Chapter 12: Abuse and Violence

Key Terms:

Abuse: the wrongful use and maltreatment of another person

Child abuse: the intentional injury of a child
Cycle of violence: a typical pattern and domestic battering: violence; honeymoon or remorseful period;
tension building; and, finally, violence; this pattern continually repeats itself throughout the relationship
Date rate (acquaintance rape): sexual assault that may occur on first date, on the ride home from a
party or when the two people have known each other for sometime
Elder abuse: the maltreatment of older adults by family members or caretakers
Family violence: encompasses domestic or partner battering; negligent and physical, emotional, or
sexual abuse of children; elder abuse; and marital rape
Intergenerational transmission process: explains that patterns of violence are perpetuated from one
generation to the next through role modeling and social learning
Intimate partner violence: the mistreatment, misuse, or abuse of one person by another in the context
of a close, personal, or committed relationship
Neglect: malicious or ignorant withholding of physical, emotional, or educational necessities for the
childs well-being
Ostracism: ignoring and excluding a target individual
Physical abuse: ranges from shoving and pushing to severe battering and choking and may involve
broken limbs and ribs, internal bleeding, brain damage, and even homicide
Psychological abuse (emotional abuse): include the name calling, belittling, screaming, yelling,
destroying property, and making threats as well as subtler forms such as refusing to speak to or
ignoring the victim
Rape: a crime of violence, domination, and humiliation of the victim expressed through sexual means
Restraining order: legal order of protection obtained to prohibit contact between a victim and a
perpetrator of abuse
Sexual abuse: involves sexual acts performed by an adult on a child younger than 18 years
Sodomy: anal intercourse
Stalking: repeated and persistent attempts to impose unwanted communication or contact on another
person

Learning Objectives:

1. Discuss the characteristics, risk factors, and family dynamics of abusive and violent behavior.
a. Family violence: spouse battering, neglect and physical, emotional or sexual abuse of children,
elder abuse, marital rape
b. Characteristics of violent families
i. Social isolation
ii. Abuse of power and control: abusive family member almost always holds a position of
power and control over the victim; may also hold economic and social control. Intimate
partner violence accounts for 14% of all homicides. Of these deaths, 70% were females
and 30% males. In the US, 3 in 10 females and 1 in 10 males report rape, physical
violence, or stalking by a partner sufficient to interfere with ability to function.
iii. Alcohol and other drug abuse: alcohol does not cause abuse; an abusive person is likely
to use alcohol or other drugs. Majority of victims of intimate violence report alcohol was
involved in the violent incident.
Chapter 12: Abuse and Violence
iv. Intergenerational transmission process: suggests that family violence is a learned
pattern of behavior; children who witness violence between their parents learn that
violence is a way to resolve conflict and is an integral part of a close relationship. NOT
ALL PERSONS EXPOSED TO FAMILY VIOLENCE BECOME ABUSIVE OR VIOLENT
AS ADULTS.
2. Examine the incidences of and trends in domestic violence, child and elder abuse, and rape.
a. Domestic violence:
i. 24 people per minute are victims of intimate partner violence in the US, more than 12
million women and men over the course of one year; 15-25% of pregnant women
experience violence during pregnancy.
ii. Domestic violence also occurs in same-sex relationships, and affects 50,000 lesbian
women and 500,000 gay men each year.
iii. One-third of abusive men are likely to have come from violent homes.
iv. Women who grew up in violent homes are 50% more likely to expect or accept violence
in their own relationships.
v. Domestic violence occurs in 33-66% of all adult cohabitating relationships regardless of
age, race, sex, religious affiliation, marital status, education, income or social standing.
b. Child abuse
i. can include physical abuse or injuries, neglect or failure to prevent harm, failure to
provide adequate physical or emotional care or supervision, abandonment, sexual
assault or intrusion, and overt torture or maiming.
ii. NEGLECT IS THE MOST COMMON FORM OF CHILD ABUSE.
iii. 678,932 victims of child abuse and neglect reported to CPS in the US in 2013. 27% were
under 3 years old. 1520 died from abuse and neglect in 2013. 75% of reported cases of
child abuse involve father-daughter incest; mother-son incest is much less frequent.
iv. Estimated 15 million women in the US were sexually abused as children, of all
sexually abused victims were molested when they were younger than 9 years of age.
Statistics may be inaccurate because many incidents are unreported due to shame and
embarrassment.
c. Elder abuse
i. may include physical and sexual abuse, psychological abuse, neglect, self-neglect,
financial exploitation, and denial of adequate medical treatment.
ii. 1 in 10 people over 65 suffer elder abuse, but many cases are not reported.
iii. Abuse is more likely when the elder has multiple chronic mental and physical health
problems, and dependent on others for food, medical care, and ADLs.
iv. 60% perpetrators spouses, 20% adult children, 20% others
v. 700,000-3.5 million are abused, neglected, or exploited each year.
vi. 1 in 6 cases are reported
d. Rape:
i. is the perpetration of an act of sexual intercourse with a female against her will and
without her consent, whether her will is overcome by force, fear of force, drugs, or
intoxicants.
ii. Rape is highly underreported. Less than one half of all rapes are reported, possibly
because of the victims feelings of shame and guilt, the fear of further injury, and the
belief that she has no recourse in the legal system.
iii. Highest incidence is in girls and women 16-24. Girls younger than 20 were victims in
80% of reported rapes.
Chapter 12: Abuse and Violence
iv. Male rape is significantly underreported. Its most prevalent in institutions such as
prisons or max-security hospitals. 9% of male inmates are sexually assaulted, but the
figure may be much higher.
3. Describe behavioral and emotional responses to abuse.
a. Domestic abuse: Dependency is the most common trait in abused wives who stay with their
husbands. She perceives herself as unable to function without her husband. She suffers from
low self-esteem and defines her success as a person by her ability to remain loyal to her
marriage and make it work. Some women internalize the criticism they receive and mistakenly
believe they are to blame. They fear their abuser will kill them if they try to leave. 75% greater
chance of a woman being murdered when leaving an abusive relationship than those who stay.
b. Child abuse: Sexually abused children talk or behave in ways that indicate more advanced
knowledge of sexual issues than would be expected for their ages. They are frightened and
anxious and may cling to an adult or reject adult attention entirely. They may refuse to eat,
behave aggressively.
c. Elder abuse: poor personal hygiene, dirt, or fecal or urine smell, rashes, sores, lice; untreated
medical condition, dehydrated or malnourished; inadequate material items (clothing, blankets,
furniture); hesitation to talk opening; fearful, withdrawn, depressed, helpless. Angry, agitation for
no reason. Denial of problems even when factors indicate otherwise. Unpaid bills, unusual
activity in bank accounts, checks signed by someone else other than the elder, recent changes
in will or POA.
d. Rape: Victims rated themselves as significantly less healthy; the experience fear, helplessness,
shock and disbelief, guilt, humiliation, and embarrassment; depression, anxiety, PTSD, sexual
dysfunction, insomnia, and impaired memory, or contemplate suicide.
4. Apply the nursing process to the care of clients experiencing abuse and violence.
a. As with all types of family violence, detection and accurate identification are the first steps.
b. Domestic abuse
i. Assessment
1. Identify the abused woman in various settings. Make referrals and contact
appropriate health-care professionals experienced in working with abused
women. Offer caring and support throughout. Ask whether they are safe at home
or in their relationships, without stereotyping. See box 12.2 Safe Questions.
ii. Treatment and Intervention
1. Studies has shown that arresting the batterer may reduce short-term violence,
but may increase long-term violence.
2. Restraining order: limited protection
3. WOmen who left their abusive relationships are more likely to be successful if
their legal and psychological needs were addressed simultaneously.
4. Battered womens shelters can provide temporary housing and food for abused
women and their children when they decide to leave the relationship.
5. Individual psychotherapy or counseling, group therapy, or support and self-help
groups
c. Child abuse:
i. Assessment
1. Assess for injuries such as fractures, burns, or lacerations with no reported
history of trauma
2. Urinary tract infections; bruised, red, or swollen genitalia; tears of the rectum or
vagina; and bruising
3. Evidence of old injuries not reported
4. Inconsistencies or changes in the childs history during the evaluation
Chapter 12: Abuse and Violence
5. Inconsistent history with severity of injury
ii. Treatment and Intervention
1. THE FIRST PART OF TREATMENT is to ensure the childs safety and well-
being. May involve removing the child from the home.
2. Psychiatric evaluation is also indicated.
3. Therapy may be indicated depending on the severity and duration of abuse and
the childs response.
4. Psychiatry, social work, psychology are usually long-term forms of treatment
5. Family therapy is used for reunification
6. Social service agencies determine whether returning the child to the parental
home is possible based on if the parents can show benefit from treatment.
d. Elder abuse:
i. Assessment
1. Determine if the clients condition results from deterioration associated with a
chronic illness or from abuse if difficult.
2. The nurse should suspect if injuries have been hidden or untreated or are
incompatible with the explanation provided, such as cuts, lacerations, puncture
wounds, bruises, welts, or burns. Dehydration or malnourishment not linked with
a specific illness also strongly indicates abuse.
3. Elder who is hesitant to talk openly, fearful, withdrawn, depressed, helpless.
4. Poor personal hygiene, dirt, or fecal or urine smell, rashes, sores, lice; untreated
medical condition, dehydrated or malnourished; inadequate material items
(clothing, blankets, furniture). Angry, agitated for no reason. Denial of problems
even when factors indicate otherwise. Unpaid bills, unusual activity in bank
accounts, checks signed by someone else other than the elder, recent changes
in will or POA.
ii. Treatment and Intervention
1. Relieving the caregivers stress and providing additional resources may help to
correct the abusive situation and leave the caregiving relationship intact.
2. In other cases, removal of the elder or caregiver is necessary.
5. Provide education to clients, families, and communities to promote prevention and early
intervention of abuse and violence.
a. Inform the victim of resources available to them including shelters, counseling, or talking with
their health-care provider.
b. Only 20% of rapes are committed by strangers. The highest incidence of rape is in girls and
women 16-24 years of age.
c. Rape most commonly occurs in a womans neighborhood, often inside or near her home.
d. Most rapes are premeditated.
6. Evaluate your own experiences, feelings, attitudes, and beliefs about abusive and violent
behavior.
a. Nurses must be prepared to listen to the clients story no matter how disturbing, and support
and validate the clients feelings with comments such as that must have been terrifying, or
sounds like you were afraid for your life. Convey acceptance and regard for the client as a
person with worth and dignity regardless of the circumstances.The nurse must remember that
they cannot fix or change things; their role is to listen and convert acceptance and support for
the client. Nurses with a personal history of abuse or trauma must seek professional assistance
to deal with these issues before working with survivors of trauma or abuse. It helps nurses
become more effective and supportive of survivors.
Chapter 12: Abuse and Violence
Pre-Lecture Quiz, Chapter 12, Abuse and Violence

True/False

1. Intergenerational transmission process suggests that family violence is a pattern of behavior learned
from one generation to the next. TRUE
2. Rape most commonly occurs in a womans neighborhood, often inside or near her home. TRUE
3. Adolescent suicide has not been correlated with bullying. FALSE
4. Depression and suicidal behavior are common in survivors of abuse. TRUE
5. The classification of sodomy as a crime can impede same-sex victims reporting partner abuse. TRUE

Fill in the Blank

1. __________ is the repeated and persistent attempts to impose unwanted communication or contact
with another person.
2. __________ is the malicious or ignorant withholding of physical, emotional, or educational necessities
to a dependents well-being.
3. Spouse battering, child abuse, elder abuse, and marital rape are examples of __________ violence.
4. The __________ phase in the cycle of violence is a period in which the perpetrator expresses remorse
and regret.
5. Date rape, also known as __________ rape, can occur on a first date or when the two individuals have
known each other for some time.

ANSWERS
1. Stalking
2. Neglect
3. Family
4. Honeymoon
5. Acquaintance