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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

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Violence & Abuse

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  1. Violence & Abuse Elisa A. Mancuso RNC, MS, FNS Professor

  2. 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) Substance Abuse↓↓ Education ↓↓ Impulse control Unemployed Victim of Abuse ↓↓ 5-HT ↓↓ GABA ↓↓ Ach ↑↑ DA ↑↑ NE

  3. Violence Outward ExpressionInward Expression Aggressive gesturesPassive-Aggressive Clenched fists & jaw Non-Compliant Verbal threats Rapid Speech Irritability Demands Attention Pacing Self-mutilation

  4. 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

  5. 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: Social Isolation Restraints

  6. 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

  7. Abuse 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

  8. 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

  9. Spousal Battering 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

  10. 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

  11. 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

  12. 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

  13. 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 Hypervigilence Victimization Drug abuse Reorganization - 2nd: Resolution with counseling

  14. Rape Nursing Interventions 1st Reinforce Pt is safe! Give victim control over choices. 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.

  15. 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.orgwww.enditnow.gov

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