Victims of Abuse or Neglect Chapter 23 Victims of Abuse or Neglect

Introduction Abuse is the maltreatment of one person by another More injuries are attributed to intimate partner violence than to all rapes, muggings, and automobile accidents combined An increase in the incidence of child abuse and related fatalities has been documented Rape is thought to be vastly underreported

Etiological Implications Biological theories Neurophysiological influences Biochemical influences Genetic influences Disorders of the brain

Etiological Implications (cont.) Psychological theories Psychodynamic theory: unmet needs for satisfaction and security result in an underdeveloped ego and a poor self-concept Aggression and violence supply the individual with a dose of power and prestige that boosts the self-image S. Freud

Etiological Implications (cont.) Psychological theories (cont.) Learning theory: children learn to behave by imitating their role models Individuals who were abused as children or whose parents disciplined with physical punishment are more likely to behave in an abusive manner as adults

Etiological Implications (cont.) Sociocultural theories Societal influences: aggressive behavior is primarily a product of one’s culture and social structure The American culture was founded on a general acceptance of violence as a means of solving problems Societal influences also contribute to violence when individuals realize that their needs and desires are not being met relative to other people

Application of the Nursing Process Background assessment data Intimate partner violence Battering may be defined as a pattern of coercive control founded on and supported by physical and/or sexual violence or threat of violence toward an intimate partner Approximately 83% of the victims are women

Application of the Nursing Process (cont.) Background assessment data (cont.) Intimate partner violence (cont.) Profile of the victim: battered women represent all age, racial, religious, cultural, educational, and socioeconomic groups They often have low self-esteem They may be without adequate support systems Many grew up in abusive homes

Application of the Nursing Process (cont.) Background assessment data (cont.) Intimate partner violence (cont.) Profile of the victimizer: men who batter are generally characterized as persons with low self-esteem, pathologically jealous, presenting a “dual personality,” and exhibiting limited coping ability and severe stress reactions The spouse is viewed as a personal possession

Application of the Nursing Process (cont.) Background assessment data (cont.) Intimate partner violence (cont.) The cycle of battering (three distinct phases) Phase I: tension-building phase Phase II: acute battering incident Phase III: calm, loving, respite (honeymoon) phase

Application of the Nursing Process (cont.) Background assessment data (cont.) Intimate partner violence (cont.) Why does she stay? The most frequent response to this question is that the woman fears for her life or the lives of her children Other reasons given include a lack of support network for leaving, religious beliefs, and a lack of financial independence to support herself and her children

Application of the Nursing Process (cont.) Background assessment data (cont.) Child abuse** Physical abuse: any physical injury as a result of punching, beating, kicking, biting, burning, shaking, throwing, stabbing, choking, hitting, burning, or otherwise harming a child Signs of physical abuse

Application of the Nursing Process (cont.) Background assessment data (cont.) Child abuse (cont.) Emotional abuse: a pattern of behavior on the part of the parent or caretaker that results in serious impairment of the child’s social, emotional, or intellectual functioning Behavioral indicators

Application of the Nursing Process (cont.) Background assessment data (cont.) Child abuse (cont.) Physical and emotional neglect Physical neglect Emotional neglect Indicators of neglect

Application of the Nursing Process (cont.) Background assessment data (cont.) Child abuse (cont.) Sexual abuse of a child Sexual exploitation of a child Incest Indicators of sexual abuse

Application of the Nursing Process (cont.) Background assessment data (cont.) Child abuse (cont.) Characteristics of the abuser Parents who abuse their children were likely abused as children themselves Other influences include Stressful life situation Few, if any, support systems Lack of understanding of child development Lack of adaptive coping strategies Expects the child to be perfect

Application of the Nursing Process (cont.) Background assessment data (cont.) Child abuse (cont.) The adult survivor of incest Common characteristics A fundamental lack of trust that arises out of an unsatisfactory parent-child relationship Low self-esteem and a poor sense of identity Absence of pleasure with sexual activity Promiscuity

Application of the Nursing Process (cont.) Background assessment data (cont.) Sexual assault Rape is an act of aggression, not passion It is identified by the use of force and executed against the person’s will Date rape Marital rape Statutory rape

Application of the Nursing Process (cont.) Background assessment data (cont.) Sexual assault (cont.) Profile of the victimizer The mother of the rapist has been described as “seductive but rejecting” toward her child She is overbearing, with seductive undertones, but is quick to withdraw her “love” and attention when he goes against her wishes Her dominance over her son often continues into his adult life

Application of the Nursing Process (cont.) Background assessment data (cont.) Sexual assault (cont.) Profile of the victimizer (cont.) Many rapists report growing up in abusive homes. Even when the abuse was discharged by the father, the rapist’s anger is directed toward the mother for not providing adequate protection from the father’s abuse

Application of the Nursing Process (cont.) Background assessment data (cont.) Sexual assault (cont.) The victim Rape can occur at any age The highest-risk group appears to be 20 to 34 years of age Most victims are single women, and the attack often occurs near their own neighborhoods

Application of the Nursing Process (cont.) Background assessment data (cont.) Sexual assault (cont.) The victim (cont.) When the attack is a “stranger rape,” victims are not chosen for any reason having to do with their appearance or behavior but simply because they happened to be in that place at that time The presence of a weapon (real or perceived) appears to be the principal measure of the degree to which a woman resists her attacker

Application of the Nursing Process (cont.) Background assessment data (cont.) Sexual assault (cont.) The victim (cont.) Victim responses Expressed response pattern Controlled response pattern Compounded rape reaction Silent rape reaction

Application of the Nursing Process (cont.) Diagnoses/outcome identification Nursing diagnoses for the client who has been abused may include Rape-trauma syndrome Powerlessness Risk for delayed development Outcome criteria are identified for measuring the effectiveness of nursing care

Application of the Nursing Process (cont.) Planning/implementation Nursing intervention for the victim of abuse or neglect is to provide shelter and promote reassurance of his or her safety

Application of the Nursing Process (cont.) Planning/implementation (cont.) Other nursing concerns include Tending to physical injuries Staying with the client to provide security Assisting the client to recognize options Promoting trust Reporting to authorities when there is “reason to suspect” child abuse or neglect

Application of the Nursing Process (cont.) Evaluation Evaluation is based on accomplishment of previously established outcome criteria

Treatment Modalities Crisis intervention Safe house or shelter Family therapy