
Nurses should be knowledgeable about reporting requirements and available community services for women who have been sexually assaulted.
Health care professionals may have an opportunity to identify victims of human sex trafficking, intervene to help them obtain necessary health services, and provide information about ways to escape from their situation.

30. Question
Which findings would cause the nurse to suspect physical abuse in a pregnant client?
The client has a history of sexually transmitted infections.
The client has a mother who was physically abused.
The client has a partner who accompanies her to all prenatal visits.
Multiple bruises in various stages of healing are found on physical examination.
ANS: D
Feedback
A Incorrect: Any female client may exhibit a history of sexually transmitted infections. This does not indicate that she is being physically abused.
B Incorrect: A history of abuse within the family does indeed increase the risk for a client to be in an abusive relationship. Although this is important information, it is not a finding that immediately causes the nurse to suspect physical abuse in a female client.
C Incorrect: A husband or partner who does not want to leave the client’s side during her prenatal visits is a cause for concern. This does not always indicate that the client is being physically abused; rather she may be the victim of psychologic or other types of abuse. Nurses should never ask about abuse with the partner present.
D Correct: Multiple bruises in various stages of healing may be an indication of physical abuse.