1. Victims of Abuse or Neglect
Chapter 23
Victims of Abuse or Neglect

2. Introduction Abuse is the maltreatment of one person by another
More injuries are attributed to intimate partner violence than to all rapes, muggings, and automobile accidents combined
An increase in the incidence of child abuse and related fatalities has been documented
Rape is thought to be vastly underreported

3. Etiological Implications
Biological theories
Neurophysiological influences
Biochemical influences
Genetic influences
Disorders of the brain

4. Etiological Implications (cont.)
Psychological theories
Psychodynamic theory: unmet needs for satisfaction and security result in an underdeveloped ego and a poor self-concept
Aggression and violence supply the individual with a dose of power and prestige that boosts the self-image
S. Freud

5. Etiological Implications (cont.)
Psychological theories (cont.)
Learning theory: children learn to behave by imitating their role models
Individuals who were abused as children or whose parents disciplined with physical punishment are more likely to behave in an abusive manner as adults

6. Etiological Implications (cont.)
Sociocultural theories
Societal influences: aggressive behavior is primarily a product of one’s culture and social structure
The American culture was founded on a general acceptance of violence as a means of solving problems
Societal influences also contribute to violence when individuals realize that their needs and desires are not being met relative to other people

7. Application of the Nursing Process
Background assessment data
Intimate partner violence
Battering may be defined as a pattern of coercive control founded on and supported by physical and/or sexual violence or threat of violence toward an intimate partner
Approximately 83% of the victims are women

8. Application of the Nursing Process (cont.)
Background assessment data (cont.)
Intimate partner violence (cont.)
Profile of the victim: battered women represent all age, racial, religious, cultural, educational, and socioeconomic groups
They often have low self-esteem
They may be without adequate support systems
Many grew up in abusive homes

9. Application of the Nursing Process (cont.)
Background assessment data (cont.)
Intimate partner violence (cont.)
Profile of the victimizer: men who batter are generally characterized as persons with low self-esteem, pathologically jealous, presenting a “dual personality,” and exhibiting limited coping ability and severe stress reactions
The spouse is viewed as a personal possession

10. Application of the Nursing Process (cont.)
Background assessment data (cont.)
Intimate partner violence (cont.)
The cycle of battering (three distinct phases)
Phase I: tension-building phase
Phase II: acute battering incident
Phase III: calm, loving, respite (honeymoon) phase

11. Application of the Nursing Process (cont.)
Background assessment data (cont.)
Intimate partner violence (cont.)
Why does she stay? The most frequent response to this question is that the woman fears for her life or the lives of her children
Other reasons given include a lack of support network for leaving, religious beliefs, and a lack of financial independence to support herself and her children

12. Application of the Nursing Process (cont.)
Background assessment data (cont.)
Child abuse**
Physical abuse: any physical injury as a result of punching, beating, kicking, biting, burning, shaking, throwing, stabbing, choking, hitting, burning, or otherwise harming a child
Signs of physical abuse

13. Application of the Nursing Process (cont.)
Background assessment data (cont.)
Child abuse (cont.)
Emotional abuse: a pattern of behavior on the part of the parent or caretaker that results in serious impairment of the child’s social, emotional, or intellectual functioning
Behavioral indicators

14. Application of the Nursing Process (cont.)
Background assessment data (cont.)
Child abuse (cont.)
Physical and emotional neglect
Physical neglect
Emotional neglect
Indicators of neglect

15. Application of the Nursing Process (cont.)
Background assessment data (cont.)
Child abuse (cont.)
Sexual abuse of a child
Sexual exploitation of a child
Incest
Indicators of sexual abuse

16. Application of the Nursing Process (cont.)
Background assessment data (cont.)
Child abuse (cont.)
Characteristics of the abuser
Parents who abuse their children were likely abused as children themselves
Other influences include
Stressful life situation
Few, if any, support systems
Lack of understanding of child development
Lack of adaptive coping strategies
Expects the child to be perfect

17. Application of the Nursing Process (cont.)
Background assessment data (cont.)
Child abuse (cont.)
The adult survivor of incest
Common characteristics
A fundamental lack of trust that arises out of an unsatisfactory parent-child relationship
Low self-esteem and a poor sense of identity
Absence of pleasure with sexual activity
Promiscuity

18. Application of the Nursing Process (cont.)
Background assessment data (cont.)
Sexual assault
Rape is an act of aggression, not passion
It is identified by the use of force and executed against the person’s will
Date rape
Marital rape
Statutory rape

19. Application of the Nursing Process (cont.)
Background assessment data (cont.)
Sexual assault (cont.)
Profile of the victimizer
The mother of the rapist has been described as “seductive but rejecting” toward her child
She is overbearing, with seductive undertones, but is quick to withdraw her “love” and attention when he goes against her wishes
Her dominance over her son often continues into his adult life

20. Application of the Nursing Process (cont.)
Background assessment data (cont.)
Sexual assault (cont.)
Profile of the victimizer (cont.)
Many rapists report growing up in abusive homes. Even when the abuse was discharged by the father, the rapist’s anger is directed toward the mother for not providing adequate protection from the father’s abuse

21. Application of the Nursing Process (cont.)
Background assessment data (cont.)
Sexual assault (cont.)
The victim
Rape can occur at any age
The highest-risk group appears to be to 34 years of age
Most victims are single women, and the attack often occurs near their own neighborhoods

22. Application of the Nursing Process (cont.)
Background assessment data (cont.)
Sexual assault (cont.)
The victim (cont.)
When the attack is a “stranger rape,” victims are not chosen for any reason having to do with their appearance or behavior but simply because they happened to be in that place at that time
The presence of a weapon (real or perceived) appears to be the principal measure of the degree to which a woman resists her attacker

23. Application of the Nursing Process (cont.)
Background assessment data (cont.)
Sexual assault (cont.)
The victim (cont.)
Victim responses
Expressed response pattern
Controlled response pattern
Compounded rape reaction
Silent rape reaction

24. Application of the Nursing Process (cont.)
Diagnoses/outcome identification
Nursing diagnoses for the client who has been abused may include
Rape-trauma syndrome
Powerlessness
Risk for delayed development
Outcome criteria are identified for measuring the effectiveness of nursing care

25. Application of the Nursing Process (cont.)
Planning/implementation
Nursing intervention for the victim of abuse or neglect is to provide shelter and promote reassurance of his or her safety

26. Application of the Nursing Process (cont.)
Planning/implementation (cont.)
Other nursing concerns include
Tending to physical injuries
Staying with the client to provide security
Assisting the client to recognize options
Promoting trust
Reporting to authorities when there is “reason to suspect” child abuse or neglect

27. Application of the Nursing Process (cont.)
Evaluation
Evaluation is based on accomplishment of previously established outcome criteria

28. Treatment Modalities Crisis intervention Safe house or shelter
Family therapy