Child, Older Adult & Intimate Partner Abuse (Chapter 28)

1. Know all of the 'Key Terms' in the front of the chapter.

Crises situation
Situation that puts stress on a family w/ violent member
Economic abuse
Withholding financial support or illegal or improper exploitation of funds/other
resources for personal gain
Emotional abuse
The infliction of mental anguish by any means, threaten, humiliate, intimidate,
isolate, subtle or blatant hostility, omitting positive behaviors. Withholding warmth
and affection, belittling and criticizing, etc.
Family violence
Intentional intimidation, abuse or neglect of children or elders by family members,
intimate partners, caretaker in order to gain power and control over victim.
Health care record
Contains an accurate and detailed description of the victims medical history, the
psychosocial history of the family and observations of the family interactions during
the interview. Important documents include
Verbatim statements of who caused the injury and when it happened
Body map showing size, color, shape, areas &types of injuries with explanations
Physical evidence of sexual abuse
Neglect
Several forms
Physical: failure to provide for basic needs or protect from harm
Emotional: fail to attend to basic emotional needs and nurturing
Educational: fail to provide child with experiences, including formal education,
necessary for intellectual growth and development.
Medical: fail to provide basic medical, dental or psychiatric care
NICs
Establish screening programs for those at risk,
Provide treatment for injuries suffered
Coordinate community services to provide continuity of care
Provide supportive psychotherapy/ support groups to help with stress /depression
Reduce caregiver burden by arranging assistance with caregiving/nursing/
housekeeping
Perpetrators
Those who initiate violence, any member of a household who is violent towards
another family member. Often have poor social skills, believe their own needs to be
more important than anyone else and look to others to meet their needs.
Physical abuse
infliction of physical pain, bodily harm, by any means
Primary prevention
Measures taken to prevent the occurrence of abuse include
Identify persons/ families at high risk
Providing health teaching and coordinating supportive services
Specific strategies
o Reducing stress
o reducing influence of risk factors
o Increasing social support, self-esteem and coping skills
Safety plan
All persons at risk of abuse should have a plan for rapid escape when abuse recurs,
including a packed bag, means of transportation and a destination.
Secondary prevention
involves early intervention in abusive situations to minimize their disabling or
longterm effects
Sexual abuse
any form of sexual contact or exposure without consent or in cases where victim is
incapable of giving consent.
Shelters/safe houses
are available in many communities for abused people

Survivor
Tertiary prevention
Vulnerable person

use of this term recognizes the recovery and healing process that follows
victimization and does not have the connotations of passivity that victim has.
involves nurses facilitating the healing and rehabilitative process by counseling
individuals and families
the person upon whom abuse is perpetrated.

2. Compare and contrast the five types of domestic abuse (at the top of p. 532).
Physical abuse; the infliction of physical pain, bodily harm, by any means
Sexual abuse ; any form of sexual contact or exposure without consent or in cases where victim is
incapable of giving consent.
Emotional abuse; the infliction of mental anguish by any means, threaten, humiliate, intimidate,
isolate. subtle or blatant hostility, omitting positive behaviors. Withholding warmth and affection,
belittling and criticizing, etc
Economic abuse; withholding financial support or illegal or improper exploitation of funds/other
resources for ones personal gain.
Neglect; several forms
o Physical; failure to provide for basic needs or protect from harm
o Emotional; fail to attend to basic emotional needs and nurturing
o Educational: fail to provide child with experiences, including formal education, necessary for
intellectual growth and development.
o Medical; fail to provide basic medical, dental or psychiatric care

3. What are the long-term effects of family violence? (Box 28-1)

Describe the Cycle of Violence. (p.534)

Pattern of behavior used by abuser to control a partner. Periods of intense violence alternate
with periods of safety, hope and trust.
3 Stages
Tension building; characterized by minor incidents, pushing, shoving, verbal abuse,
which partner may ignore/ accept in hopes of avoiding escalation. Abuser takes this as a
validation of their behavior. Both may try to reduce tension, abuser by using alcohol/
drugs. Victim by excusing partner, I should have had dinner ready
Acute battering; brutal beating, can and does result in injury.
Honeymoon; characterized by kindness, loving behaviors. Abuser is remorseful,
attentive, loving, makes lots of promises which victim usually believes and drops any
legal charges.
Without intervention the cycle repeats, violence increases, and victim self-esteem becomes
lower and lower.
1. What are common characteristics of abusive parents? (Box 28-2)

2. How do domestic abuse survivors usually present to the Healthcare team. (See
General Assessment and Box 28-4)
Complaints may be vague, can include chronic pain, insomnia, hyperventilation,
gynecological problems.

3. Describe guidelines for interviewing suspected survivors of domestic abuse.

Interview process and setting should facilitate accurate assessment of physical and
behavioral indicators of family abuse. Ask questions about any hx of sexual abuse, family
violence and drug/alcohol use/abuse

8. How should an RN assess possible elder and/or child abuse during a home visit? (Box 28-5)

9. What factors should an RN look for when assessing homicide potential?

Having a gun in the home

Alcohol and/ or drug abuse
Hx of violence by perpetrator in other situations
Extreme jealousy and obsessiveness on part of perpetrator regarding relationship with
victim and attempts to control victims daily life.
Victims should be asked if theyve ever thought about killing their abuser and if so, do
they currently wish to kill them and have the means to do so. If answer is yes
intervention is required

10. When should a nurse report child abuse? Elder abuse?

Nurses are legally mandated to report suspected or actual cases of child and vunerable adult
abuse. Every state has its own guidelines regarding time, format.
11. How would you counsel a survivor of recent or ongoing domestic abuse?
Emphasize that everyone has a right to live without fear of violence, physical harm or
assault. Telling them no-one deserves to be hit can be a powerful message.
Counsel regarding safety- help develop a safety plan\
Facilitate access to resources
Listen, support, discuss options and describe alternate ways of living to increase
awareness of other possibilities for the victim.
12. Be familiar with common NANDAs and nursing interventions used for survivors and
perpetrators of violence.
NANDAS Risk for injury
Pain
Risk for infection
Impaired skin integrity
Risk for post trauma syndrome
Powerlessness
Ineffective coping
Fear
Risk for self-directed violence
Chronic or situational low self esteem
Helplessness
Spiritual distress
Rape trauma syndrome

NICs

CASE STUDY: DOMESTIC VIOLENCE

Sharon is a 32-year-old woman who arrives at the emergency department with her three
small children. She has multiple bruises around her face and neck. Her right eye is swollen shut.
Sharon says to the nurse at the E.D., "I didn't want to come here. I'm really okay. He only does
this when he has too much to drink. I just shouldn't have yelled at him." The E.D. nurse begins
interviewing Sharon while she inspects her wounds. "He's been getting more and more violent
lately," Sharon says. "He's been under a lot of stress at work the past few weeks . . . He's been
drinking a lot when he gets home . . . He always gets mean when he drinks . . . I was getting
scared. So I just finally told him I was going to take the kids and leave . . . He got furious when I
said that and began beating me with his fists."
When Sharons oldest child, her 12 year old daughter, tells the E.D. nurse that her
mother lost consciousness after her father hit her, the nurse decides to admit Sharon to your
med/surg unit.
A. What data would you like to have that you dont already have?
How long was Sharon unconscious, what are her current neuro symptoms. VS. Hx of past
abuse, other hospital visits, police involvement. Any hx of violence by husband outside family
setting. Any weapons in the home.
Are children being abused, have CPS ever been involved with family
Medical hx for patient and family. Medications.
Possible support systems, friends, other family for mother.
NANDA 1
Risk of neurologic dysfunction r/t loss of consciousness AEB daughters report that
mother lost consciousness after father hit her.
NOCs
1. Patient will maintain a stable neurologic state.
2. Patient will state and carry out appropriate interactions for pain relief.
NICs
1. Check patient regularly to ensure no deterioration.
2. Teach patient to recognize signs and symptoms of complications that may occur after
discharge
NANDA 2
Risk for injury r/t Hx of physical violence AEB trauma to face and neck and patient report
NOCs
1. Patient will formulate a safety plan before leaving the hospital and will be able to list
two community resources she may contact in any future violent situation.
2. Patient will verbalize that she does not deserve to be hit and that the violence is not
her fault before leaving the hospital.
NICs
1. Help patient formulate safety plan and provide information on community resources
2. Tell patient that no-one deserves to be hit, and the violence is not her fault.