Victims of Abuse

							                                Victims of Abuse – Violence
   Types of abuse
       o Abuse happens mostly to women and children on home setting
       o Among adolescents
               63% - 68% of adolescents use violence to resolve conflict
               Peer abuse occurs most frequently at the junior high school level
       o Child abuse – homicide (1 of 5 leading cause of death)
                       Physical abuse
                       Neglect
                       Shaken baby syndrome (1/3 of victims die, 1/3 suffer brain damage) It involves
                          vigorous shaking of babies while by held by the extremities or shoulders which
                          causes whiplash – induced intracranial and intraocular bleeding.
                       Munchausen syndrome proxy – often goes unrecognized as a form of child abuse.
       o Intimate partner violence
       o Elder – an deliberate action or negligence that harms elderly people.
       o Abuse of pregnant
   Assessment – child physical abuse
       o Suspect parent or caregiver:
       o Physical abuse
       o Neglect
               Physical – refusal / delay of caregiver to provide health care, inadequate supervision,
                  expulsion form home, abandonment
                       Physical indicators – malnutrition, begs / steal food, infected sores, lacks
                          appropriate clothing, etc
                       Behavioral indicators – continue hunger, poor hygiene, unsupervised activities,
                          poor school activities, etc
               Suspect caregiver – indifferent, abuse alcohol / drugs, depressed
               Emotional neglect – failure to provide the child with hope, love, and support to help
                  develop healthy personality.
       o Sexual abuse of the child
               Use of any child – in any sexually explicit conduct, prostitution (exploitation)
               Rape, statutory rape
               Incest – occurs with close relatives / kinship bond (e.g. caretakers, step parents, step
                  siblings)
               Molestation
       o Indicators of sexual abuse
               Physical – STD, UTI, night mares, difficulty walking / sitting, etc
               Behavioral – clinging attachment to parents, nightmares, unusual sexual knowledge,
                  sexual abuse of others etc,

   FOR TESTING: What parameters do you look for that signal a problem?
    Indications seen in sexually abused children
        o Clinging attachment to parents
        o Impulse control / aggression
        o Social isolation
        o Sexual acting out
        o Self-destructive behaviors
        o Running away from home
        o Flashbacks, nightmares
        o Guilt and shame cause social isolation and alienation
        o Powerlessness
        o Rage – sometimes self-directed
        o Self-blame leading to anxiety, depression, and panic attack
        o Common characteristics of adult survivor of incest
                Lack of trust
                Low self-esteem
                Absence of pleasure with sexual activity
                Promiscuity
   Types of abuse
        o Adult/spouse/interpersonal abuse
                Battering
                The cycle of battering [KNOW THIS]
                        Phase I
                               o Men’s frustration level is declining
                               o Women’s becomes nurturing compliant
                               o Stay out of his way
                               o Minor battering
                               o Rationalizes for his behavior
                               o Assumes the guilt for the abuse
                               o Battering becomes more intense
                        Phase II – acute pattering incident
                               o Most violent and the shortest
                        Phase III – clam, loving, respite (honeymoon)
                               o Batterer – extremely loving, kind contrite
                               o Victim believes ne can change symbiotic relationship
                Why does she/he stay?
                        Fear for their lives (spouse & children)
                        Lack of support network for leaving
                        Religious beliefs
                        Lack of financial independence
   Assessment – sexual assault
        o Rape
                Date
                Marital rape
                Statutory rape
   Implication for rape victims
       o Expressed response – fear, anger, anxiety
       o Compounded rape reaction – depression, suicide, drug addiction, psychosis
       o Silent – tells nobody, anxiety is suppressed
       o Fear of future attacks, fear of intimacy
       o Self-blame, limited decision-making ability
   Nursing diagnosis
       o Rape-trauma syndrome
       o Risk for violence
       o Powerlessness
       o Altered growth & development
       o Outcome – reflect empowerment of victim and start of healing
   Planning/Implementation [KNOW THESE]
       o Safety is priority
       o Treat physical injuries immediately
       o Report child and elder abuse
       o Report to authorities is there is “reason to suspect” child abuse of neglect
       o Help client meet physiological needs
       o Stay with the client to provide security
       o Promote trust
       o Encourage verbalization of feelings
       o Teach how to stop the cycle to violence
       o Provide shelter, help client create an escape plan
       o Increase the client self-worth, empowerment & autonomy
       o Teaching to include phone numbers & access to community supports
       o Plan for music, play, and art therapy for children
       o Treatment – multidisciplinary approach
   Treatment modalities
       o Crisis intervention
       o Safe house or shelter
       o Family therapy
       o Play therapy