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(Psychiatric Nursing) I. Definition of terms: A. ABUSE  Wrongful use and maltreatment of another person.  Willful infliction of physical injury or mentally anguish and deprivation by provider or essential services, may in value omission or commission. B. VIOLENCE  Physical force exerted for purpose of violating or damaging.  Unjust exercise of power often resulting in physical injury. C. OFFENDER OR PERPETRATOR  Person who inflicts violence or abuse in another person. D. VICTIM  Person who is scapegoat, target, recipient of abuse or violence. II. TYPES A. PHYSICAL 1. poking, beating, hitting, shooting, cutting, burning, scolding, raping. 2. with holding personal care, neglecting basic needs for: • Food, water, warmth, cleanliness • Health care including preventive care • Social contact • Education and supervision for children B. PSYCHOLOGICAL 1. verbal assault and threats of physical harm, usually to intimidate & manipulate. 2. sarcasm, humiliation, devaluing, criticism 3. disturbed, inconsistent communication patterns including withdrawal and silence emotional deprivation and withholding of affection. 4. exposure to parental alcoholism, drug use and prostitution.

C. MATERIAL 1. Theft of money or property. 2. Misuse of money or property. D. SOCIAL 1. violation of personal right ( families, friends, social activities ) 2. isolation of victim. E. SEXUAL 1. pressured or force sexual activity ( by person or with an object )  Sexually stimulating talk or actions  Inappropriate touches or intercourse ( acts of molestation: rubbing, fondling, exposure of genitals, oral-genital-anal acts )  Rape 2. Incest: sexual behavior between blood & relatives 3. Exploitation: promoting or selling pornography, usually involving coercion of minors to participate in obscene acts. III. CAUSATIVE THEORIES A. No single cause, multiple factors interact in any situation of family violence or abuse. B. Neubiologic theory 1. Humans possess natural instinct for fighting 2. Limbic-system and neurotransmitter irregularities precipitate violence. ( serotonin exhibits inhibitory control over aggression, losing temper, explore range ) Limbic system -- emotional aspect of the brain. C. FAMILY THEORY 1. family system theory  violence is the outward manifestation of tension produced in an undifferentiated family system intergenerational process through role modeling and social learning.  Structural family theory - violence occurs in a dysfunctional families with problems.

D. BEHAVIORAL THEORY  Violence is lessened and becomes reinforced by the environment. E. PSYCHODYNAMIC THEORY  Family violence linked to personal histories and conflicts F. SOCIAL LEARNING THEORY IV. FAMILY VIOLENCE  Encompasses physical, emotional and sexual abuse and neglect of client / children, spouse, battering, marital rape and elder abuse. A. SPOUSE OR PARTNER  Mistreatment or misuse of one person or another in the context of an intimate relationship. 1. General characteristics of an Abuser and Victim Characteristics Abuser Victim A. Behavioral  Former victim of  Lack of abuse relationship with family / friends  Socially isolated  Financially  History of drug dependent on or alcohol abuser  Poor impulse  Socially isolated control  Fear of abuser yet attempts to conceal it from  Involves in crisis others situation  Efforts to please abuse / prevent from getting angry B. Affective  Extremely  Depressed / jealous and anxious possessive  Feelings of guilt

 Feels superior and in control using violence C. Cognitive  Perfectionist standards for family members  rigid obsessive regarding retaining control  Inflexible with poor problems skills  narcissistic

or self blame  Helplessness / fear of reciprocal  low self-esteem  worthlessness  tendency to excuse abuses behavior  hope that abuse will stop  view spouse as male dominant

2. Other characteristics a. Spouse abuse may also refer to battered husband b. It is largely ignored because of men’s embarrassment in reporting abusive incidents. c. The battered man is very cautious of his power or he may be ill, feeble, old passive on the woman and self- blaming. d. men stay in violent marriages due to emotional and economic dependence or custody of children. 3. Cycles of abuse and violence 2 Violent behavior 1 Tension building remorse or Contrition a. Tension building  complaints  silent treatment 3 Period of

 argument  blaming  accusation  verbal attacks b. Violent behavior  abuser relieve tension  victim escalates tension  physical injury and abuse c. period of remorse and contrition “honeymoon period “  asking of forgiveness of abuser  promising “ sorry it will not happen again “ 4. Treatment and Intervention a. restraining order b. referrals to appropriate health care professionals c. ask for SAFE questions S - Stress / Safety A - Afraid / Abused F - Friends / Family E - Emergency Plan 5. DO’s AND DON’T’s DO’s 1. Disclose client’s information without his/her consent 2. Preach, moralize or imply doubt about the client’ 3. Minimize the impact about the violence 4. express outrage with the perpetrator 5. Imply the client is responsible for the abuse 6. Recommend couple counseling 7. Direct the client to leave the relationship DON’T’s Ensure and maintain client’s confidentiality / privacy Listen, affirm and say “ I am sorry you have been hurt” express “ I am concerned for your safety” Tell the victims “ You have the right to be safe and respected” Say “ The abuse is not your fault” Recommend couples counseling support group \identify community resources and encourage to develop safety plan

1. 2. 3. 4. 5. 6. 7.

8. Take charge 7 do 8. Offer to help contact, a shelter, everything for the client police or other resources. B. Child Abuse and Maltreatment  Intentional injury of a child.

Two (2) types of a Child Abuse and it’s Physical & Behavioral Indicators PHYSICAL INDICATORS
1.Unexplained bruise • on face, lips, & mouth, torso, back buttocks, thighs • In various stage of healing: --Red to blue – 24 hours --Purple to dark blue – 4 day --Green to yellow green – 5 – 7 days --Yellow to brown – 7-10day --Disappearance 1-3 weeks • Clustered forming regular patterns reflecting shape of article used inflict (cord/belt) • Regularly appear after absence, weekend or vacation 2. Unexplained burns • Cigarette burns on soles, palm, back buttock • Immersion burns; ( sack- like, glove like, doughnut shaped on buttock or genetalia) • Pattern3ed like electric burner, iron etc.. • Rape burn on arms, legs, neck or torso 3. Unexplained Fractures: • To skull, nose, facial structure on various stage of healing • Multiple or spiral fractures 4. Unexplained laceration or abrasion • To mouth, lips, gums, eyes, external genetalia

1. Physical Abuse -- results of severe unreasonable & unjustifiable corporal punishment or intentional assault

 wary of adult contact  apprehensive when other children cry  Behavioral extreme Aggressions or withdrawal  Frightened of parents  Afraid to go home  Reports injury by parents

2. Physical Neglect

--- malicious or ignorant withholding of physical, emotional or educational necessities for child’s well being

• Consistent hunger, poor hygiene, inappropriate dress • Consistent lack of supervision in dangerous activities for long periods of time • Unattended physical medical problems or needs • abandonment

• Begging, stealing food • Extended stays of school( early arrivals & late departures) • Frequent unexplained absences from school or work • Constant fatigue, restlessness or falling asleep in class • Non-participants on activities • Alcohol / drug abuse • Delinquency ( theft) • States there is no caretaker

3. Sexual Abuse -- Involves sexual acts performed by an adult on child younger 18 years old 4. Emotional maltreatment -- Involves verbal assault & emotional deprivation after accompanied by physical or sexual abuse.

• Difficulties in walking

• Speech disorders • in physical development • Failure to thrive

• Habit disorders ( sucking, , rocking • Conduct disorders ( anti social ) • Developmental lap(mental/emoti

onal) • Attempted suicide Republic Act 7610  Anti-child abuse law  Report to DSWD, brgy, officials, police within 48 hours 2. Parents who abuse their children 3. Treatment and Intervention C. Elder Abuse Physical Abuse Indicators - Frequent unexplained injuries - Reluctance to seek medical treatment Disorientatio n or grogginess indicating misuse of medications - Fear or edginess in the presence of family member Psychological or emotional abuse indicators - Helplessnes -hesitance to talk openly - Anger or agitation - Withdrawal or depression Financial abuse indicators Indicators Warning of selfindicators neglect from caregiver - Unusual or - Dirt, fecal -Inability -Elder is not inappropriate or urine to manage given activity in smell personal opportunity bank - rashes, finances to speak for accounts sores or -Inability self - signature lice on the to manage - Attitude of on checks elder activities indifferences that differ - elder has -Wanderin -Blaming the from the untreated g elder of his elderly medical -Failure to illness - recent conditione keep Conflicting changes in d needed accounts of will -Confusio elder’s - Missing Inadequate n, memory abilities, valuable clothing loss problems & belongings - Lack of so forth - lack of toilet -Previous amenities facilities history of - unusual abuse or Neglect Indicators

concern by the caregiver

problems with alcohol or drugs

R.A. 8353  Insertion of penis into the mouth, vagina, anus of a victim considered as an act of hostility, anger and violence. ELEMENT:  Use of threat or force  Lack of consent from victim  Actual penetration to vagina STATUTORY RAPE  Minor female, older male  Date rape --- acquaintance rape  Male rape --- between two persons, G to G etc..  Sodomy --- fellatio and anal sex 4 Categories of male rapist 1. 2. 3. 4. sexual sadist exploitative predators inadequate men men who considers rape as a displaced expression of anger and large displacement of anger

R - rape T - trauma S - syndrome Phases of RTS 1. Acute  Shock, disbelief & numbness 2. Denial  Refuses to talk about the event

3. Heightened anxiety  Fear, tension, nightmares,  Rape victims vulnerable to PTSD 4. Reorganization  Normalizes, go on ADL, open