ABUSE & VIOLENCE CHAPTER 55 (ASIO) - Stress has a greater impact on individuals who do not

have strong support people around them

Abuse - To prevent an abuse, a child may assume a role
- Willful injury reversal with the parent of become the comforting,
- Intentional solacing person
- Long term consequences
- 30% children from abusive parents are more likely to
be one Reporting Suspected Child Abuse
- Nurses are the first one to recognize who are abused
2 types of responsibility in reporting child abuse

1. Mandatory reporters
Nursing Care of Family in Crisis: 2. Permissive reporters

CHILD ABUSE Nurses are included in the mandatory category in most states:
they must report suspected child abuse when they identify it.
- may be physical or neglect, psychological or even
emotional A. Physical Abuse
- Has immediate risk but can also lead to long-term
effects - action of a caregiver that causes injury to a child
- Commonly revealed by burns or by injuries to the
Behaviors of abused child: head or hands

- Aloof Assessment
- Angry
- Irritable - done by interviewing the parents about an injury to a
- Noncompliant child’s body
- Hyperactive - Some injuries may be due to unintentional accidents
- Low self esteem caused by the child’s inability to distinguish safe
- Poor self-control situations from dangerous ones
- If a child has been physically abused, the injury is
THEORIES OF CHILD ABUSE: (Special Triad) usually out of proportion to the history of the injury
given by the parent
SPECIAL PARENT: PARENTS WHO ABUSE - Parents may give conflicting stories or may give no
- seem a little different from others reason for the injury
- Only a small fraction of them ha e a history of mental - Abused children often repeat the parent’s story
illness but many of them were abused as children Physical examination
- Have less self-control
- May be unfamiliar with the normal growth & - make sure the child is fully undressed so that the
development of children and have many unrealistic entire body can be observed
expectations of a child - Plot height & weight on a standard growth chart
- May be socially isolated, with no support people (delayed growth = neglect)
readily available & so can become overwhelmed by
childbearing Common findings
- Abuse is strongly a/w excessive parental use of - beaten with electrical cords, belts or clotheslines -
alcohol, a substance that removes inhibitions and circular or linear lesions
self-control - Belt buckle or other weapons - curved laceration or
SPECIAL CHILD: CHILDREN WHO ARE ABUSED contusions
- Tied to a bed or against a wall - abrasions or
- viewed as somehow “different” by their parents ecchymotic areas on the wrists or ankles
- May be more or less intelligent than other children in - Burns - dorsal surface of their hands
the family - Scalding with hot water - ring of burns causing a
- May have a birth defect; may have an attention span “doughnut-hole” effect
deficit - Cigarette burns - if fresh, blister is seen that
resembles the scab or impetigo. If healed, a definite
SPECIAL CIRCUMSTANCES: STRESS circular scar is observed
- may be a result to an event that would not necessarily - Broken bones - multiple fracture in different stages of
be stressful for an average parent like a blocked toilet healing, a single fracture with multiple bruises, rib or
or an illness in the family occipital fractures, and metaphyseal-epiphyseal
injuries
 - Deliberate poisoning - usually occurs in a child - Pedophile - adult who seeks out children fir sexual
younger than 2.5 yrs old gratification

Nursing Diagnosis and Related Interventions B. Incest

- Nursing diagnosis: Risk for injury RT documented - sexual activity between family members
abused by parent - Often involves an older man and a young girl,
- Outcome evaluation: child has no further physical although it may involve and older woman and a
injuries identifiable as being inflicted by abusing younger boy, a brother and sister, or same-sex
parent partners
- Interventions: - Results in a destructive relationship because it causes
• prevent further abuse a great deal of guilt and loss of self-esteem in both the
• Identify abusive parents abusing and the abused person
• Provide consistent care and support for
C. Pornography and Prostitution
abused child (consistency & security)
• Evaluate and promote family health - child pornography - photographing or describing
sexual acts by any media involving children, or
B. Ritual Abuse
distributing such material in person or by mail or fax
- a cult based or religiously, spiritually or satanically or over the internet
motivated - Child prostitution - arranging or participating in sexual
- Can involve physical, sexual or psychological abuse acts with children
with bizarre or ceremonial activities
Assessment

- verbal reports of sexual activity with an adult

C. Physical Neglect - Awareness of sex and sexual vocabulary beyond age
expectations
- a more subtle form of abuse than physical abuse, but - Participation in sexual expression with dolls
it can be just as damaging to a child’s welfare - Pregnancy in a girl younger than 15 years of age
- Child may appear unwashed, thin & malnourished or - Perineal, vaginal or anal inflammation
be dressed inappropriately - Vaginal tears or anal fissures
- Ex. Not requiring child to go to school - Presence of STIs
- Asking child to draw what happened
D. Psychological Abuse
- Sx: increased anxiety such as sleep disturbance,
- constant belittling or threatening, rejecting, isolating development of tics, nail biting or stuttering
or exploiting a child - Change in school performance, school phobia or
- Abused child is likely to have difficulty becoming truancy
emotionally confident adults - Fear of being left alone with a certain adult
- Most difficult form abuse to detect - may occur only - Vague abdominal pain or acting-put behavior
at home
Therapeutic management

- Report immediately to authorities

SEXUAL ABUSE - Psychological counselling for both the adult & child -
to improve child’s self-esteem & let adult admit his
- any sexual contact between a child and an adult fault
- Involves the coercion of dependent, developmentally - Treatment for STIs
immature children and adolescents in sexual activities - Encourage parents to teach children some simple
that they do not fully comprehend, to which they are rules ti help then avoid sexual abuse
unable to give informed consent, or that violate the
social taboos of family roles
- Is physically or emotionally destructive; it leaves
RAPE
children unable to trust others, and they have a sense
of ambivalence toward intimacy and an overall sense - Sexual activity that occurs under actual or threatened
of worthlessness force
- Forcible rape - intercourse or penetration of a body
A. Molestation
orifice by a penis or other object
- a vague term that includes “indecent liberties” such - Statutory Rape - sexual activity with a person under
as oral-genital fondling and viewing or masturbation the age of consent
 - Sexual assault - refer to other forces sexual acts, such - abuse by a family member against other individuals
as oral-genital or anal-genital acts living in the household, such as spouse child, parent
- Date Rape – indiv. forces a date or casual friend into or grandparent
having coitus despite voiced unwillingness. - Children who are exposed to intimate partner abuse
may demonstrate conduct problems, noncompliance
Assessment and aggression
2 stages pf rape trauma Syndrome: - They may display distress behaviors such as clinging,
crying, abdominal pain or sleeping disorders
1. Disorganization phase - victims feel a combination of
humiliation, shame and guilt, embarrassment, anger Theories About Intimate Partner Abuse:
and vengefulness; 3 days 1. Violence preceded the relationship or children
2. Reorganization phase - may last for months or years - Violence is usually brought into the family by a man
and report recurring nightmares, perhaps sexual with a history of violence
dysfunction, and continuing inability to relate to men - His violence-prone characteristics usually erupt early
or face new surprising situations in the courtship and grow progressively worse
- 3 phases in the cycle of violence
- Silent rape syndrome - experienced by those who do a. Tension-building
not report rape and receive no counseling b. Acute violence
Emergency care c. “Honeymoon” or tranquil, loving phase

- Describe the victim’s physical appearance 2. Violence developed after the relationship was
- Gynecologic or anal examination established or children were born
- Presence of acid phosphate - violence develops as a last resort after all other
- Vaginal and anal cultures attempts at communication have failed
- Pregnancy test - The behavior of one partner threatens the
- VDRL test for syphilis psychological defenses of the other, and each
- Prophylactic administration of antibiotics against projects his or her feelings and shortcomings onto the
gonorrhea and syphilis other.
- Oral contraceptives to avoid pregnancy
Assessment
Legal considerations
- ask about the possibility of abuse since 20-25% of
- Nurses can testify women seen in emergency departments for trauma
- Chart is a legal document and can be used in court received their wounds from abuse
- Common injuries suffered by abused woman are
Nursing Diagnosis and Related Interventions: burns, bruises, and head injuries.
1. Nursing diagnosis: Rape Trauma Syndrome r/t recent - Physical examination helps detect physical abuse
rape while emotional abuse can be detected by asking
• Outcome evaluation: victim is able to discuss what about their safety or well-being.
happened and voice intense feelings about the crime; Therapeutic Management
victim states ability to go forward with life
• Interventions: - don’t blame the victims
- Ask the victim to describe the incident to you - Help them find a shelter where they can feel safe
- Counseling - Treatment for abusers needs to be scheduled, but
- Follow up testing and care safety is first priority
2. Nursing Diagnosis: Disabling family coping r/t recent
rape of family member
• Outcome evaluation:
- partner or other family members express
feelings about the rape to health care
provider; states confidence in ability to
support rape victim
• Intervention:
- Counseling

INTIMATE PARTNER ABUSE