intimate partner violence a pattern of coercive behaviors perpetrated by someone who is or was...
TRANSCRIPT
The problem knows no Boundaries
95% of all cases of reported domestic violence and sexual assault involve men abusing women
…… but……….
Abuse can also include:• Women against men• Gay couples• Remember: issue of
POWER & CONTROL
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Societal Problem
• Economics – increased use of healthcare system.• Increased incidence of child maltreatment in
homes with IPV;• Furthers the cycle of violence; increased incidence
of criminal behavior.
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Reporting Requirements (general abuse mandate)
Registered nurses are mandated to report known or observed instances of abuse to the appropriate authorities– Professional capacity/within scope of employment– Failure to report is considered “unprofessional conduct”
[by BRN] and can lead to disciplinary action against license
– Failure to comply is a misdemeanor, punishable by up to 6 months in jail, a fine of $1000 or both
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Reporting Laws (1)
General Abuse: CPC 11160• Provider of medical
services for a physical condition that they know or reasonably suspect is the result of assaultive or abusive conduct
• Includes “adults, children, & others, (including spouses)”
• Report the incident to local law enforcement immediately or as soon as practically possible
• Prepare & send a written report to local law enforcementlwithin 2 working days
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Reporting Laws (obj. 1)
Child Abuse-[CPC 11166]• Knowledge• Observation• Reasonable suspicion
…that a child is the victim of child abuse
• Report to CPS immediately or as soon as practically possible by phone
• Prepare & send a written report to CPS within 36 hours of receiving the information about the incident
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The Face of the Victim
• stress in household• Abused as a child• Married at a young age• self esteem• Helplessness or perceived helplessness• Financial dependence• Pregnancy a dangerous time
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Characteristics of the Abuser
• Abused or witnessed abuse as a child• Abuse of ETOH or drugs• Controlling behaviors• Pathologic jealousy• Verbal abuse physical abuse over time
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The Abuser
• Use of isolation, intimidation, threats• Extreme jealousy or possessiveness• Controls access to $$$ & transportation• Low tolerance for frustration• Poor impulse control• Little insight into own behavior• Blames victim for the behavior
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Cycle of ViolenceWalker, Lenore (1979), The Battered woman.
1. Tension building• hostile behaviors• use of alcohol,
drugs• Victim tries to stay
out of the way; placates
2. Battering Incident• Abuser explodes into
violence– Hit– Burn– Beat– Rape
• Victim is powerless• Victim endures until
incident runs its course, usually 2-24 hours
• Self-esteem 10
Cycle of Violence
Honeymoon Phase • Abuser remorseful• Abuser makes promises• Victim wants to believe
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Physical Evidence• Symmetrical bruises on
upper arms, wrists, neck• Nail marks or swatch of hair
missing from head• Black eyes, fx mandible,• Lacerations around eyes &
lips• Subdural hematomas• Rib fx• Bruises on breasts &
genitalia
• No single sign• Subtle signs• Injuries that do not
match the stated mechanism
• History of frequent admissions/ visits to health care provider
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High Index of Suspicion Abused watches partner for approval before
answering Abused edges to side of bed when abuser comes
near Abused heart rate increases when abuser comes
near Abusers refuse to allow a male nurse to care for
partner Abusers refuse to allow partner alone with
caregivers Abusers refuse to leave the room
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Further Assessment
• Nurse must be alone with the patient when questions are asked– Asking when abuser is in the room
may trigger a battering incident!!• Open the subject as a routine
– FUND* recommendations:– All females > age 14, regardless of sx
of violence. • *Family Violence Prevention Fund
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CDC “RADAR” screening guideline
• R-routinely screen every patient• A-ask directly, kindly, w/o judgment• D-document findings• A-assess patient's safety• R-review options and provide referrals
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Assessment Tools
PVS – Partner Violence Screen• Have you ever been hit, kicked, punched or
otherwise hurt by someone in the past year?• Do you feel safe in your current relationship?• Does a partner from a previous relationship make
you feel unsafe now?• Benefits of Screening:
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Safety-Promoting Behaviors• Hide money, house key, car key• Code w/family or friends• Remove weapons• SSN• Birth certificates• Bank account numbers• Hidden bag w/extra clothing• Rent/utility receipts
• McFarlane, J. et al (2004), “Increasing the Safety-Promoting Behaviors of Abused Women”, AJN, 104(3) 40-50.
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Child Maltreatment
Child abuse is defined in the California State Penal Code to include:
• intentional physical injury to a child less than 18 years of age, inflicted by another
• sexual abuse • neglect• permitting to be or willfully endangering the person or
health of a child• unjustifiable physical pain or mental suffering• unlawful corporal punishment • abuse or neglect in out-of-home care
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Children who grow up with violence:
• learn that violence is an acceptable way to relieve stress, get what they want, and interact with the world and the people they love.
• They then incorporate these attitudes and values into their relationships as they grow up.
(Childabuse.stanford.edu)
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Parental Characteristics (obj.2)
• Childhood punishment was seen as unfair and severe
• Relationship with parents was negative
• Has difficulty controlling aggressive impulses
• Free expression of violence is consistent
• Socially isolated• Fewer support systems• Teenaged mothers• Low self esteem
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Child Characteristics (obj. 2)
“fit” between child’s temperament and parent’s ability to deal with that behavioral style
• Illegitimate• Unwanted• Brain damaged• Physically disabled• Hyperactive• Reminder• Prematurity• Difficult labor & delivery• Multiple births
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Environmental Characteristics
• Chronic stress– Divorce– Poverty– Poor housing– Frequent relocation– Alcoholism– Drug addiction
• All social strata• Poverty predisposes but
….• Concealed crises in
wealthy families
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Clinical Tipoffs• Serious injury – no hx of trauma• History inconsistent with severity of injury• Delay in seeking care for significant injury• History that changes during eval• Recurrent injuries w/poor explanation
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Talking with children• Private place• Do not promise not to tell• Required by law• Do not express shock or criticize family• Use their vocabulary• Avoid leading statements that can distort their report• Reassure them that they have done the right thing by
telling• Abuse is not their fault• Determine immediate need for safety• Prepare child about next steps
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