Violence & AbuseViolence & Abuse

Elisa A. Mancuso RNC, MS, FNSElisa A. Mancuso RNC, MS, FNS

ProfessorProfessor

ViolenceViolence Anger = Emotional responseAnger = Emotional response

– Interpersonal threat,Interpersonal threat,– Frustration of desires/needsFrustration of desires/needs

AggressionAggression = Harsh physical or verbal responses= Harsh physical or verbal responses– Rage against objects, people or selfRage against objects, people or self

ViolenceViolence = Destructive behavior= Destructive behavior – Extreme rage against a personExtreme rage against a person

Risk factorsRisk factorsYoung males (15-25) Young males (15-25) Substance AbuseSubstance Abuse ↓↓ Education↓↓ Education↓↓↓↓ Impulse controlImpulse control UnemployedUnemployed Victim of Victim of

AbuseAbuse ↓↓ ↓↓ 5-HT5-HT ↓↓ GABA↓↓ GABA ↓↓ Ach ↓↓ Ach ↑↑ DA ↑↑ NE↑↑ DA ↑↑ NE

ViolenceViolence

Outward ExpressionOutward Expression Inward ExpressionInward Expression

Aggressive gesturesAggressive gestures Passive-AggressivePassive-Aggressive

Clenched fists & jawClenched fists & jaw Non-CompliantNon-Compliant

Verbal threatsVerbal threats

Rapid SpeechRapid Speech

IrritabilityIrritability

Demands AttentionDemands Attention

PacingPacing

Self-mutilationSelf-mutilation

Violence InterventionsViolence Interventions 11stst Set limits! Safety & prevent injury. Set limits! Safety & prevent injury.– Assess affect & non-verbal behavior.Assess affect & non-verbal behavior.

Remain calm and present a (+) attitude.Remain calm and present a (+) attitude. Encourage verbalization of feelings in a Encourage verbalization of feelings in a

constructive manner.constructive manner. Identify anger triggers, source and target!Identify anger triggers, source and target! Channel anger Channel anger → socially acceptable → socially acceptable

behaviorsbehaviors

Violence InterventionsViolence Interventions Clearly state expectations:Clearly state expectations:– Identify consequences of (-) behaviorIdentify consequences of (-) behavior

Loss of privileges, time-out, etc.Loss of privileges, time-out, etc.

– Praise (+) behaviorPraise (+) behavior– ↑↑ ↑↑ Accountability & responsibilityAccountability & responsibility

Define situation: Problem with a solutionDefine situation: Problem with a solution Explore alternative coping skills &Explore alternative coping skills &– Anger management.Anger management.

Last Resorts: Last Resorts: – Social Isolation Social Isolation RestraintsRestraints

MedicationsMedications AnxiolyticsAnxiolytics– Lorazepam (Ativan) quick onsetLorazepam (Ativan) quick onset– Buspirone (BuSpar) Buspirone (BuSpar)

↓ ↓ aggression & agitationaggression & agitation

SSRIsSSRIs– Fluoxetine (Prozac) Fluoxetine (Prozac)

↓ ↓ aggression & irritabilityaggression & irritability

– Sertraline (Zoloft) Sertraline (Zoloft) ↓ ↓ aggression & irritabilityaggression & irritability

Atypical AntipsychoticsAtypical Antipsychotics– Risperidone (Risperdal) Risperidone (Risperdal)

↓ ↓ hallucinations & delusions hallucinations & delusions

AbuseAbuse

Maltreatment of another personMaltreatment of another person Abuser is known to the familyAbuser is known to the family All members of family are affectedAll members of family are affected Types of ViolenceTypes of Violence– Spousal Battering Spousal Battering – RapeRape– Children: Children:

Physical, Emotional, Sexual Abuse & NeglectPhysical, Emotional, Sexual Abuse & Neglect

– Elder AbuseElder Abuse

Characteristics of Violent FamiliesCharacteristics of Violent Families Social IsolationSocial Isolation– Family SecretFamily Secret– Limited support systemLimited support system

Multigenerational TransmissionMultigenerational Transmission– Cycle of violenceCycle of violence– Learned patterns of aggression & victimizationLearned patterns of aggression & victimization– Violence is method to solve problemsViolence is method to solve problems

Abuse of Power & ControlAbuse of Power & Control– Physical, economic & social control over victimPhysical, economic & social control over victim– Force ETOH/Drug useForce ETOH/Drug use– Undermine victim’s self-worthUndermine victim’s self-worth– Instill fear via threats against children, petsInstill fear via threats against children, pets– Isolate from family & friendsIsolate from family & friends

ETOH/Drug AbuseETOH/Drug Abuse– ↓↓ ↓↓ Inhibitions & ↑↑ Violent behaviorInhibitions & ↑↑ Violent behavior– Flumitrazepam (Rohypnol) “Roofies” Date RapeFlumitrazepam (Rohypnol) “Roofies” Date Rape

Spousal BatteringSpousal Battering 90-95% women victims, 45% ER visits90-95% women victims, 45% ER visits Pregnancy escalates violencePregnancy escalates violence Women stay RT fear for Women stay RT fear for ↑ violence to self & kids↑ violence to self & kids Cycle of AbuseCycle of Abuse– Initial episode of violenceInitial episode of violence– HoneymoonHoneymoon

Abuser apologizes and promises never again Abuser apologizes and promises never again Affectionate & buys giftsAffectionate & buys gifts

– Tension BuildingTension Building Arguments, complaints & silence Arguments, complaints & silence

– ViolenceViolence Repeats initial behavior and gets progressively worseRepeats initial behavior and gets progressively worse

Elder AbuseElder Abuse 5 million victims (60% spouses)5 million victims (60% spouses)– Socially isolated, Socially isolated, Cognitively impairedCognitively impaired– ↑↑ ↑↑ Disability & Complex needsDisability & Complex needs– Fear to report Fear to report

↑↑ ↑↑ Caregiver stress & ↓↓ supportCaregiver stress & ↓↓ support Physical, Sexual or Emotional abusePhysical, Sexual or Emotional abuse NeglectNeglect– Poor hygiene: urine, feces, lice, skin breakdownPoor hygiene: urine, feces, lice, skin breakdown– Malnutrition, dehydrationMalnutrition, dehydration– Denial of adequate treatment & Med Errors Denial of adequate treatment & Med Errors

Financial ExploitationFinancial Exploitation– Bank accounts, “lost” valuables, Will revisedBank accounts, “lost” valuables, Will revised

Nursing InterventionsNursing Interventions Abuse ProtectionAbuse Protection– ↓↓ ↓↓ Society’s acceptance of violence in mediaSociety’s acceptance of violence in media

Identify families @ risk.Identify families @ risk.– Strengthen communication & coping skillsStrengthen communication & coping skills– ↑↑ ↑↑ Problem solving & anticipatory guidanceProblem solving & anticipatory guidance– Caregiver support & respiteCaregiver support & respite

SAFE QuestionnaireSAFE Questionnaire– SStress/Safetytress/Safety– AAfraid/Abusedfraid/Abused– FFriends/Familyriends/Family– EEscape/Emergency Planscape/Emergency Plan

Nursing InterventionsNursing Interventions Stop current abuse & prevent reoccurrenceStop current abuse & prevent reoccurrence– Assess for abuse in every situationAssess for abuse in every situation

Non-judgmental listening & supportNon-judgmental listening & support Explore relationshipsExplore relationships Empower survivor to be proactiveEmpower survivor to be proactive– Avoid closed areas that Avoid closed areas that ↑ risk of injury↑ risk of injury– Keep emergency # Keep emergency # – Teach danger signals to children & neighborsTeach danger signals to children & neighbors– Separate savings account in different bankSeparate savings account in different bank– Tell family, friends, coworkers & policeTell family, friends, coworkers & police

RAPERAPE Sexual assault with violence, humiliation & domination.Sexual assault with violence, humiliation & domination. Occurs q 2 minutes! 1/6 women Occurs q 2 minutes! 1/6 women 65% knew attacker65% knew attacker Underreported Underreported – only 4/10 due to:– only 4/10 due to:– Fear, Shame, Guilt & Embarrassment Fear, Shame, Guilt & Embarrassment

Genital/Anal lacerationsGenital/Anal lacerations BruisingBruising STDs HIVSTDs HIV PregnancyPregnancy

Rape Trauma SyndromeRape Trauma Syndrome– DisorganizationDisorganization - 1 - 1stst: Anxiety, Shock & Anger: Anxiety, Shock & Anger

VulnerabilityVulnerability HypervigilenceHypervigilence Victimization Victimization Drug abuseDrug abuse

– ReorganizationReorganization - 2 - 2nd: nd: Resolution with counseling Resolution with counseling

Rape Nursing InterventionsRape Nursing Interventions 11stst Reinforce Pt is safe! Reinforce Pt is safe! – Give victim control over choices.Give victim control over choices.

Contact support system.Contact support system. Take time to explain exam, proceed slowlyTake time to explain exam, proceed slowly Optimal to have SANEOptimal to have SANE Obtain physical evidence & document objectivelyObtain physical evidence & document objectively Maintain chain of custody @ all times.Maintain chain of custody @ all times. Treat for potential STDs/pregnancy.Treat for potential STDs/pregnancy. Referrals for counseling, community services & Referrals for counseling, community services &

support groups.support groups.

ResourcesResources

National Center for Victims of CrimesNational Center for Victims of Crimes 1-800-394-4255 (FYI CALL)1-800-394-4255 (FYI CALL) Provides immediate referrals to closest Provides immediate referrals to closest

community services.community services.

National Domestic Violence HotlineNational Domestic Violence Hotline 1-800-799-72331-800-799-7233 Crisis intervention & referralsCrisis intervention & referrals

www.endabuse.orgwww.endabuse.org www.enditnow.govwww.enditnow.gov