Caring for Abused Persons
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Transcript of Caring for Abused Persons
Self-esteem: how one feels about oneself. Its components are self-
acceptance, self-worth, self-love and self-nurturing.
Abuse
• Most abuse of women, children and elderly is intimate violence (perpetrator loved and trusted person).
• World is no longer safe.
• Empowerment is foreign.
• Empowerment is the promotion of the continued growth and development of strength, power and personal excellence.
Woman Abuse
• Significant health problem crossing all racial, ethnic and SES lines
• 2-4 million women abused each year
• Single, divorce separated women at highest risk
• Violence begins early in dating relationship
• Dynamics of intimate relationships– Chronic syndrome characterized by emotional abuse, degradation,
restrictions on freedom, abuse, threats, stalking and isolation from family
– Core pattern of coercive control
Battering, Rape and Sexual Assault
• Single greatest cause of injury to women• Women are aware that they are in danger of being killed.• Sexual assault occurs once every 6.4 minutes.• Types of rapists:
– Power (55%)• Attack people own age, using intimidation and minimal physical force• Premeditated
– Anger (40%)• Target either very young or old• May use extreme force resulting in injury
– Sadistic (5%)• Most dangerous• Premeditated, often torture or kill victims• Derive erotic gratification
Child Abuse• Can take several forms, varies from state to state• Prevalence unknown• Child neglect most common
– Failure to protect child– Physical neglect– Medical neglect
• Physical - severe spanking, kicking, shoving or any other type of physical action
• Sexual abuse - ranges from mild (covert) to severe (overt)– Incest– Sexual abuse by a non-family member– Pedophilia
Child Abuse (cont.)• Emotional abuse
• Acts of omission, co-mission that psychologically damage the child
• Types– Rejecting
– Isolating
– Terrorizing
– Ignoring
– Corrupting
• Munchausen’s by proxy (factitious disorder)
• Children of battered women
Elder Abuse• Estimated at 1.5 million cases
• Neglect (58.5%)
• Physical abuse (15.7%)
• Financial/material mismanagement (12.3%)
• Emotional (7.3%)
• Sexual (.04%)
• Risks• Older age
• Impairment in ADL
• Dependency on caregiver
• Isolation, stressful events
• History of intergenerational conflict
Biologic Theories
• Neurologic problems– Traumatic brain injury, seizure disorder (post-
ictal), dementia
– Orbitofrontal cortex damage
– Disruption of neurotransmitter system
• Links with substance abuse
Psychosocial Theories• Psychopathology theory
– Type I - antisocial and violent in many situations– Type II - antisocial and abuse family members– Type III - dysphoric-borderline, only family
• Social learning theory– Men who view violence as children become violent as adults.
• Social– Acceptance of violence as normal– Family stress theory
Dynamics of Woman Abuse
• Feminist theories• Men perpetuating control over women
• Patriarchal society
• Power inequity
• Borderline personality organization • Consistent with cycle of violence
• Why women stay in relationships• Economic
• Responsible for maintenance of marriage, family
Dynamics of Woman Abuse (cont.)
• Traumatic bonding• Explains why women stay in relationship
• Emotional attachments formed because of intermittent abuse
• Structural components of relationship– Power imbalance
– Intermittency in abuse
• Cycle of violence
Biologic Responses
• Depression
• Acute stress disorder (ASD)• New disorder in updated DSM-IV
• Barrage of stress-related events persists for two days
• If lasts longer, becomes PTSD
• Post-traumatic stress disorder (PTSD)
• Dissociative identity disorder (DID)
Post-traumatic Stress Disorder
• Lifetime prevalence: 1 to14%
• More prevalent in women than men
• 30% of women develop PTSD after exposure to a traumatic event, 15% of men
• May develop anytime after trauma
• Young and elderly more sensitive
PTSD
• Hyperarousal– Stress system goes on permanent alert– Dopamine hyperactivity– Behavioral sensitization
• Intrusion– Re-live as if it were continually recurring– Flashbacks, nightmare vivid– Amygdala involved in memory
• Avoidance and numbing– Develop periods of dissociation
Dissociative Identity Disorder
• Formerly multiple personality disorder• Two or more distinct identities with unique
personality characteristics and inability to recall important information about self
• Prevalence unknown
Dissociative Identity Disorder
• Etiology unknown, but causative factors include:
– A traumatic event
– A psychological or genetic vulnerability
– Formative environmental factors
– Absence of external support
Substance Abuse and Dependence
• Association between childhood abuse, PTSD and substance abuse is well-established.
• Survivors who experience PTSD, depression and other forms of hyperarousal or emotional distress often abuse substances that inhibit noradrenergic activity and lessen stress.
Psychological Responses• Low self-esteem
• Alienation from self (painful feelings that go to the core)
• Alienation from others (painful feelings from being disconnected to others)
• Guilt and shame• Blame self for abuse
• Prevent victims from seeking medical care and reporting abuse
• Anger• Chronic irritability, unexpected or uncontrollable feelings of anger
Social and Interpersonal Responses
• Problems with intimacy– Difficulty forming trusting relationships
– Sexual problems common
• Revictimization– Victims usually become victims again
– High risk for dissociative disorders
– Alexithymia may add risk for revictimization
Assessing for Abuse
• Health care providers often miss abuse or re-victimize the patient by blaming.
• Establishing a nurse-patient relationship is the most important step.
• Lethality assessment first
• Assessment questions
Biologic Assessment
• Past seven present medical history, ADLS
• Document injuries.
• Observe for:• Elevated pulse and BP
• Sleep and appetite disturbances
• Nightmares
• Memory difficulties
• Substance abuse
Psychological Assessment
• Mental status evaluation• Suicide assessment• Observe for:
– Anhedonia– Difficulty concentrating– Feelings of worthlessness or guilt– Thoughts of suicide or death
Social Assessment
• Social networks and support
• Daily activities
• Financial support
• Assess restriction of freedom
• Degree of dependency in relationship
Sexual Assault
• Assess for injuries.
• Collect evidence for forensic evaluation.
• Someone specially trained should conduct it.
Nursing Management: Children• Careful physical assessment• Safety of child• Breaking the silence• Increasing self-esteem• Dealing with loss• Learning to trust• Learning to protect oneself• Assertive conflict resolution• Empowerment
Nursing Management: Elderly• Accurate assessment
• Determining danger
• Interventions depend on acceptance
• Included in mandatory reporting
• Improving functional level
• Involving other family members
Biologic Interventions
• Restoring physical health• Teaching sleep hygiene, promoting exercise• Administering and monitoring medications
• PTSD -benzodiazepine, -blockers and antidepressants (SSRIs- Zoloft)
• Referring to treatment center for substance abuse
Psychological Interventions
• Assisting with psychotherapy or counseling
• Providing education
• Behavioral interventions– Anxiety management
– Measuring gains in small steps
Social Interventions
• Family interventions– Parenting skills
– Leisure skills
– Household organization
• Working in the community– Assistance in developing support networks
– Home visits
Special Considerations in Sexual Assault
• Early treatment crucial• Diminish survivor distress• Supportive, caring, non-judgmental• Unwanted pregnancies• STD, HIV• Interventions
– Education– Counseling– Emotional support