Transcript Violence & Abuse

Violence & Abuse
Elisa A. Mancuso RNC, MS, FNS
Professor
Violence
 Anger = Emotional response
– Interpersonal threat,
– Frustration of desires/needs
 Aggression = Harsh physical or verbal responses
– Rage against objects, people or self
 Violence = Destructive behavior
– Extreme rage against a person
 Risk factors
Young males (15-25)
↓↓ Impulse control
↓↓ 5-HT
↓↓ GABA
Substance Abuse
Unemployed
↓↓ Ach ↑↑ DA ↑↑ NE
↓↓ Education
Victim of Abuse
Violence
Outward Expression
Aggressive gestures
Clenched fists & jaw
Verbal threats
Rapid Speech
Irritability
Demands Attention
Pacing
Self-mutilation
Inward Expression
Passive-Aggressive
Non-Compliant
Violence Interventions
 1st Set limits! Safety & prevent injury.
– Assess affect & non-verbal behavior.
 Remain calm and present a (+) attitude.
 Encourage verbalization of feelings in a
constructive manner.
 Identify anger triggers, source and target!
 Channel anger → socially acceptable
behaviors
Violence Interventions
 Clearly state expectations:
– Identify consequences of (-) behavior
 Loss of privileges, time-out, etc.
– Praise (+) behavior
– ↑↑ Accountability & responsibility
 Define situation: Problem with a solution
 Explore alternative coping skills &
– Anger management.
 Last Resorts:
Medications
 Anxiolytics
– Lorazepam (Ativan) quick onset
– Buspirone (BuSpar)
 ↓ aggression & agitation
 SSRIs
– Fluoxetine (Prozac)
 ↓ aggression & irritability
– Sertraline (Zoloft)
 ↓ aggression & irritability
 Atypical Antipsychotics
– Risperidone (Risperdal)
 ↓ hallucinations & delusions
Abuse
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Maltreatment of another person
Abuser is known to the family
All members of family are affected
Types of Violence
– Spousal Battering
– Rape
– Children:
 Physical, Emotional, Sexual Abuse & Neglect
– Elder Abuse
Characteristics of Violent Families
 Social Isolation
– Family Secret
– Limited support system
 Multigenerational Transmission
– Cycle of violence
– Learned patterns of aggression & victimization
– Violence is method to solve problems
 Abuse of Power & Control
– Physical, economic & social control over victim
– Force ETOH/Drug use
– Undermine victim’s self-worth
– Instill fear via threats against children, pets
– Isolate from family & friends
 ETOH/Drug Abuse
– ↓↓ Inhibitions & ↑↑ Violent behavior
– Flumitrazepam (Rohypnol) “Roofies” Date Rape
Spousal Battering
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90-95% women victims, 45% ER visits
Pregnancy escalates violence
Women stay RT fear for ↑ violence to self & kids
Cycle of Abuse
– Initial episode of violence
– Honeymoon
 Abuser apologizes and promises never again
 Affectionate & buys gifts
– Tension Building
 Arguments, complaints & silence
– Violence
 Repeats initial behavior and gets progressively worse
Elder Abuse
 5 million victims (60% spouses)
– Socially isolated, Cognitively impaired
– ↑↑ Disability & Complex needs
– Fear to report
 ↑↑ Caregiver stress & ↓↓ support
 Physical, Sexual or Emotional abuse
 Neglect
– Poor hygiene: urine, feces, lice, skin breakdown
– Malnutrition, dehydration
– Denial of adequate treatment & Med Errors
 Financial Exploitation
– Bank accounts, “lost” valuables, Will revised
Nursing Interventions
 Abuse Protection
– ↓↓ Society’s acceptance of violence in media
 Identify families @ risk.
– Strengthen communication & coping skills
– ↑↑ Problem solving & anticipatory guidance
– Caregiver support & respite
 SAFE Questionnaire
– Stress/Safety
– Afraid/Abused
– Friends/Family
– Escape/Emergency Plan
Nursing Interventions
 Stop current abuse & prevent reoccurrence
– Assess for abuse in every situation
 Non-judgmental listening & support
 Explore relationships
 Empower survivor to be proactive
– Avoid closed areas that ↑ risk of injury
– Keep emergency #
– Teach danger signals to children &
neighbors
– Separate savings account in different bank
– Tell family, friends, coworkers & police
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RAPE
Sexual assault with violence, humiliation & domination.
Occurs q 2 minutes! 1/6 women
65% knew attacker
Underreported – only 4/10 due to:
– Fear, Shame, Guilt & Embarrassment
Genital/Anal lacerations
Bruising
STDs HIV
Pregnancy
 Rape Trauma Syndrome
– Disorganization - 1st: Anxiety, Shock & Anger
 Vulnerability
 Victimization
Hypervigilence
Drug abuse
– Reorganization - 2nd: Resolution with counseling
Rape Nursing Interventions
 1st Reinforce Pt is safe!
– Give victim control over choices.
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Contact support system.
Take time to explain exam, proceed slowly
Optimal to have SANE
Obtain physical evidence & document objectively
Maintain chain of custody @ all times.
Treat for potential STDs/pregnancy.
Referrals for counseling, community services &
support groups.
Resources
National Center for Victims of Crimes
 1-800-394-4255 (FYI CALL)
 Provides immediate referrals to closest
community services.
National Domestic Violence Hotline
 1-800-799-7233
 Crisis intervention & referrals
www.endabuse.org www.enditnow.gov