Kathyrine G.

Cabatingan, RN, MN

ABUSE & VIOLENCE

Clinical Picture of Abuse & Violence

May have physical & psychological injuries

Domestic violence remains undisclosed for
months or even years because victims fear
their abusers
Suppress anger and resentment
Guilt and shame
Degraded, humiliated and dehumanized
Low self-esteem; feels unlovable
Family Violence

Consist of:
Spouse battering
Neglect
Physical, emotional or sexual
abuse
The home is the most
dangerous place for the
victims
Characteristics of Violent Families

Social isolation
Abuse of power and control
Alcohol and other drug abuse
90% has a history of substance abuse
50% of women who have been abused
seek refuge in alcohol
Intergenerational transmission process
1/3 of abusive men are likely to have
come from violent homes
 SPOUSE or PARTNER ABUSE
Mistreatment or misuse of one person by
another in the context of an intimate
relationship
Emotional or psychological
Physical or sexual
Combination
Battering precipitates 1:4 suicide attempts
of all women
Wives explain the injuries as being self-
inflicted or accidental
ABUSE
Click to edit Master text styles
Second level
● Third level

● Fourth level

● Fifth level
SPOUSE or PARTNER ABUSE

Cycle
Tension-building: series of small incidents that leads to
beating
Acute beating phase: wife becomes object of assault
behavior
Honeymooning/ loving phase: batterer is remorseful
and assures spouse that he will not harm her again.
This leads to reconciliation.
Myths
They believe that if they try not to antagonize with
their husband, he will change.
Efforts to coerce the wife out of the victim role can
be fruitful.
Facts
Women stay in relationships with men who batter
because they feel guilty or responsible of the
husband’s behavior
Wife develops little sense of self-worth, immobilized
and unable to remove self from the relationship.
Assessment: injuries, other evidence

ABUSE
Adult Abuse Protocol

Consent for photos of injuries

Detailed description of the battered (victim)
Detailed description of the incident
Involve family, friends, clergy, police,
prosecutor’s office
Legal interventions
Restraining order
Safety plan
Safety plan

Safety signal
Have bag packed (include the following if
possible)
Change of clothes for yourself and
children
Address book – include phone numbers
of friends, relatives, doctors, lawyers
Money – include change for pay phone
Extra keys – to house and car
CHILD ABUSE

Maltreatment of a child
by the child’s caretaker
Can occur from birth
through adolescence
Shaken-baby syndrome
Severe head trauma =
retinal detachment,
subdural hematoma,
cerebral edemaABUSE
Forms of Child Abuse

PHYSICAL BATTERING
MENTAL
EMOTIONAL
VERBAL
SEXUAL
NEGLECT
Abuse can be suspected when:

Parent’s story does not explain the injury

When the parents frequently change
doctors or clinics
Many unexplained old injuries
Multiple scars in various stages of
healing
Common Behaviors of an Abused/
Neglected Child
Shows little or no distress at being separated
from parents (frightened of parents)
Acts unpleasant, demanding
Causes trouble or interferes with others
Unusually shy or fearful
Often does not obey
Wears long sleeves or other concealing clothing
to hide injuries
Common Behaviors of an Abused/
Neglected Child
Clothes dirty or wrong for weather
Tired, no energy
Hungry
Frequently breaks or damages objects
Evidence of bruises, burns, bite marks

Source: Frisch & Frisch, 2002

Click to edit Master text styles
Second level
● Third level

● Fourth level

● Fifth level
Characteristics of the Abusing Parent

Comes from all economic and

educational levels
Has low self-concept
Has poor coping ability
Lacks parenting skills
Was abused as a child
Has unrealistic expectations of the child
Primarily uses physical means of
discipline
Characteristic of an Abusing Parent

Has a passive spouse

Has poor interpersonal
relationships
Is lonely
Has marriage
difficulties
Has not bonded with
the child
Cannot handle criticism
 ELDERLY ABUSE

A variety of behaviors that threaten

the health, comfort, and possibly the
lives of the elderly
including physical and emotional
neglect,
emotional abuse,
violation of personal rights,
financial abuse, and
direct physical abuse. ABUSE
Elderly Abuse
Click to edit Master text styles
Second level
● Third level

● Fourth level

● Fifth level
 SEXUAL ABUSE
Components
Sexual Misuse: inappropriate sexual activity
Rape: there is actual penetration
Incest: refers to the relationship between the
victim and abuser as blood relative or step
parent role
Interventions
Children: thru play or role playing with
puppets
Prevention of further sexual abuse
ABUSE
Rape

Is a sexual assault is a forcible,

degrading, and humiliating act.
An act of aggression and violent sexual
crime
Occurs to both men and women
Sexual Abuse Protocol

Attention to psychological needs

Care of wounds
Notification of police
Emotional support during police
questioning
Medication is ordered
Obtaining sperm, nail, and hair samples
Clear explanation of procedures
Sociological Aspects of Rape

The attacker is
usually a person with strong hostility
toward women.
Has the need to control by sexually
dominating women.
Feels that power will ensure potency
For women
Inflicts a feeling of loss on the victim
Feelings of anger, mistrust and anxiety
Nursing interventions

Evaluate need for sedatives.

Speak slowly and allow time for
comprehension.
Do not permit the victim to bathe until all
evidence has been collected.
Let the victim understand each
procedure and the reason for it.
Only the doctor, nurse and police is
allowed access to the evidence.
suicide
SUICIDE

Self-inflicted death
May occur during the critical stages of
life
Adolescence
Menopause
Aging
Precipitating factors
Loss
Significant Behavioral Cues

Despairing mood
Prolonged depression
Change in eating or sleeping patterns
Problems with school grades for the
adolescent
Loss of previous interest in social
situations
Uncharacteristic behavior such as
reckless driving or serious drug abuse
Teen Suicide

Risk factors
Stressors due to transition to adulthood
are overwhelming.
Little or no adult guidance or support
Low self-esteem
Suicidal Assessment

Intent or plan: fleeting thoughts of

suicide versus a specific plan (low,
medium, or high lethality)
History: Assessment of previous attempts
(how many, types, lethality) and
impulsivity
Recent losses
Drinking/ drug abuse
Depression
 LEVELS OF SUICIDE

Ideation: thought
Attempt: acted upon but failed
Completed

SUICIDE
Nursing Care Plans

Assignment
Risk for self-directed violence, related to
recent increased pressures in life
Ineffective coping related to insufficient
psychological resources to cope with
increased pressures as evidenced by the
lack of self-esteem, self-derogatory
statements, self-doubt, and desire to
commit suicide
Compromised family coping related to
NURSING DIAGNOSIS #1

NURSING RATIONALE IDEAL EVALUATION

INTERVENTIONS OUTCOMES
Restraints & seclusion
 RESTRAINTS

CHEMICAL RESTRAINTS: Medications used to

restrict the patient’s freedom of movement or for
emergency control of behavior but are not a
standard treatment for the px’s medical or
psychiatric condition.

PHYSICAL RESTRAINTS: Are any manual method or

physical or mechanical device attached to or
adjacent to the px’s body that he or she cannot
easily remove and that restricts freedom of
movement or normal access to one’s body,
material or equipment.
 SECLUSION AND
RESTRAINTS
SECLUSION: the involuntary confinement
of a person alone in a room from which
the person is physically prevented from
leaving.
No therapeutic evidence other than a
last resort to ensure safety.
Evidence suggest that it adds to further
trauma and physical harm
GUIDELINES
All hospital staff who have direct
contact with the px should have
ongoing education and training in the
proper use of seclusion and restraints
and other alternatives

Physician or licensed practitioner

should evaluate need within 1 hour
after the initiation of this intervention.

Max of 4 hours for adults, 2 hours for

ages 9-17, and 1 hour for children
under 9 yrs
Orders may be renewed for 24 hrs
before another face to face
evaluation

Continuous assessment, monitoring

and evaluation; recorded

Good nursing care

For both restrained and secluded:

constant monitoring face to face or
by both audio and video equipment.
OTHER GUIDELINES
SECLUSION RESTRAINTS
Room should allow Give support &
observation and reassurance
communication with Position in
px anatomical position
Remove all items that Privacy is important
px might use to harm v/s & Circulation
self check
Document: rationale, Should be released q
response to 2hrs
intervention, physical Avoid tying to the
condition, nsg care, & side rails of bed
 TERMINATING THE
INTERVENTION
As soon as the criteria for release is met
Review with px the behavior that precipitated
the intervention & px’s capacity to exercise
control over behavior
DEBRIEFING: reviewing the facts related to an
event & processing the response to them; can
be used after any stressful event