1 care of survivors of abuse and violence prepared by: mohammed f. el-burai supervised by: dr....

1

CARE OF SURVIVORS OFCARE OF SURVIVORS OF ABUSE AND VIOLENCE ABUSE AND VIOLENCE

PREPARED BY:PREPARED BY:MOHAMMED F. EL-BURAIMOHAMMED F. EL-BURAI

SUPERVISED BY: SUPERVISED BY:

Dr. ASHRAF EL-JEDI RN DrPHDr. ASHRAF EL-JEDI RN DrPH

Faculty of Nursing

Community Mental Health Nursing

04/19/23

CONTENTS CONTENTS

204/19/23

PREFACE PREFACE

The words used to describe people who have The words used to describe people who have experienced violence are important , experienced violence are important , Traditionally the word ( victim) has been used Traditionally the word ( victim) has been used along with discussions of syndromes .along with discussions of syndromes .

In this chapter the word ( survivor) is used to In this chapter the word ( survivor) is used to emphasize that the person who has experienced emphasize that the person who has experienced abuse has many strengths and coping strategies abuse has many strengths and coping strategies that can be incorporated into the plan of care.that can be incorporated into the plan of care.

3Community Mental Health Nursing

04/19/23

Dimensions of family violenceDimensions of family violence

Family violence is a range of harmful behaviors that Family violence is a range of harmful behaviors that occur among family and other household members. occur among family and other household members. It includes physical and emotional abuse of children It includes physical and emotional abuse of children , child neglect, abuse b/w adult intimate partners , , child neglect, abuse b/w adult intimate partners , marital rape & elder abuse. marital rape & elder abuse.

Family violence although often unnoted ,is at the Family violence although often unnoted ,is at the core of many family disturbance .core of many family disturbance .

Violence may be a family secret and often continues Violence may be a family secret and often continues through generation.through generation.


04/19/23

Cont.Cont.

Violence and abuse are caused by an interaction of Violence and abuse are caused by an interaction of personality demographic , biological , situational, personality demographic , biological , situational, & sociocultural factors, many of the unique ch.ch. & sociocultural factors, many of the unique ch.ch. of the family as asocial group - time spent together of the family as asocial group - time spent together emotional involvement privacy and in depth emotional involvement privacy and in depth knowledge of each other - can lead to both knowledge of each other - can lead to both intimacy and violence , thus a given family can be intimacy and violence , thus a given family can be loving and supportive as well as violent.loving and supportive as well as violent.


04/19/23

Characteristics of violent familyCharacteristics of violent family

Factors common to violent families Factors common to violent families include multigenerational transmission include multigenerational transmission social isolation, the use and abuse of social isolation, the use and abuse of power and effect of alcohol and drug power and effect of alcohol and drug abuse.abuse.


04/19/23

Multigenerational TransmissionMultigenerational Transmission

Multigenerational transmission means that family violence is often Multigenerational transmission means that family violence is often perpetuated through generations by a cycle of violence perpetuated through generations by a cycle of violence ( Ehrensaft) ( Ehrensaft)

Violence & victimization are behavior learned through childhood Violence & victimization are behavior learned through childhood experience. The child learns both the means and approval of experience. The child learns both the means and approval of violence.violence.

Experiencing abuse as a child does not totally determine an adults Experiencing abuse as a child does not totally determine an adults later behaviors many people who were abused as children are able later behaviors many people who were abused as children are able to avoid violence with their own children, A key factor may be the to avoid violence with their own children, A key factor may be the age at which the child was abused or which parent was abusive. age at which the child was abused or which parent was abusive. Experiences from a father at age 4- year may be totally different Experiences from a father at age 4- year may be totally different from experiencing abuse from a mother as an adolescent .from experiencing abuse from a mother as an adolescent .


04/19/23


04/19/23

Social Isolation Social Isolation

Violent families are also socially isolated one Violent families are also socially isolated one reason may be that some types of violence are reason may be that some types of violence are considered abnormal or illegitimate & become considered abnormal or illegitimate & become a family secret, a family secret,

Social isolation is a factor in elder abuse , Social isolation is a factor in elder abuse , intimate partner violence and child abuseintimate partner violence and child abuse


04/19/23

Use and Abuse of powerUse and Abuse of power

In almost all forms of family violence the abuser has In almost all forms of family violence the abuser has some form of power or control over those whom they some form of power or control over those whom they abuse power issues appear to be a central factor in abuse power issues appear to be a central factor in intimate partner abuse and violence intimate partner abuse and violence ( Tilly & Brackly 2005)( Tilly & Brackly 2005)

In marriage abuser may justify the use of violence for In marriage abuser may justify the use of violence for trivial events such as not having a meal ready.trivial events such as not having a meal ready.

(Box 38-1) (Box 38-1) describes five forms of abuse within families describes five forms of abuse within families that reflect domestic struggles for power and control:that reflect domestic struggles for power and control:


04/19/23

04/19/23 Community Mental Health Nursing

11

Alcohol and Drug AbuseAlcohol and Drug Abuse

Survivors of violence often report substance Survivors of violence often report substance abuse by the abuser. How ever .one behavior is abuse by the abuser. How ever .one behavior is not necessary for the other to occur . that is not necessary for the other to occur . that is people who abuse alcohol are not consistently people who abuse alcohol are not consistently violent and people who are violent are not violent and people who are violent are not always intoxicated always intoxicated

The person uses alcohol as a socially The person uses alcohol as a socially acceptable explanation for the behavior.acceptable explanation for the behavior.


04/19/23

Nursing Attitude toward Nursing Attitude toward Survivors of ViolenceSurvivors of Violence

Studies of heath care professionals attitudes indicate that myths Studies of heath care professionals attitudes indicate that myths about battered women are accepted even through there is about battered women are accepted even through there is sympathy toward the survivor .sympathy toward the survivor .

(Table 38-1 )(Table 38-1 )describes common myths about survivors of abuse.describes common myths about survivors of abuse. Studies describe how survivors find the health care system to be Studies describe how survivors find the health care system to be

unhelpful and even traumatizing when they go for help. Nurses unhelpful and even traumatizing when they go for help. Nurses often use a paternalistic and individualistic model of helping often use a paternalistic and individualistic model of helping battered women the paternalistic model may be contrasted with the battered women the paternalistic model may be contrasted with the empowerment model empowerment model (Table 38-2) (Table 38-2) compares the Ch. Ch. compares the Ch. Ch.

The empowerment model is not only more helpful to the survivor The empowerment model is not only more helpful to the survivor but also more professionally satisfying for the nurse.but also more professionally satisfying for the nurse.


04/19/23


04/19/23


15

Origins of Negative AttitudesOrigins of Negative Attitudes

The just world hypothesis proposes that people believe that others The just world hypothesis proposes that people believe that others generally get what they deserve Good things happen to good generally get what they deserve Good things happen to good people & Bad things happen to bad people..people & Bad things happen to bad people..

According to the just world hypothesis when a person victimized According to the just world hypothesis when a person victimized by violence people feel a need to make rational sense of this by violence people feel a need to make rational sense of this horrible circumstance, If bad things happen to bad people the horrible circumstance, If bad things happen to bad people the victimized person must have done something wrong or unwise victimized person must have done something wrong or unwise therefore we ( blame the victim) , Because the nursing profession therefore we ( blame the victim) , Because the nursing profession remains a predominantly female group, more nurses have been remains a predominantly female group, more nurses have been victimized by violence than other groups which might explain victimized by violence than other groups which might explain nurses negative attitudes toward other survivors.nurses negative attitudes toward other survivors.


04/19/23

Overcoming Negative Attitude Overcoming Negative Attitude

The 1The 1stst step in providing effective nursing care is exploring one step in providing effective nursing care is exploring one own attitudes toward survivors of family violence own attitudes toward survivors of family violence understanding the mechanisms that help create such attitudes is understanding the mechanisms that help create such attitudes is also helpful.also helpful.

Nurses who have had clinical experience with survivors may be Nurses who have had clinical experience with survivors may be less blaming than nurses who have not, therefore it is important less blaming than nurses who have not, therefore it is important to gain this experience through educational program.to gain this experience through educational program.

Nurses also can increase their own understanding and Nurses also can increase their own understanding and appreciation of the experience of survivors by reading book and appreciation of the experience of survivors by reading book and watching media program about these issues .watching media program about these issues .


04/19/23

Responses of SurvivorsResponses of Survivors A growing body of knowledge describes how A growing body of knowledge describes how

people respond to violence from other family people respond to violence from other family members for example women in dangerous members for example women in dangerous initiate partner relationship have been shown to initiate partner relationship have been shown to have significant mental health symptoms and have significant mental health symptoms and health behaviors, including anxiety, depression, health behaviors, including anxiety, depression, difficulty concentrating memory loss, suicide difficulty concentrating memory loss, suicide attempts, wt gain, past history of smoking.attempts, wt gain, past history of smoking.


04/19/23

Physical Responses to Physical Responses to family violencefamily violence

A ch.ch pattern of injuries, especially to the A ch.ch pattern of injuries, especially to the head, neck, face, threat, trunk and sexual head, neck, face, threat, trunk and sexual organs, has been seen in all forms of family organs, has been seen in all forms of family violence. For all groups experience physical violence. For all groups experience physical abuse, this has been best documented in abuse, this has been best documented in battered women. Several studies have found battered women. Several studies have found that approximately 40% were also sexually that approximately 40% were also sexually assaulted by their partners.assaulted by their partners.


04/19/23

Physical Responses to Physical Responses to family violencefamily violence

All survivors of family violence tend to have All survivors of family violence tend to have injuries at multiple sites in various stage of injuries at multiple sites in various stage of healing.healing.

Although the physical manifestations of family Although the physical manifestations of family violence have often been diagnosed as evidence violence have often been diagnosed as evidence of somatization they may be more accurately of somatization they may be more accurately identified as part of a physical stress reaction identified as part of a physical stress reaction that is common to those who have experienced that is common to those who have experienced various types of emotional trauma.various types of emotional trauma.


04/19/23

Behavioral Response of Behavioral Response of family violencefamily violence

Many attempts have been made to understand Many attempts have been made to understand the behavior of survivors of family violence, the behavior of survivors of family violence, especially their continued involvement with an especially their continued involvement with an abuser, this has been especially damaging in abuser, this has been especially damaging in literature addressing. In actuality, when a literature addressing. In actuality, when a battered woman leaves, she is in the most battered woman leaves, she is in the most danger of being stalked and killed by a partner danger of being stalked and killed by a partner with power and controlwith power and control


04/19/23

Behavioral Response of Behavioral Response of family violencefamily violence

At the other end of the continuum, some At the other end of the continuum, some battered women are able to end the violence battered women are able to end the violence but maintain their relationship using a variety but maintain their relationship using a variety of strategies.of strategies.

Most women eventually leave a Most women eventually leave a relationship that is continuously violent, but relationship that is continuously violent, but there is often a pattern of leaving and returning there is often a pattern of leaving and returning many times before making a final break.many times before making a final break.


04/19/23

Psychological Responses of family Psychological Responses of family violenceviolence

Nurses often are involved in the recovery process Nurses often are involved in the recovery process of adults who, years after the traumatic event are of adults who, years after the traumatic event are dealing with the effects of childhood sexual abuse. dealing with the effects of childhood sexual abuse. The question of "false memories" ahs complicated The question of "false memories" ahs complicated the diagnosis and treatment process.the diagnosis and treatment process.

Psychological Responses studied most often Psychological Responses studied most often include the cognitive response of attribution and include the cognitive response of attribution and problem solving and emotional responses of problem solving and emotional responses of depression, anxiety, and lowered self-esteem.depression, anxiety, and lowered self-esteem.


04/19/23

Problem-solving techniquesProblem-solving techniques

Problem with academic performance and Problem with academic performance and school behavior have been reported in abused school behavior have been reported in abused children in addition some studies have found children in addition some studies have found that women in abusive relationship have that women in abusive relationship have trouble with problem solving, so however trouble with problem solving, so however recent research has revealed that women use a recent research has revealed that women use a variety of approaches to achieve and maintain variety of approaches to achieve and maintain safety for themselves and their children.safety for themselves and their children.


04/19/23

Preventive Nursing InterventionsPreventive Nursing Interventions

All nurses have important roles to play in the All nurses have important roles to play in the primary prevention of family violence. They primary prevention of family violence. They do this through education the public, detecting do this through education the public, detecting risk factors for or actual experience of family risk factors for or actual experience of family violence early on to facilitate timely violence early on to facilitate timely intervention and preventing complication and intervention and preventing complication and recurrence of abuse or violence for survivors.recurrence of abuse or violence for survivors.


04/19/23

PrimaryPrimary PreventionPrevention

Primary Prevention is an activity that stops a Primary Prevention is an activity that stops a problem before it occurs. Changing society's problem before it occurs. Changing society's acceptance of violence and abuse in an acceptance of violence and abuse in an important first step in prevention. important first step in prevention.


04/19/23

SecondarySecondary PreventionPrevention

Secondary Prevention efforts involve identification Secondary Prevention efforts involve identification of families at risk for abuse, neglect, or exploitation of families at risk for abuse, neglect, or exploitation of family members, as well as early detection of of family members, as well as early detection of those who are beginning to use violence.those who are beginning to use violence.

Assessing the health and well-being of women Assessing the health and well-being of women during their pregnancies affords and ideal during their pregnancies affords and ideal opportunity to identify women at risk for becoming opportunity to identify women at risk for becoming battered or those who may be involved in the early battered or those who may be involved in the early stages of an abusive relationship. stages of an abusive relationship. (Libbuset al. 2006)(Libbuset al. 2006)


04/19/23


28


29

SecondarySecondary PreventionPrevention

Early indication of families at risk include violence in Early indication of families at risk include violence in the family of origin of either partner, communication the family of origin of either partner, communication problem & excessive family stress. Such as an problem & excessive family stress. Such as an unplanned pregnancy, inadequate family resources.unplanned pregnancy, inadequate family resources.

When the nurse becomes aware of risk factors immediate When the nurse becomes aware of risk factors immediate nursing intervention is required, taking the time to nursing intervention is required, taking the time to explore a safety planning checklist with the pt. is time explore a safety planning checklist with the pt. is time well spentwell spent.(Box38-3).(Box38-3)


04/19/23


31

TertiaryTertiary PreventionPrevention

Tertiary Prevention efforts refer to those Tertiary Prevention efforts refer to those nursing activity that address the immediate and nursing activity that address the immediate and long-term needs of survivors as they recover long-term needs of survivors as they recover from their experiences in order to ameliorate from their experiences in order to ameliorate negative effects. Tertiary Prevention also in negative effects. Tertiary Prevention also in focused on stopping the current abuse focused on stopping the current abuse preventing the recurrence of abusepreventing the recurrence of abuse


04/19/23

33

THANKS FOR YOUR THANKS FOR YOUR ATTENTIONATTENTION

Faculty of Nursing

Community Mental Health Nursing

04/19/23

1 care of survivors of abuse and violence prepared by: mohammed f. el-burai supervised by: dr....

Documents