Chapter 20 Violence Affecting Families

Dynamics & Characteristics of a Crisis Internal or external force disrupts system of balance Attempts to restore balance via coping Precipitated by a specific identifiable event that becomes too much for usual problem-solving skills Normal in that all people feel overwhelmed occasionally Possibly not an event per se, but a person’s perception of the event Resolution, either positive or negative; adaptive  growth and improved health; maladaptive  illness or death

History of Family Violence Global history United States history Public laws and protection Children’s Bureau Child Abuse Prevention and Treatment Act; Adoption Reform Act; Family Violence Prevention and Services Act; Child Abuse Prevention, Adoption, and Family Services Act; Keeping Children and Families Safe Act Healthy People 2010 goals

Question Is the following statement true or false? A crisis typically results from an external force.

Answer False A crisis can result from either an internal or external force that disrupts the balance of the system.

Family Violence Against Children Child abuse Child neglect (see Display 20.4) Physical abuse (corporal punishment, battered child syndrome; see Display 20.5) Sexual abuse (rape, gang rape, incest, sodomy, lewd or lascivious acts with child <14, oral copulation, genital fondling, penetration of genital or anal opening by a foreign object, molestation; see Display 20.6) Sexual exploitation Intrafamalial sexual abuse Emotional abuse (see Display 20.7)

Specific Abusive Situations Shaken baby syndrome Bilateral retinal hemorrhages; subdural or subarachnoid hematomas; no other external signs of abuse; possible breathing difficulties, seizures, dilated pupils, lethargy, unconsciousness Munchausen syndrome by proxy Parent or caretaker attempts to bring medical attention to self by injuring or inducing illness in the child

Specific Abusive Situations (cont.) Internet crimes against children Child abduction Crimes against children by babysitters School violence

Cycle of Violence Tension building Acute battering Loving reconciliation Increasing spiral of violence (see Display 20.8)

Question Which of the following would lead a community health nurse to suspect shaken baby syndrome? Bruises in various stages of healing Bilateral retinal hemorrhages History of broken bones Lacerations and abrasions on extremities

Answer b. Bilateral retinal hemorrhages Signs of shaken baby syndrome include bilateral retinal hemorrhages; subdural or subarachnoid hematomas; no other external signs of abuse; possible breathing difficulties, seizures, dilated pupils, lethargy, and unconsciousness. Bruising, lacerations, abrasions, and fractures would be associated with physical abuse.

Partner/Spousal Abuse Types Dating violence Spousal abuse: intimate partner violence; domestic violence (physical, sexual, emotional, economic or psychological abuse) Violence during pregnancy Batterer characteristics Victim characteristics Effects of violence on children

Mistreatment of Elders Neglect; physical, sexual, emotional, or fiduciary abuse Perpetrator characteristics Victim characteristics Risk factors (invisibility, vulnerability) Prevention

Other Forms of Family Violence Suicide Warning signs (IS PATH WARM) Homicide Rape

Primary Prevention Health promotion and education Anticipatory guidance; parenting skills Positive coping strategies; problem-solving skills and assertiveness skills Social support and other resources Health protection Reduce factors that increase vulnerability Reduce hazards in some events

Secondary Prevention Early diagnosis: recognize signs and symptoms of crisis, signs and symptoms of abuse Prompt treatment Provide necessary assistance, including emergency medical and emotional support, and assist with reaction to the event and functioning Ensure safety Allow behavior (dependence, grief, etc.) Refer to resources Set goals with client Reporting of abuse

Question Is the following statement true or false? Secondary prevention for crisis involves providing anticipatory guidance and teaching problem-solving skills.

Answer False Providing anticipatory guidance and teaching problem-solving skills are examples of primary prevention activities.

Tertiary Prevention Rehabilitation Promote adaptation to a changed level of wellness Promote interdependence Reinforce newly learned behaviors, lifestyle changes, coping strategies Explore application of learned behaviors to new situations Identify and use additional resources Continue primary prevention to avert future crises

Families Facing Violence from Outside the Family Home invasion Purposeful and sudden entry into a home by force while the family is home and awake Terrorist activities Use of biologic, chemical, or radioactive agents against civilians during peace or war designed to create fear, terror, and death

Methods of Crisis Intervention Generic approach Use of adaptive behaviors and coping strategies Support the individual/family Prepare for the practical and emotional future Anticipatory guidance

Methods of Crisis Intervention (cont.) Individual approach Used for those who do not respond to generic approach or need special therapy Treatment is directed toward immediate state of disequilibrium, identifying causes and developing coping mechanisms Include family members or significant others

Four Steps for Intervention During Crisis Assessment Planning Intervention Resolution

Question Is the following statement true or false? The individual approach to crisis intervention is used more often than the generic approach.

Answer False The individual approach for crisis intervention is used for those who do not respond to the generic approach or for those who need special therapy.

Role of CHN in Caring for Families in Crisis Assessment Nature of crisis and client’s response to it; immediate problem; client’s perceptions; available support; coping abilities Formulation of nursing diagnoses Planning: factors affecting client; client’s general health status, age, past experiences, sociocultural and religious influences, actual assets and liabilities Implementation: demonstrating acceptance, confronting crisis, finding facts, expressing feelings, not offering false reassurance, encouraging no blame, seeking coping mechanisms, encouraging acceptance of help Evaluation of resolution; anticipatory planning

Internet Resources Centers for Disease Control and Prevention, Division of Violence Prevention: http://www.cdc.gov/ncipc/dvp/dvp.htm Child Abuse Prevention Network: http://child- abuse.com/ Convention on the Rights of the Child: http://www.unicef.org/crc/ Domestic Violence Resources: http://www.growing.com/nonviolent/