Transcript Child Abuse

Prepared by :
Ibrahim H. H. Rabeea
120093471
Supervised by :
Dr. Ashraf El-Jedi
2009 - 2010
CARE OF SURVIVORS OFABUSE
AND VIOLENCE
SPECIAL
POPULATION
RAPE AND SEXUAL
ASSAULT
Child Abuse
Definition of Sexual
Assault
Intimate Partner
Violence
Marital Rape
Elder Abuse
Nursing Assessment
Nursing Intervention
Nursing care of the Sexual
Assault Survivor
SPECIL
POPULATIONS
Child Abuse
The earliest from of family violence recognized in
the health professional literature was physical
abuse of children.
The many forms of child abuse, include physical
abuse, emotional abuse, sexual abuse, and
neglect.
Most maltreated children have been exposed to
multiple types of abuse
Children who witness family violence and abuse
are themselves victimized. Although they are
often overlooked , they can be affected in many
ways as a result of this abuse
(Teicher et al, 2006)
(box 38-4)
Sexual Abuse of Children and
Adolescents
Sexual abuse is involvement of children and
adolescents in sexual activities they do not fully
comprehend and to which they do not or cannot
freely consent because of physical cognitive and
psychological immaturity. When this occurs
within families, the perpetrators is a relative or
surrogate relative who exploits the child for the
perpetrator's sexual gratification.
Sexual abuse within families violates children's
trust in an adult who is supposed to love and
protect them.
Observable signs of sexual abuse include sexual
acting out, physical aggression, excessive
masturbation, social withdrawal, expressions of
low self-esteem, impaired school performance,
and disturbed sleep.
Children also may develop a variety of physical
problems related to sexual abuse, including
sexually transmitted infections; bleeding,
soreness, or itching in or around the genitalia,
perineum, or rectal area; recurrent urinary tract
infections; chronic pain syndromes; or
unintended pregnancy.
Abdudion of Children
The vast majority of cases of child abduction involve a
family member, usually a parent, taking or keeping the
child in violation of a custody order or other legitimate
custodial right. Cases in which a child or adolescent is
kidnapped
by a stranger or slight acquaintance remain relatively rare.
A survey of family abductions found that children under
age 6 years were particularly vulnerable to abduction,
and abduction was more
likely to occur in families in which the child did not live with
both parents. The majority of children abducted by a
family member were abducted by their biological father;
25% were abducted by
their biological mother (Finkelhor et ai, 2002).
Nursing Assessment
Nursing assessment of actual or potential child abuse
begins with a thorough history and physical examination.
Gathering a history of child abuse can be a stressful
experience for both the nurse and the family.
The setting for the interview must be quiet, private, and
uninterrupted.
In general, the child and the adults should be separated for
the initial interview. However, deciding whether to do this
depends
on the child's age and other factors. The nurse should
honestly state the purpose of the interview and the type
of questions being asked and describe the subsequent
physical examination
Nursing Interventions
When child abuse is suspected, the nurse must report it to
protective services.
Nurses who work with violent families need to know exactly
how protective services in their community operate.
Ongoing professional relationships with colleagues at the
agency will enable the nurse to remain informed about
policies and reporting protocols and ensure successful
coordination and continuity.
In cases of separated or divorced parents, all staff
members involved in the care of the child must be clear
about custody and visitation arrangements
for that child and about any restrictions placed on one or
both parents' access to their child.
Intimate Partner Violence
The term intimate partner violence refers to a pattern of
assaultive and coercive behaviors, including physical,
sexual, and psychological
abuse and violence, that adults or adolescents use against
their intimate partners
Abuse of female partners is the most widespread form
family violence
One in three adult women
expectancies at least one physical assault by a partner
during adulthood.
Sexual abuse, or marital rape, is part of the violence
against female partners in almost one half the cases.
(Box 38-5).
. A woman is in most danger of homicide when
she leaves her abusive partner or makes it clear
to him that she is ending the relationship. Risk
factors for this degree of danger include having
a handgun in the house, a history of suicide
threats or attempts in either
partner, battering during pregnancy, sexual abuse,
substance abuse, and extreme jealousy and
controlling behavior. A statement often made by
potentially lethal abusers is, "If I can't have
you, no one can."
Nursing Assessment
The most prevalent cause of trauma in women treated in
emergency rooms is abuse by an intimate partner.
women who experience partner violence are at increased
risk of not receiving mental health care (Lipsky and Caetano, 2007
For example, the nurse must carefully assess a woman's
beliefs regarding the abuse and responsibility for the
abuse. Because many abusive male partners find an
excuse for the violence, the woman may be
unnecessarily accepting the blame for the abuser's
actions.
If the patient is an abuser, mental state is also important,
and the potential for further violence must be assessed
carefully.
The safety of the abuser's survivors is a concern, as is
treatment for the abuser.
Nursing Interventions
Many communities have treatment programs for abusive men. They have been
found to be most effective when the court has ordered treatment, with
punishment for noncompliance. Severely abusive men seldom admit they
have a problem and often need to be mandated to enter and remain in
treatment.
. A combination of strategies may be needed to get the abuser into treatment if
he is not involved with the court. The type of referral chosen is extremely
important. Long-lasting change is more likely if the treatment combines
behavioral therapy
centered on anger control with a program designed to change attitudes toward
women. Traditional marriage therapy or couple counseling as the only
treatment is potentially dangerous to the woman because of the unequal
power in the relationship and the possibility of retaliatory violence. Several
themes expressed by women who have been in abusive relationships with
men have been identified (Hall, 2003; Smith, 2003). These themes, outlined in Box 38-6,
can help the nurse in assessing and intervening with women who have
been in abusive
relationships. Interventions for survivors of intimate partner violence are
presented in Box 38-7.
To empower an abused woman, one must
first make sure she has accurate
information on which to base her difficult
decisions
Effective interventions are those that reduce
isolation, empower through accurate
knowledge about abuse and about
community resources, and attend to safety
needs.
Elder Abuse
Estimates of the numbers of older people in the United
States who are abused, neglected, or exploited vary
widely because the problem is underreported.
The U.S. Senate Special Committee on Aging estimates
that there may be as many as 5 million survivors each
year. Older adults are primarily abused, neglected, or
exploited by their caregivers, most of whom are spouses,
adult children, or other family members.
Personal care attendants, paid or volunteer, in the home or
in long-term care facilities, also are perpetrators of elder
abuse, neglect, and exploitation.
Because much of the abuse is by spouses, spousal abuse
and elder abuse are often overlapping categories.
Older persons who are socially isolated, cognitively impaired, or
dependent on others for daily personal needs seem to be most
vulnerable to abuse and neglect. Social isolation also puts an
older person at risk for financial exploitation by a family member
or by scams perpetrated by non-family members. Characteristics
of the abuser, such as having mental and emotional problems
including substance abuse, create a family situation at risk for
elder abuse
Nursing Assessment
It is important to assess for elder abuse in families where
an emotionally ill person is financially dependent on
aging parents. Family interviews should not focus
exclusively on the patient but should also assess the
interactions among family members for indications of
verbal and physical control and aggression
Signs of neglect are more common than those of physical
abuse.
Neglect may be manifested by poor hygiene, breakdown of
the skin, malnutrition, dehydration, or underdosing or
overdosing of prescriptive medications.
Determining whether the neglect is intentional is the key to
planning a nursing course of action .
Nursing Interventions
may include counseling, therapy for mental
disorders, or substance abuse treatment.
The success of various interventions for elder
abuse is not yet know because research into this
issue is scant. However, it is clear that an
interdisciplinary approach is needed to address
the complex components of elder abuse,
neglect, and exploitation. Nurses in long-term
care facilities and home health agencies may
need to coordinate the services of health care
professionals, state agencies, and community
programs in cases of elder abuse (Burgess et al, Muehlbauer and
Crane, 2006).
RAPE AND
SEXUAL
ASSAULT
RAPE AND SEXUAL ASSAULT
Rape and sexual assault are concerns for individuals,
families, and the community. Sexual assaults against
women and children (the most common survivors) result
in physical trauma, psychic and spiritual disruptions, and
deterioration of social relationships. In addition, fear of
rape and sexual assault shapes women's daily conduct
as they restrict their activities in attempts to ensure
personal safety.
Survivors of sexual assaults include women and men of all
ages, social classes, races, and occupations.
Sexual assault disrupts every aspect of the survivor's life,
including social activities, interpersonal relationships,
employment, and career.
definition of Sexual Assault
sexual assault is the forced perpetration of an act of sexual
contact with another person without consent. Lack of
consent could be related to the survivor's cognitive or
personality development or feeling of fear or coercion or
to the offender's physical or verbal threats. Sexual
assault is not a sexual act but is instead motivated by a
desire to humiliate, defile, and dominate the survivor.
A sexual assault occurs once every 6.4 minutes in the
United states.
One in every six women will be raped in her lifetime.
Although a woman is four times more likely to be assaulted
by someone she knows than by someone she does not
know, the majority of these crimes go unreported even
though rape is a felony.
Marital Rape
marital rape is legally recognized in most states and is often
reported along with physical abuse. Many husbands of
abused women believe it is their right to have sex whenever
they want.
survivors of marital rape describe forced vaginal intercourse;
anal intercourse; being hit, burned, or kicked during sex;
having objects inserted into their vagina and anus and other
degradations while being threatened with weapons or
beaten if they refuse to take part in these activities.
Marital rape is especially devastating for the survivor who often
must continue to interact with the rapist because of her
dependence on him. In addition, many survivors do not seek
health care or the support of family members or friends
because of embarrassment or humiliation.
Nursing Care
of the Sexual Assault Survivor
Nursing Assessment
The initial assessment is an important phase of the treatment of rape and
sexual assault survivors. Although most nurses would quickly recognize
the woman brought to the emergency department by the police after an
attack by a stranger, many survivors of sexual assault are not so easily
identified (Esposito, 2006). Therefore all nursing assessments must
include questions to determine current or past sexual abuse.
Because people have different definitions of rape, the assessment question
must be broadly stated, such as "Has anyone ever forced you into sex
that you did not wish to participate in?" This question may uncover other
types of sexual trauma, such as incest, date rape, or childhood sexual
abuse. If the answer is yes, it can be gently followed with broad
questions, such as "Can you tell me more about it?" or "How often has it
happened?
Often the response may be hesitation, questioning, or an embarrassed
laugh. When this occurs, the nurse can increase the patient's comfort by
explaining that the question is routine because sexual assault is
common and that it affects health in many ways
Nursing Interventions
Disclosure of sexual abuse indicates trust in the nurse. Rather than immediately referring
the patient
elsewhere, the nurse's initial response of nonjudgmental listening and psychological
support is essential.
The organizations listed in Box 38-9 may be useful when helping survivors of abuse and
violence organize their resources.
People respond to sexual assault differently depending on their past experiences,
personal characteristics, and the amount and type of support received from
significant others, health care providers and the criminal justice system. The acute
stage, immediately after the attack, is characterized by extreme confusion, fear
disorganization, and restlessness. Although many will be visibly upset, some
survivors may mask these feelings and appear to be outwardly calm or subdued.
The second phase involves the long-term process of reorganization. It generally begins
several weeks after the attack. This phase may include intrusive memories of the
traumatic even during the day and while asleep; fears; or phobias, such as extreme
Fears of being alone, being in a crowd, or traveling survivors often have a sense of living
in a dangerous, unpredictable world and may become preoccupied with feelings of
victimization and vulnerability. They may encounter difficulties in sexual relationships
or in their ability to relate comfortably to persons of the same gender as the
perpetrator. Some survivors develop secondary phobic reactions to people, places, or
situations that remind them of the attack.
Any Questions