NURS 304.

3 Week 10
Interpersonal Violence & Nursing

Practice

Rod McKendrick
Manager Victim Services
Interpersonal Violence Specialist
Saskatchewan Ministry of Justice
rod.mckendrick@gov.sk.ca

Need to Break the Silence

Family Violence
Background Information

What is abuse (what forms does

abuse take)?

Emotional or psychological abuse

Social abuse (Social abuse involving
children)Those who are in control tend to
use children for this type of abuse
Economic/financial abuse
Ritual abuse
Physical abuse without the person consent
Sexual abuse
Religious abuse eg in religious court

Family Violence
Background Information

What is family violence?

It is a complex problem, no two situations

are the same
Ranges across the lifespan
It involves an abuse of power and the
violation of a position of trust
Any behaviour by one person against
another person in an intimate relationship
which may endanger that persons survival,
security or well-being
Must look beyond the family and consider
the values and attitudes of the community
and the larger society. The community has

Family Violence by
Province 2011

Family Violence
Prevalence of Abuse in Canada

Most often, victims of family violence were in a

spousal relationship with the accused, with about
half of victims (49%) being currently or
previously married to the accused. Another 18%
of family violence victims were victimized by
their parent, 13% by an extended family
member, 11% by a sibling and 9% by a child,
most often a grown child.

Victims of family violence were predominantly

female (69%). This disproportionate
representation was most pronounced for spousal
violence, as 80% of victims were female, but was
Canada 2011
also evident when the accused wasStatistics
a child

Family Violence
Prevalence of Abuse in Canada

Family Violence (Violence during

pregnancy)

Incidence of violence during pregnancy

ranges from 4% to 17%, however domestic
violence during pregnancy is underreported
Women who are abused during pregnancy
are 4 times as likely to experience serious
physical violence (i.e. choking, gun threats)
WHY? Because the abuser dont want the
child
Restricting her access to food

Saskatchewan Prevention Institute

Family Violence
Prevalence of Abuse in Canada

Family Violence (Children/Youth)

Male family members were identified as the

accused in a sizable majority of familyrelated sexual (96%) and
physical assaults (71%) against children
and youth.

Infants (<1yr) experience higher rates of

family-related homicide, than older children
Young

parents are disproportionally represented

among those accused (60%)

Family Violence
Prevalence of Abuse in Canada

Family Violence (Abuse of the

Elderly)

Most often, frustration, anger or despair was the

apparent motive for family-perpetrated
homicides against seniors. In contrast, financial
gain was the most commonly identified reason
behind senior homicides committed by nonfamily members.
14.9 % of seniors in saskatchewan

Between 4% - 10% of seniors (in Canada)

experience some type of abuse
Government of Canada (2008). Quick Facts on Elder
in
Victims
whofrom,
are elderly are most likely to
Abuse
Canada. Retrieved

Family Violence
Prevalence of Abuse in Canada

Family Violence (Abuse of the Elderly

Continued)

Older adults may experience different types

of abuse including:
Physical

or sexual abuse
Psychological or emotional abuse
Financial abuse
Neglect, unintentional neglect, self neglect
They are doing this to take control of their life

Government of Canada (2008). Quick Facts on Elder

Abuse in Canada. Retrieved from,

Family Violence
Health Care Implications of Abuse

Adults who experience abuse are

103% more likely to become smokers

95% more likely to become obese
103% more likely to become alcoholics
192% more likely to develop drug
addictions
43% more likely to become suicidal

Red Cross (http://www.redcross.ca/article.asp?id=3043&tid=083

Family Violence

Consequences of Abuse of Women

Health consequences
Economic consequences
Impact of abuse on children

Health Consequences of Abuse

of Women

Physical
Sexual and Reproductive
Psychological and Behavioral
Fatal Health Consequences

Economic Consequences

Burden on society

Impact on employment

Indirect costs, sick time, child care

Impact on Children

Physical Effects
Psychological and Behavioral Effects( it
affects sleep

Family Violence
The Cycle of Violence

Tension
Building Phase

Remorse/Rom
ance Phase
(Absence of
Battering)
Walker, L. (1979). The battered woman. New York: Harper and Row.

Violent
Incident
(Battering),
death occur
in this phase

Family Violence
The Cycle of Violence

Three Stages of the Cycle of Violence

1.
2.
3.

Tension builds and escalates

Violent Incident - Blow up
Absence of Violence Remorse/Romance
Phase

Family Violence
The Cycle of Violence

Phase 1: Tension Building Phase

Duration: days, weeks, months, years
Initial infatuation of the relationship fades
Abuser - starts exhibiting aggressive/abusive
tendencies

Victim - attempts to stop aggression by pleasing, placating, or

staying out of the way, thinking those actions can control the
abusive behavior
When

these actions do not control or stop the

abuse, the victim withdraws

Abuser feels rejected and tries harder to control the victim's

activities
At this point, an abusive incident will inevitably happen

Family Violence
The Cycle of Abuse

Traits of the abuser in phase 1 (tension

building)

Jealousy
Actions that isolate the victim( forced
confinement)
Rule changing
Name calling
Dominating

Family Violence
The Cycle of Abuse

Traits of the victim in phase 1 (tension

building)

Use of calming techniques

Minimizing abusers behaviours
Anger suppression
Fatigue
Confusion
Self-doubt
Withdrawal
Fear

Family Violence
The Cycle of Abuse

Phase 2: Violent Incident Phase

Physical, emotional, mental, spiritual or sexual
abuse
The violent incident relieves the stress/tension
of the abuser
While the perpetrator feels instant relief, the
victim experiences shock/denial
Police are usually involved at this stage, victim
may seek safe shelter, only 11-13% victims
report to the police

Family Violence
The Cycle of Abuse

Traits of the abuser in phase 2 (violent

incident)

Anger
Assault on the victim
Uncontrolled tension
Exhaustion

Family Violence
The Cycle of Abuse

Traits of the victim in phase 2 (violent

incident)

Fear
Anger
May call the police
May seek safety

Family Violence
The Cycle of Abuse

Phase 3: Remorse/Romance Phase

Abuser becomes tender, apologetic, gift giving,
proclaims love, one time event etc.
Abuser may take actions and demonstrate
willingness/desire to change (i.e. rehab, stop
drinking etc)
High number of women return to the abuser
during this phase, believing the abuser and
their actions to be sincere

Family Violence
The Cycle of Abuse

Traits of the abuser in phase 3

(Remorse/Romance)

Apologies and promises

Shows insecurities
Loving
Demonstrates dependency on the victim

Family Violence
The Cycle of Abuse

Traits of the victim in phase 3

(Remorse/Romance)

Guilt
Hope
Loneliness
Low-self esteem
Dependency

Challenges Facing Women:

Why do they stay?

Fear of injury (or death)

Finances
Family
Faith
Father
Fatigue
Fantasy and Forgiveness
Familiar
Foresight
(PATHs, 2005)

http://www.youtube.com/watch?v=jHZlO0abyAU

Nov 18, 20, 2009

Nursing Practice & Family Violence

What is the goal of nursing interventions in

relation to family violence? (CNA, 1992)
to empower the client to take control
to provide support
to maximize safety

Screening: Role of the

Nurse

Ask the question

Acknowledge the abuse
Validate the womans experience
Access immediate safety
Explore options
Refer to services at the womans request
Document the interaction

Screening for Abuse

Universal ( general)
Routine(specific to domestic violence)
Indicator Based (words that points
towards violence)

Barriers to Screening and

Disclosure

Barriers to screening from the providers

perspective
Barriers to disclosure from the clients
perspective

Asking the Question

Responding when she says YES

Responding when she says NO and you
suspect YES
Responding when she says NO
(RNAO, 2005)

Guiding Principles for

Screening
Attitude and approachability of the
ABCD-ER
health care provider

Belief in the womens account of her

experience
Confidentiality is essential for
disclosure
Documentation that is consistent and
legible, document what the victim
exactly says
Education about the serious effects of
violence & abuse
Recognition that dealing with violence
& abuse has to be at her pace, directed

Nursing Practice & Family

Violence

Documentation
Document quotes, observed behaviour,
physical assessment and interventions (facts
not opinions)
Accuracy is important (specifics
who/what/where/when)
Document as soon as possible document
physical and psychological symptoms be
objective, quote the client) when possible
Use tools such as body maps to document
locations
and patterns of physical injuries
With a clients permission photograph injuries

Nursing Practice & Family Violence

What types of nursing actions might

jeopardize your relationships with patients
experiencing abuse?

Telling people what to do

Blaming the victim
Violating confidentiality
Confronting the abuser about the abuse

Nursing Practice & Family

Violence

Challenges of a rural setting related to

family violence include:

Lack of access to public

transportation/phone service
Decreased anonymity and confidentiality
Lack of services / ineffective services
Increased number of weapons in the home
(i.e. hunting)
Fewer resources (i.e. employment, child
care etc.)

http://www.mincava.umn.edu/documents/nursing/nursing.html

What needs to be considered

when a disclosure of abuse is
made?

Reporting of violence and abuse against

females
Young women and disclosure of abuse

Age of consent for sexual activity 16 years

in Canada

Children who witness violence and abuse

Nursing Practice & Family

Violence

Child Maltreatment
Professionals must report cases in which
there are reasonable and probable
grounds to believe or reasonable
grounds to suspect that a child is or may
be suffering or may have suffered abuse
(p. 4)
Child protection overrides obligation to
confidentiality

Nursing Practice & Family

Violence

Reporting child abuse/neglect

Anyone who has a reason to believe that a
child is being abused or neglected has a legal
duty to report it
You are not expected to determine if a child is
being abused or neglected
Members of the public are obligated by the law
to report suspected abuse or neglect
Consequences for failing to report a suspicion
of abuse or neglect (in Saskatchewan) include:

A fine up to $25,000
A jail term of up to 24 months
Or both
As nurses professional licensing body would also be

Nursing Practice & Family

Violence

Who do I report to?

Social Services Child Protection Office

(306-

787-3700 Regina)

After Hours Crisis Services

Prince Albert 306-764-1011
Saskatoon 306-933-6200
Regina 306-569-2724

A community crisis centre or unit

A police officer
A First Nations Child and Family Service
Agency

Nursing Practice & Family

Violence

Additional Resources for Child

Maltreatment

Kids Help Phone (1-800-668-6868)

http://www.kidshelpphone.ca
Child Welfare League of Canada
http://www.cwlc.ca
National Child Exploitation Coordination Centre
http://www.rcmp-grc.gc.ca/ncecc-cncee/index-accueileng.htm
Canadian Child Welfare Research Portal
http://www.cecw-cepb.ca
First Nations Child & Family Caring Society of Canada
http://www.fncfcs.com

Nursing Practice & Family

Violence

Additional Resources for Family

Violence

National Clearinghouse on Family Violence

http://www.phac-aspc.gc.ca/nc-cn
PATHS (Provincial Association of Transition
Houses and Services of Saskatchewan)
http://abusehelplines.org/resources/abuse-help
-lines/
http://abusehelplines.org/about-abuse/informa

tion-for-professionals
/

Nursing Practice & Family

Violence

Abuse against Older Adults

Reassurance
Unlike child abuse, reporting is not
mandatory
Abuse help lines in SK Tel phonebooks
Review available services

Nursing Practice & Family

Violence

LEGISLATION
Government of Saskatchewan

Gunshot and Stab Wounds Mandatory Reporting Act

(effective Sept 1, 2007)
2nd province in Canada to enact this legislation
Overrides confidentiality requirements
http://www.qp.gov.sk.ca/documents/English/Statutes
/Statutes/G9-1.pdf

Nursing Practice & Family

Violence

The Power and Control Wheel

Developed by the Domestic Abuse

Intervention Program (Duluth, Minnesota)
Addresses violence in a community context
http://www.theduluthmodel.org/wheelgaller
y.php

The Power & Control Wheel

http://www.theduluthmodel.org/training/wheels.html

The Equality Wheel

http://www.theduluthmodel.org/training/wheels.html