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SURVIVORS OF VIOLENCE OR

ABUSE
Abuse crosses all economic, & social
boundaries
CHILD ABUSE
Physical discipline has roots in the
Holy Bible
Most parents do not intentionally
injure their children
Psychological and sexual abuse,
neglect are as damaging as physical
abuse
Reportable offense
SEXUAL ABUSE
Is abuse of power
It is uncommon for children to admit to
being sexually abused
Effects can be devastating and life-long
Includes commercial sexual exploitation
( internet)
Usually propagated by a family member
Common between father/step & daughter
Most important goal in working w/ these
children is to minimize the long term
traumatic effects of the abuse

Sexual Exploitation
Child pornography, sexual explicit
reproduction or childs image or child
prostitution
Sexual Battery: legal term used to
describe touching of another persons
private part w/out their permission
Negligent Treatment
The failure of the parent or parent
substitute to provide, for reasons
other that poverty, adequate food,
clothing, shelter, medical care, to
seriously endanger the physical
health of the child. Blind child fell from
3
rd
floor window- child had been tired
to a radiator. See open sores,
unkempt appearance
Physical Injury
Includes but not limited to lacerations,
fractured bones, burns, internal
injuries, severe bruising or serious
bodily harm. Eg Shaken Baby
Syndrome
SHAKEN-BABY SYNDROME
Violent shaking by extremities or
shoulders
Classic signs include retinal
hemorrhage and intracranial injury
Infants present with respiratory
difficulty
Difficult to diagnose because of vague
symptoms, unreliable history
Mental Injury
Harm to a childs psychological or intellectual
functioning. May be exhibited by severe
anxiety, depression, withdrawal or
outward aggressive behavior or a
combination of those behaviors, which
may be demonstrated by a change in
behavior.
Is the most harmful type of abuse
Leaves no visually apparent scars
Is longer lasting & more difficult to treat

Characteristics of caregivers who
abuse or neglect children
Hx of abuse or neglect as a child
Use of harsh discipline not
appropriate to childs age
Uses violence to reduce tension, low
tolerance for frustration, poor impulse
control
Never mentions good qualities of the
child
Fails to respond to the child or
responds inappropriately
Characteristics of caregivers who
abuse or neglect children
Extremely protective (does not allow
the child to do things socially or
otherwise) or jealous towards the
child
Critical of the child, angry if the child
is sick or injured
Leaves child alone or abandons child
Marital difficulty or chaotic home life
Socially isolated
Significantly misperceives the child

Characteristics of caregivers who
abuse or neglect children
Personality disorder: drug abuse
May neglect own physical health
Attempts to hide childs injuries
Unable to admit need for help
Encourages the child to engage in
prostitution or sexual acts in the
presence of the parents
COMMUNITY VIOLENCE
Epidemic in many urban communities
Gang membership meets unmet
needs in children
Needs include belonging, excitement,
protection, money, food, drugs,
shelter
Extracts high toll on children, families,
communities
INTIMATE PARTNER VIOLENCE
Common pattern (Lenore Walker,
Battered Woman)
Phase One: The tension building phase
Phase Two: The acute battering incident
Phase Three: The loving reconciliation
Women who leave are at greater risk of
being killed by the batterer. The appearance
of physical signs of abuse usually prompts
the woman to leave
Intimate Partner Abuse
http://www.youtube.com/watch?v=iJfI
ZZqOnMM
ELDER ABUSE
Physical abuse- May need to talk to
elderly person in private
Passive physical abuse
Financial abuse most common
Psychological abuse
Sexual abuse
Violation of rights

NURSING RESPONSIBILITIES
Deal with own beliefs and feelings
before attempting to provide care
Be knowledgeable about dynamics of
interpersonal abuse and violence
Know state legal requirements for
reporting abuse



ASSESSMENT
Must know symptoms of abuse
Must know characteristics of abusers
Interview
Physical exam
Legally mandated collection
procedures

OUTCOME IDENTIFICATION
Must be developed in conjunction with
client
Be careful to avoid projecting
personal opinion and desires onto
clients situation
Remain as impartial as possible
END
Child Molestation
Sexual involvement such as oral-
genital contact, genital fondling &
viewing or masturbation
NURSING PERSPECTIVES ON
ABUSE AND NEGLECT
Self-Care Deficit Theory
Nurses assist client until client can
engage in self-care
Crisis Intervention



NURSING DIAGNOSIS
Anxiety
Acute stress disorder
Post-trauma syndrome
Post-traumatic stress disorder
Other diagnoses depend on injuries
PLANNING/INTERVENTIONS
Require input from clients and survey
of resources
Primary prevention - reduces or
controls causative factors
Secondary prevention- involves early
detection and treatment
Tertiary prevention - to provide
appropriate services

(continues)
EVALUATION
Continuing assessment of client
Changes in behavior, attitude, family
circumstances
Consider progress toward goals
Evaluate coping mechanisms
Redirect client to more effective
strategies