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192 Cards in this Set
- Front
- Back
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Family violence is defined as...
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physical injury or mental anguish inflicted upon a member by another. It can also mean deprivation of essential services by a care giver.
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What is needed for abuse/family violence?
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Perpetrator
Victim Crisis |
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Perpetrator
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this person often considers their own needs more important than anyone else’s. They look to others to meet their needs.
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Victim
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this person is vulnerable to the abuse. Women, pregnant women, children who are “different,” a woman who is working toward independence are common victims.
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Crisis
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any time there is stress on the perpetrator the family is at risk.
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Cycle of violence
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Violence alternates with periods of safety, hope, and trust. This is called escalation and de-escalation. The cycle has 3 stages.
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3 stages of family violence
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Tension building stage
Acute battering stage Honeymoon stage |
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Tension building stage
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Minor pushing/shoving
Victim does not protest (fear of more violence) Perp rationalizes abuse is acceptable As tension increases both try to decrease the tension. The Perp often w/ drugs, the victim minimizes importance of the incidents. |
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Acute battering stage
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Perpetrator releases tension with brutal/uncontrollable beatings. They may not even remember it.
Victim depersonalizes during the violence and usually remembers very well. Afterwards both are in shock |
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Honeymoon stage
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Perpetrator is remorseful, brings presents, and promises to change
Victim believes the perpetrator and stays in the situation hopeful that the violence will not happen again. If the victim has pressed charges, he/she will try to drop them at this stage. |
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Does the cycle repeat itself with more time between cycles and less intensity?
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No-the cycle repeats itself with more intensity and shorter calm periods in between the violence. Severe injuries, even death, can occur.
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How does the victim feel?
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The victim often accepts the blame for the situation and develops feelings of depression and hopelessness. This results in immobilization further keeping the victim in an unsafe situation
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Types of maltreatment:
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Physical, sexual, emotional, neglect
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Types of physical maltreatment
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battering and endangerment
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battering
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bruises at different stages of healing, bilateral bruising
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Endangerment
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reckless behavior which could lead to injury of vulnerable person. For example a mother who speeds and also does not put children in seat belts/car seats.
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Sexual maltreatment
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this is any sexual approach or act without consent or when the victim is incapable of giving consent. In California the age of consent is 18. Sexual acts with minors is usually called abuse; with adults it is usually referred to as sexual assault or rape.
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Is sexual abuse culture specific?
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no, it is found in all cultures
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What is a new arena for sexual predators?
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Internet pornography and entrapments a new arena for sexual predators.
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Emotional maltreatment
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kills the spirit of the victim = threatening, belittling, ignoring. Can be difficult to report and prove
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4 types of neglect
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physical, developmental, educational, and economic
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Physical neglect
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failure to provide medical, dental, psychiatric care as needed, can me malnourished, cachectic- skeletal body
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Developmental neglect
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failure to provide emotional nurturing and appropriate stimulation to help a child complete developmental stages.
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Educational neglect
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failing to provide adequate education.
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economic neglect
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using another’s resources without their permission for personal gain. For example stealing from trust funds or social security.
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Discussing maltreatment requires...
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tact, sensitivity, and developing rapport with both victim and perpetrator.
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How to conduct an interview when suspecting maltreatment?
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Conduct the interview privately, use language the patient understands, be professional and avoid showing strong emotions, and be honest about needing to call adult or child protective services if that is necessary.
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The victim may not be responsive if the nurse shows a...
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strong negative reaction to the situation
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Areas to assess when dealing with abuse
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anxiety
coping patterns support system suicidality/homicidality physical signs |
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abuse- anxiety
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hesitation, vague statements, hypervigilance, can be indicators of anxiety. Use anxiety reduction techniques to help ease the situation
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abuse coping patterns
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family life skills and attitudes toward caring for vulnerable people. For example the perpetrator may see women, children, or elders in a negative light.
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Abuse- support system
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victims are often isolated and controlled by perpetrator. Also the victim may feel unworthy and disgraced and be reluctant to seek support from friends and family.
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When assessing for physical signs of abuse...
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use body map and pictures to document injuries. Follow established procedures for collecting any physical evidence.
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What is the rule/law of nurses and reporting abuse?
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Moral and legal obligation to report all abuse. Nurses have immunity if they report and may be prosecuted if they don’t. It is not the nurse’s job to provide a complete “case” to the protective agency. It is the nurse’s job to report suspected cases so that the appropriate agency can investigate.
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Cycle of violence
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Tension building phase, acute (serious) battering phase, and honeymoon phase
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the withholding of financial support or illegal or improper exploitation of funds or other resources for ones personal gain
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Economic abuse
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depriving and individual of a nurturing atmosphere in which he or she can thrive, learn, and develop.
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Emotional abuse
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intentional intimidation, abuse or neglect of children, adults, or elders by a family member, intimate partner, or caretaker in order to gain power and control over the victim.
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Family violence
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time in the cycle of violence when the perpetrator is nice and apologetic, they may promise to not do it again.
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Honeymoon phase
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failure to provide basic needs be they financial, physical, emotional, or educational
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Neglect
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those who initiate violence
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Perpetrator
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when a person is beaten
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Physical abuse
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when a person is forced to do any sexual act they do not consent to.
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Sexual abuse
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plan for rapid escape when abuse occurs
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Safety plan
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the person that survived the abuse
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Survivor
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this is when the acute physical abuse occurs with kicking/hitting/slapping/etc., many times they will strike in an area that can be easily covered
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Serious battering phase
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this phase is signified a much yelling/pushing/shoving/etc.
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Tension building phase
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family member that upon whom abuse is perpetrated
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Vulnerable person
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Safety Plan
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plan for rapid escape- it is helpful to give victims personalized safety guides to help them mobilize quickly-also resources for shelters or safe houses.
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sexual assault
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Any type of sexual activity that is no agreed to by the victim
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Are Rapists are oversexed?
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No, Rape is an act of aggressionAre
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Are more Women raped by strangers?
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No, 69% are raped by someone they know
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Do only females get raped?
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No, There is a growing number of male victims
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Rape
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is nonconsensual vaginal, anal, or oral penetration.
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1996 Drug-Induced Rape Prevention Act
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Provides for up to 20 years’ imprisonment and fines for anyone who intends to commit crime by administering a controlled substance to an unknowing victim.
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Drugs known as Date Rape?
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GHB, Rohypnol, Ketamine, Burundanga
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ETOH is implicated in __% of rapes
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69%
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Rape-Trauma Syndrome- Acute Phase
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Stage seen in emergency room, Immediately after and up to two weeks.
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After rape, acute phase- Expressed style
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crying, restless, angry, confused, tense
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After rape, acute phase- Controlled style
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Confusion, masked affect, calm, numb, distractible.
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After rape, acute phase- Emotional reaction
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fear of violence, humiliation, shock, self-blame, shame, guilt , anger
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After rape, acute phase- Physical reaction
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trauma, poor appetite, sleep disturbances, vaginal discomfort
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Rape Trauma Syndrome
Long-Term reorganization |
2 or more weeks after rape
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Long-term reorganization Phase
Intrusive Thoughts |
remembering the rape when awake and sleeping, flashbacks, anger
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Long-term reorganization Phase
Increased motor activity |
moving, taking trips, changing telephone numbers, visiting friends
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Long-term reorganization Phase
Increased emotional lability |
mood swings, crying spells, depression
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Long-term reorganization Phase
Fears and phobias |
fear of type of environment where rape occurred, fear of being alone, fear of sexual
encounters. |
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Should the nurse contact family for the patient after rape?
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Support system- some victims may be ready for friends/family to be contacted, some may not be ready for others to know- we need to be sensitive to this and not leave them to go home along upon discharge
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What to assess physically after rape
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Characteristic physical signs = injuries to face head, neck, & extremities – document on body map
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What evidence is collected after rape?
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Collection of evidence such as hair, skin, semen – consent required
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Nursing diagnoses for rape victims?
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Rape-trauma syndrome
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What is different about syndrome diagnoses?
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As it is a syndrome, not R/T or AEB required
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May also add: Compound reaction...
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This means that the patient relies on alcohol or drugs
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Another variation is: Silent reaction
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This means that the patient will not talk about the assault.
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All information should be in ____, as the patient is unlikely to remember much due to anxiety.
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writing
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When should the patient follow up with their doctor?
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w/in 48 hours
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What to assess and advise if working a rape victim hotline
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Determine location, what happened, safety, help needed
Encourage to go to hospital Do not wash, change clothes, douche, brush teeth, eat, or drink. |
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Follow-up visits should be scheduled for...
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2, 4, and 6 weeks after the rape to assess progress and/or complications
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Outcomes for the victim
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Most resume their lives but some have fears, phobias, flashbacks. Group and individual therapy is helpful. Support groups are also valuable
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Outcomes for the rapist
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Most do not acknowledge the need for change. No single method has proved completely reliable. Usually will ever change
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How are survivors evaluated as recovered?
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Sleep well
Eat according to pre-rape pattern Are calm, relaxed Show minimal strain in relationships with family & friends Are generally positive about themselves Free from somatic reactions |
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Rape-trauma syndrome is similar to what other disorder?
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PTSD
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What should you say to a victim who wants to shower and change before coming to the ER?
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Please don’t do it, come here exactly as you are and we will help you with everything once you get here.
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Name one thing that should be documented in the written record.
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Verbatum statements and injuries documented on a body map
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Short term criteria for victim leaving the ER
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patient will begin to express feelings before leaving ER, will acknowledge need to keep follow up appointments
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Long term goals for victim after rape
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will state the memory is less vivid and that the physical symptoms have subsided in 3-5 months.
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Interventions
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provide nonjudgmental care and emotional support, allow victim to talk, help victim separate issues of vulnerability from blame, provide referrals and follow up information, avoid showing anger (interferes with good care) give all info in written format
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Identify three behaviors, which signify recovery from rape
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Sleeping well, eating according to pre rape pattern, free from somatic reactions
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Acquaintance rape
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raped by someone they know
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Rape-trauma syndrome
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acute and long term reorganization phases
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Neurobiological Theory to Eating Disorders
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eating disorders may be related to depression; see the same neuroendocrine abnormalities
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Psychological Theory to Eating Disorders
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control issues in anorexia, poor impulse control in bulimia
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Sociocultural Theory to Eating Disorders
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being thin is idealized- not the cause but does not help with individuals that are predisposed
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Biopsychological Theory to Eating Disorders
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genetic link
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Are eating disorders mainly problems of white, middle to upperclass modern western society?
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No- have found references to the symptoms in 17 century England as well as ancient Chinese and Persian manuscripts as well as in African tribal lore.
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Diagnostic criteria for anorexia nervosa
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Body weight > 85%
Fear of gaining wt or becoming fat despite being underweight Weight unduly influences self-evaluation, denies seriousness of low body wt Amenorrhea |
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Amenorrhea
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loss of 3 consecutive menstrual cycles
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Is anorexia nervosa a serious disease?
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Yes- it is potentially life threatening
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Two types of anorexia nervosa
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Binge eating/purging and
restricting type |
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Binge eating/purging
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person engages in recurrent episodes of binge eating or purging episodes
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Binging
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eating more food than is normal in a specific period
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Purging
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eliminating food by vomiting, laxatives, enemas, diuretics
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Restricting type of anorexia nervosa
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no binging or purging episodes but severely restricts intake
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S/S of anorexia nervosa
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Low weight
LANUGO Yellow skin Cold extremities Peripheral edema Low BP, P, and Temperature |
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When are pts with anorexia nervosa admitted as an inpatient?
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admitted if weight below 75% of ideal (probably in ICU, trying to keep them alive- may be having heart attacks)
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What type of treatment if they are admitted as inpatient?
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Treatment addresses only acute complications such as electrolyte imbalance or cardiac problems
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Psychiatric treatment for anorexia nervosa
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Milieu therapy focuses on precise meal times, adherence to menu, observation during & after meals, schedule weights, privileges tied to weight gain
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Types of therapy for anorexia nervosa
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Family therapy, individual, cognitive therapy
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Diagnostic criteria for bulimia nervosa
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Recurrent binge eating
Recurrent inappropriate compensatory behavior to prevent wt gain Binging and compensatory behavior happen @ least 2x a week for 3 mos. Self eval unduly influenced by wt |
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Inappropriate compensatory behavior would be...
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self induced vomiting; misuse of laxatives, diuretics, enemas; fasting, excessive exercise
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Types of bulimia nervosa
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Purging type and
nonpurging type |
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Purging type
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regularly engaged in self-induced vomiting or misuse of laxatives, diuretics, or enemas- any way to get rid of the food
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nonpurging type
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other inappropriate compensatory mechanisms such as fasting or excessive exercise.
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S/S of bulimia nervosa
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Normal to slightly low wt
Dental erosion Parotid swelling Calluses, scars on hand Peripheral edema Hypokalemia, hyponatremia Relationships chaotic Poor impulse control |
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Why do pts with bulimia have peripheral edema?
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due to malnutrition- low albumin which regulates osmotic pressure
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Why do pts with bulimia have hypokalemia or hyponatremia?
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Because they are actively getting rid of fluids
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Who forms a therapeutic relationship more easily, anorexic or bulimic patients?
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Bulemic patients can form a therapeutic relationship more easily than someone with anorexia nervosa
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How can milieu therapy help pts with bulimia?
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Milieu therapy structured to interrupt the binge/purge cycles by observation to prevent, appropriate exercise, normalization of eating
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How can cognitive behavioral therapy help pts with bulemia?
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Cognitive behavioral therapy works best, focus is on dysfunctional attitudes
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common cognitive distortions in eating disorders
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Overgeneralization
All-or-nothing thinking Castastrophizing Personalization Emotional reasoning |
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Example of Overgeneralization:
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“I was happy at size 4. I must get back to that weight.”
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Example of All-or-nothing thinking:
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“If I eat 1 popsicle, I must eat 5.”
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Example of Castastrophizing:
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“If I gain weight, my weekend will be ruined.”
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Example of Personalization:
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“I know everyone is watching me eat.”
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Example of Emotional reasoning:
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“I know I’m fat, because I feel fat.”
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Binge Eating disorder
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Recurrent episodes of binge eating, marked distress over binge eating
occurs @ leat 2 days a wk for 6 mos |
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Binge eating associated with 3 or more of the following:
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Eating more rapidly than normal
Eating until uncomfortably full Eating lg amts when not hungry Eating alone due to lg amts Feeling disgusted or guilty after overeating. |
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Binge eating is not associated with...
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inappropriate compensatory behaviors.
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Higher rates of affective and personality disorders found among...
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binge eaters
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Binge eating often used to sooth...
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negative mood states.
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Most successful therapy for binge eaters
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Cognitive-behavioral therapy
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Treatments for significantly overweight binge eaters?
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residential treatment or surgery
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refuse to maintain ideal body weight, fear of weight gain, body image disturbances, amenorrhea
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Anorexia nervosa
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Satiety
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a time of being fed or gratified at or beyond capacity
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eating uncontrollably more food than normal in a specific period, uncomfortable about it
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Binge eating
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Body image
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the way one views themselves
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Body image disturbance
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disturbance between what they see in themselves and what others see.
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characterized by binge eating and purging (or other compensatory mechanisms)
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Bulimia nervosa
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vomiting shortly after eating or use of laxatives, enemas, or diuretics
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purging
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not eating
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restricting
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recurrent episodes of binge eating, marked distress over binge eating, binge eating occurs at least two days a week for six months, binge eating is not associated with inappropriate compensatory behaviors, binge eating associated with three or more of the following:
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Binge eating disorder
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Describe one type of cognitive distortion found in eating disorders
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Overgeneralization (I was happy at a size four, I must get back to that weight)
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Name one characteristic of anorexia nervosa and explain how it differs from bulimia nervosa.
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will develop lanugo over body, bulimia pts do not experience this
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Name one type of treatment for either anorexia, bulimia, or binge eating disorder
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cognitive behavioral therapy
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What is a crisis?
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Crisis is an acute, time-limited phenomenon experienced as an overwhelming emotional reaction to a stressful event.
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The reaction to crisis causes _____
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disequilibrium
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A crisis is any situation for which a person does not have adequate ___ _____
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coping skills.
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Crisis is self-defined...
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What is a crisis for one person may not be for another.
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3 types of crisis
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Maturational
Situational Adventitious |
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Maturational crisis
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follow different stages of growth, old coping skills not adequate for new stage, must learn new ones, during this time there is anxiety
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Dealing with more than one life change at a time....
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increases the risk for experiencing crisis
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Example of maturational crisis
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marriage, birth of a child, retirement, death of a parent
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Situational crisis
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Source= personal/physical or interpersonal/social. Events that force people to take action to resolve them, occur suddenly. Regular life events.
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Example of situational crisis
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severe mental or physical illness, abortion, loss of job, change in financial status, divorce
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Adventitious crisis
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Things that are not a part of everyday life- rather a disaster of some sort.
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Examples of Adventitious crisis
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earthquake, flood, act of terrorism, war, riots, rape, murder, bombing
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Anyone or any age group who experiences an adventitious crisis benefits from...
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counseling. Critical Incident Stress Debriefing is a process developed to help victims of adventitious crises cope.
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Whether or not one of these three experiences turns into a crisis depends on a variety of factors:
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Severity of situation
previous problem solving skills perception of the event support from others |
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Severity of the situation
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More severe situations are more likely to cause a crisis
Multiple problems or crises experienced at one time are more likely to overwhelm a person |
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Previous problem solving skills
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Strong coping skills protect against being overwhelmed
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Perception of the event
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Realistic perceptions promote coping
Cognitive distortions impede coping |
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Support from others
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Good support systems increase the likelihood of finding a solution to a problem.
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Crisis is seen as both...
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a threat and an opportunity for growth
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Crisis Intervention is...
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what nurses and other health professionals do to help people in crisis cope and not be overwhelmed by the threat.
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Crisis theory
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severe stress at first, but that after about 6 weeks there is a type of resolution. people who have early help to deal with the crisis recover better than those who have no help.
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The process of crisis can viewed in ___ basic stages.
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four
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1st stage of the process of crisis
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confronted by a conflict or problem, responds with anxiety and starts using their usual problem solving techniques. If works= crisis averted. If fails, move to stage 2
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2nd stage of the process of crisis
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If the person is not successful in resolving the problem, they start using trial and error in an attempt to resolve the crisis.
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3rd stage of the process of crisis
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If trial and error fails, anxiety escalates to severe or panic levels. The person may withdraw or run from the problem. They may try to resolve the issue by compromise to lower level functioning, or redefining expectations.
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4th stage of the process of crisis
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If the problem is still not resolved, anxiety may overwhelm the person. The person may be confused, violent, or simply running around aimlessly.
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Three possible ways of crisis resolution:
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1. The person functions at a lower level than prior to the crisis.
2. The person functions at the same level as prior to the crisis. 3. The person functions at a higher level that prior to the crisis. |
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What is the goal of crisis resolution?
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The person functions at the same level as prior to the crisis.
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Crisis is self-limiting:
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4-6 weeks. Therefore the intervention is short term.
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Resolution of the crisis depends on...
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the actions of the person and the intervention of others.
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Classic crisis intervention assumes that people are mentally...
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healthy.
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Crisis intervention deals with the person’s...
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immediate problem and only that problem. We do not go on to the other problem’s in the person’s life.
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____ intervention increases the chances of a positive outcome.
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Early
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Must consider patient’s goals – goal development is a...
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partnership between the nurse and the patient
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Nursing Outcomes/goals
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Patient safety
Anxiety reduction |
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3 diagnoses for crisis?
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Anxiety
Ineffective coping- decision making abilities Risk for suicide- recommend hospitalization |
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Nurse takes an active role in developing a plan but the patient _______ the plan
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implements
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crisis intervention focuses on the ________ problem- must _______ after dealing with the ________ crisis.
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immediate
terminate immediate |
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Critical Incident Stress Debriefing
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The process allows participants to share their feelings in a safe environment and receive guidance in managing stress and any future problems resulting from the incident.
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What steps can you take while you are in the nursing program to avoid a crisis?
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have support system
deal with anxiety producers one at a time as they come along seek help if overwhelmed plan ahead adequate/consistant sleep use outlets (exercise), have fun |
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Client is encouraged to set ______ goals
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realistic
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Therapists (nurses) must be willing to take an _____, _______ approach.
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active, directive
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Determine the client’s ______ of the event
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perception
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Determine situational ______
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supports
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Determine the person’s usual ____ _____ & what’s been tried already
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coping skills
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people with _____ disorders, _____ disorders, and _______ have a very hard time with situational crisis
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personality disorders
addictive disorders schizophrenia |
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Risk factors for crisis
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Severity of the situation or trauma.
Pre-existing mental conditions Previous traumas, childhood abuse Poverty Cultural expectations which prohibit asking for help Perception of the event. |
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Analyze the role of balancing factors for crisis.
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Perception of the event
Situational supports Coping mechanisms |
